Influencing factors for the increased stem version compared to the native femur in cementless total hip arthroplasty

Hirata, Masanobu; Nakashima, Yasuharu; Itokawa, Takashi; Ohishi, Masanobu; Sato, Taishi; Akiyama, Mio; Hara, Daisuke; Iwamoto, Yukihide

doi:10.1007/s00264-014-2289-y

Cited by 41 publications

(54 citation statements)

References 27 publications

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“…A further limitation of our study is that all the THAs were performed by a single surgeon and one specific implant geometry. However, other works have previously compared the FNV with the postoperative version and similar discrepancy values were obtained using other methodologies to assess version 22‐28 . For example, Marcovigi et al 22 reported a standard deviation of 9.7 deg for the achieved stem version, with a discrepancy of 1.6 ± 9.8 deg respect to the FNV, while we obtained a version discrepancy of −1.4 ± 8.2 deg.…”

Section: Discussionsupporting

confidence: 85%

Uncemented femoral stem orientation and position in total hip arthroplasty: A CT study

Belzunce

Henckel

Laura

et al. 2020

Journal Orthopaedic Research

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In total hip arthroplasty (THA), accurate positioning of components is important for the functionality and long life of the implant. Femoral component version has been underinvestigated when compared with the acetabular cup. Accurate prediction of the femoral version on the preoperative plan is particularly important because a well‐fitting uncemented stem will, by definition, press‐fit into a version that is dictated by the anatomy of the proximal femur. A better understanding of this has recently become an unmet need because of the increased use of uncemented stems and of preoperative image‐based planning. We present the first, three‐dimensional (3D) comparison between the planned and achieved orientation and position of the femoral components in THA. We propose a comparison method that uses the 3D models of a, computed tomography‐generated (CT‐generated), preoperative plan and a postoperative CT to obtain the discrepancy in the six possible degrees of freedom. We ran a prospective study (level 2 evidence) of 30 patients undergoing uncemented THA to quantify the discrepancy between planned and achieved femoral stem orientation and position. The discrepancy was low for femoral stem vertical position and leg length, and varus‐valgus and anterior‐posterior orientation. The discrepancy was higher for femoral version with a mean (±SD) of −1.5 ± 7.8 deg. Surgeons should be aware of the variability of the eventual position of uncemented stems in THA and acknowledge the risk of achieving a less‐than‐optimal femoral version, different from the preoperative 3D CT plan.

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Section: Discussionsupporting

confidence: 85%

Uncemented femoral stem orientation and position in total hip arthroplasty: A CT study

Belzunce

Henckel

Laura

et al. 2020

Journal Orthopaedic Research

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“…It has been believed that the difference is related to the stem design. Compared with the double‐wedge stem, the single‐wedge stem is relatively thin, has more freedom in the horizontal plane, and is prone to tilting, which could change the stem anteversion. However, only one measurement method was used in the current study and the study by Taniguchi et al …”

Section: Discussionmentioning

confidence: 99%

“…However, whether measuring femoral anteversion via two‐dimensional CT can predict postoperative stem anteversion remains controversial. Some studies reported that postoperative stem anteversion was predictable, but the results varied widely, with the reported difference between preoperative femoral anteversion and postoperative stem anteversion varying from 2.3° ± 5.9° to 22.7° ± 11.6°, and the correlation coefficient varying from 0.46 to 0.93. Furthermore, some studies found that it was difficult to predict postoperative stem anteversion, especially for the single‐wedge stems.…”

Section: Introductionmentioning

confidence: 99%

“…We speculated that one main reason for the controversy may lie in the inconsistency of the methods used to measure femoral anteversion for stem anteversion prediction. Because of the torsion in the proximal femur, the anteversion angle measured at different levels of the femoral neck could be different. However, at present, the optimal level of the femoral neck for measuring femoral anteversion to predict postoperative stem anteversion is not yet established.…”

Section: Introductionmentioning

confidence: 99%

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Optimal Level of Femoral Neck for Predicting Postoperative Stem Anteversion in Total Hip Arthroplasty for Crowe Type I Dysplastic Hip

Zhai

Zhang

et al. 2020

Orthopaedic Surgery

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Objective: To investigate the optimal level of femoral neck for measuring femoral anteversion to predict postoperative stem anteversion in Crowe type I developmental dysplasia of the hip.Methods: This retrospective study analyzed 108 Crowe type I hips that underwent THA between January 2016 and December 2017, including 70 women and 19 men with a mean age of 63.08 AE 9.13 (range, 41-83) years. The single-wedge stem was used in 37 hips, the double-wedge stem was used in 71 hips. Computed tomography scans were performed pre-and post-operation. Femoral anteversion at six levels of the proximal femur were measured via preoperative two-dimensional computed tomography. Femoral anteversion at the level of the femoral neck osteotomy plane and postoperative stem anteversion were measured via three-dimensional reconstructed models.Results: The mean follow-up period was 18.5 months (range, 12-27 months). The mean preoperative Harris Hip Score was 51.5 AE 8.7 and improved to 90.4 AE 7.8 (P < 0.001) by the last follow-up. There were no intraoperative fractures, and no infections occurred during the follow-up period. Two patients developed deep venous thrombosis. There was no sign of prosthetic loosening in all hips. No significant correlations were found between the height of the femoral neck osteotomy plane and postoperative stem anteversion (r = −0.119, P = 0.220). Femoral anteversion decreased gradually from 64.00 AE 10.51 at the center of lesser trochanter to 15.21 AE 13.31 at the head-neck junction, which was changed from more to less than stem anteversion (24.37 AE 13.86 ). The femoral anteversion at femoral head-neck junction (15.21 AE 13.31 ) was significantly less than postoperative stem anteversion (P = 0.000), with a difference of −9.16 AE 9.27 . The femoral anteversion at the level of the osteotomy plane (28.48 AE 15.34 ) was significantly more than the postoperative stem anteversion (P = 0.000), with a difference of 4.11 AE 9.56 . Among all six levels and the level of osteotomy, femoral anteversion at the 10-mm level above the proximal base of lesser trochanter (22.65 AE 12.92) displayed the smallest difference (−1.72 AE 8.90 ) and a good correlation (r = 0.764) with postoperative stem anteversion for all 108 hips, with a moderate correlation of 0.465 for single-wedge stem hips and an excellent correlation of 0.821 for double-wedge stem hips.Conclusion: For Crowe type I hips, femoral anteversion would be different if it was measured via different levels of the femoral neck. The 10-mm level above the proximal base of the lesser trochanter could be an optimum choice for measuring femoral anteversion to predict postoperative stem anteversion.

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“…In total hip arthroplasty, version of the femoral component has a narrow window of acceptability . Excessive anteversion or retroversion leads to impingement between the prosthetic neck and acetabular component causing increased wear and instability . As such, femoral neck version must be accurately measured and corrected for long‐term function of the hip joint.…”

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confidence: 99%

Automated femoral version estimation without the distal femur

Veilleux

Kalore

Wegelin

et al. 2018

Journal Orthopaedic Research

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Femoral version impacts the long-term functioning of the femoroacetabular joint. Accurate measurements of version are thus required for success in total hip arthroplasties and hip reconstructive surgeries. These are impossible to obtain without visualization of the distal femur, which is often unavailable preoperatively as the majority of imaging scans are isolated to the pelvis and proximal femur. We developed an automated algorithm for identifying the major landmarks of the femur. These landmarks were then used to identify proximal axes and create a statistical shape model of the proximal femur across 144 asymptomatic femora. With six proximal axes selected, and 200 parameters (distances and angles between points) from the shape model measured, the best-fitting linear correlation was found. The difference between true version and version predicted by this model was 0.00 ± 5.13° with a maximum overestimation and underestimation of 11.80 and 15.35°, respectively. The mean absolute difference was 4.14°. This model and its prediction of femoral version are a substantial improvement over pre-operative 2D or intra-operative visual estimation measures. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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Influencing factors for the increased stem version compared to the native femur in cementless total hip arthroplasty

Abstract: Since a cementless stem has little version adjustability in the femoral canal, these findings are useful for surgeons in preoperative planning and to achieve proper component placement in THA.

Cited by 41 publications

References 27 publications

Uncemented femoral stem orientation and position in total hip arthroplasty: A CT study

Uncemented femoral stem orientation and position in total hip arthroplasty: A CT study

Optimal Level of Femoral Neck for Predicting Postoperative Stem Anteversion in Total Hip Arthroplasty for Crowe Type I Dysplastic Hip

Automated femoral version estimation without the distal femur

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