Effect of changes of femoral offset on abductor and joint reaction forces in total hip arthroplasty

Rüdiger, Hannes A.; Guillemin, M; Latypova, Adeliya; Terrier, Alexandre

doi:10.1007/s00402-017-2788-6

Cited by 57 publications

(48 citation statements)

References 31 publications

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“…Accurate surgical techniques as well as optimal prosthesis design and positioning, can reduce the impact of joint replacement on peripheral muscle function. A previous study suggested that accurate intraoperative femoral offset reconstruction is essential for maintaining the abductor muscle moment arm [8]. The displacement of the centre of the femoral head may occur due to surgeon preferences (e.g., excessive correction of native femoral anteversion), inaccurate preoperative templating, or limited selection of available implants.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, studies have demonstrated that insu cient muscle strength and tension in the hip abductor and adductor muscles (nerve injury or limb shortening) are the causes of THA dislocation [6,7]. Rudiger et al [8] reported that the decrease in the femoral offset after THA would reduce the abductor moment arms during gait using musculoskeletal model in OpenSim. Precise evaluation of the function of the hip abductor and adductor muscles in THA patients during gait could help prevent postoperative complications and optimize the rehabilitation training program.…”

Section: Introductionmentioning

confidence: 99%

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Adverse Effects of Total Hip Arthroplasty on The Hip Abductor and Adductor Muscle Lengths and Moment Arms During Gait

Zheng

Hsu

et al. 2020

Preprint

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Background: Precise evaluation the hip abductor and adductor muscles function in total hip arthroplasty (THA) patients during gait could help prevent postoperative complications and optimize the rehabilitation training program. The purpose of this study was to elucidate the effects of THA on the hip abductor and adductor muscle lengths and moment arms of in vivo patients during gait.Methods: Ten unilateral THA patients received CT scan and dual fluoroscopic imaging for the hip kinematics during gait. The hip abductor and adductor muscle insertions were digitized on the 3D hip model for the determination of their dynamic lines of action and moment arms. Changes in the hip abductor and adductor muscle lengths and moment arms of THA patients between the implanted and non-implanted sides were quantified during gait.Results: The adductor longus, adductor brevis, and pectineus of the implanted hips had significantly (P<0.05) less elongation than that of the non-implanted side during the stance phase. The gluteus medius, gluteus minimus, and piriformis moment arms of the implanted side were significantly shorter. The piriformis muscle moment arm was significantly larger. In the double support phase, the adductor magnus and adductor longus moment arms of the implanted sides were significantly decreased. Conclusions: Results suggested that the adverse effects of THA on hip stability. Development of a rehabilitation program considering the effects of THA is essential. Accurate surgical techniques may reduce the impact of THA on the peripheral muscles.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adverse Effects of Total Hip Arthroplasty on The Hip Abductor and Adductor Muscle Lengths and Moment Arms During Gait

Zheng

Hsu

et al. 2020

Preprint

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“…It should be noted that most of the comparative studies have focused on cup position but have largely ignored the femoral component with the exception of leg length. Femoral offset and/or total offset can substantially affect the function of the hip abductor muscles [12,13]. During hip replacement, most surgeons attempt to position the acetabular component in a relative "safe zone" and utilize the femoral component to recreate leg length and offset.…”

Section: Introductionmentioning

confidence: 99%

Anatomic Total Hip Component Position Is More Reproducible With the Direct Anterior Approach Using Intraoperative Fluoroscopy

2020

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Background: Total hip arthroplasty (THA) has demonstrated excellent results regardless of the surgical approach. However, the approach used may be a factor in final positioning of implants. We hypothesized that the direct anterior approach (DAA) with fluoroscopy would be associated with more anatomic implant positioning than the posterior approach (PA). Methods: A retrospective review of 200 patients was performed. One hundred patients underwent THA utilizing the PA, and 100 patients, with the DAA. All patients had an anterior-posterior pelvis radiograph preoperatively and postoperatively with a magnification marker present to standardize each radiograph. Exclusion criteria included contralateral THA or any pelvic or femoral deformity. Results: Preoperative radiographs demonstrated identical cohorts with respect to leg length, femoral offset, and total offset. Postoperatively, the DAA achieved more accurate anatomic restoration of leg length (1.6 mm vs 5.5 mm; P < .0001), femoral offset (4.8 mm vs 9.3 mm; P < .0001), and total offset (0.5 mm vs 4.7 mm; P < .0001) compared with the PA. Ideal cup abduction and anteversion were significantly superior to the DAA (96% vs 78%, P ¼ .0002, and 69% vs 24%, P < .0001, respectively). Conclusions: This study is the first to compare anatomic implant positioning between patients undergoing THA with these 2 approaches. All parameters were significantly closer to anatomic implant positioning with the DAA. There are at least 2 potential explanations for this: (1) The DAA implant positioning was performed under fluoroscopic guidance, whereas the PA was not. (2) The PA disrupts the posterior capsule and external rotators, and therefore, increased offset or leg length may be necessary to achieve comparable hip stability with the DAA.

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“…Postoperative changes in femoral offset may lead to altered muscular function that can result in hip abductor muscle insu ciency and pain as well as early prosthesis wear [2,3]. Furthermore, loss of femoral offset necessitates increased abductor muscle force to maintain normal gait pattern [4], and a loss exceeding 15% can result in gait alterations [5].…”

Section: Introductionmentioning

confidence: 99%

The Trochanteric Double Contour is a Valuable Landmark for Assessing Femoral Offset Underestimation on Standard Radiographs: A Retrospective Study

Blümel

Stadelmann

Brioschi

et al. 2020

Preprint

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Background: Inaccurate projection on standard pelvic radiographs leads to the underestimation of femoral offset—a critical determinant of postoperative hip function—during total hip arthroplasty (THA) templating. We noted that the posteromedial facet of the greater trochanter and piriformis fossa form a double contour on radiographs, which may be valuable in determining the risk of underestimating femoral offset. We evaluate whether projection errors can be predicted based on the double contour width.Methods: Plain anteroposterior (AP) pelvic radiographs and magnetic resonance images (MRIs) of 64 adult hips were evaluated retrospectively. Apparent femoral offset, apparent femoral head diameter and double contour widths were evaluated from the radiographs. X-ray projection errors were estimated by comparison to the true neck length measured on MRIs after calibration to the femoral heads. Multivariate analysis with backward elimination was used to detect associations between the double contour width and radiographic projection errors. Femoral offset underestimation below 10% was considered acceptable for templating.Results: The narrowest width of the double line between the femoral neck and piriformis fossa is significantly associated with projection error. When double line widths exceed 5 mm, the risk of projection error greater than 10% is significantly increased compared to narrower double lines, and the acceptability rate for templating drops below 80% (p = 0.02).Conclusion: The double contour width is a potential landmark for excluding pelvic AP radiographs unsuitable for THA templating due to inaccurate femoral rotation.

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Effect of changes of femoral offset on abductor and joint reaction forces in total hip arthroplasty

Cited by 57 publications

References 31 publications

Adverse Effects of Total Hip Arthroplasty on The Hip Abductor and Adductor Muscle Lengths and Moment Arms During Gait

Adverse Effects of Total Hip Arthroplasty on The Hip Abductor and Adductor Muscle Lengths and Moment Arms During Gait

Anatomic Total Hip Component Position Is More Reproducible With the Direct Anterior Approach Using Intraoperative Fluoroscopy

The Trochanteric Double Contour is a Valuable Landmark for Assessing Femoral Offset Underestimation on Standard Radiographs: A Retrospective Study

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