Flagpole Femoral Prosthesis Trial: An Aid to Leg Length Equalization in Revision of the Deficient Proximal Femur

2003 ◽  
Vol 13 (2) ◽  
pp. 116-118
Author(s):  
P.J. Roberts ◽  
P.A. Gregson ◽  
C. McGeoch
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Proximal Femur ◽  
Limb Length ◽  
Soft Tissue Balance ◽  
Femoral Prosthesis ◽  
Leg Length ◽  
Total Hip ◽  
Limb Length Inequality

Obtaining soft tissue balance and correct tension across a total hip arthroplasty can be challenging. This is particularly so following revision of a proximally deficient femur. Although stability of the hip arthroplasty is the paramount concern, limb length inequality is a consideration that is of importance to both surgeon and patient. We describe a novel adaptation in instrumentation to help the surgeon faced with these problems when using cemented Exeter components.

Intraoperative two-stage evaluation of muscle contractures in Crowe type IV hips in total hip arthroplasty (a new surgical technique)

2020 ◽  
pp. 112070002095978
Author(s):  
Ömer F Bilgen ◽  
Osman Yaray ◽  
Müren Mutlu ◽  
Ahmet M Aksakal
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Soft Tissue Balance ◽  
Total Hip ◽  
Length Discrepancy ◽  
Type Iv ◽  
Adductor Muscles

Background: It is important to maintain soft-tissue balance and prevent muscle contractures after hip reduction during total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH). To make such hips functional and durable, the techniques to achieve soft-tissue balance were studied to create an algorithm for intraoperative 2-stage evaluation of muscle contractures, specifying the optimal order for contracture release. Methods: Between February 2011 and March 2015, we evaluated 64 patients (75 hips) with DDH for muscle contractures as they underwent THA. Following acetabular implantation, femoral osteotomy was applied of various lengths according to limb-length discrepancy. First, the distal part of the femur was prepared by broaching, and the hip was then reduced. The tensor fascia lata, rectus femoris, sartorius, hamstrings, and adductor muscles were evaluated, and any contractures were released. A trial conjoining of the distal and proximal parts of the femur was made, and the hip was reduced again. Finally, the iliopsoas and abductor muscles were evaluated, and contractures were released. Results: The mean follow-up duration was 4.6 years. Preoperative and postoperative Harris Hip Scores were 52 and 87, respectively. Limb-length discrepancy was mean 4.2 cm preoperatively, and <1 cm postoperatively. All contractures were released according to our newly developed algorithm. Conclusions: It is challenging to pinpoint the main muscle causing contractures, because other muscles acting on the hip joint have similar secondary functions. The method we describe here may provide better and more specific restoration of muscle function in a hypoplastic hemipelvis in DDH.

Soft-Tissue Balance in Short and Straight Stem Total Hip Arthroplasty

Orthopedics ◽  
2015 ◽  
Vol 38 (3) ◽  
pp. S14-S20 ◽  
Author(s):  
Henning Windhagen ◽  
Andra Chincisan ◽  
Hon Fai Choi ◽  
Fritz Thorey
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Soft Tissue Balance ◽  
Total Hip ◽  
Straight Stem

A Proximal Referencing System for the Charnley Low Friction Arthroplasty

2002 ◽  
Vol 12 (3) ◽  
pp. 303-307
Author(s):  
M.D.A. Fletcher ◽  
J.C.J. Webb ◽  
T. Maung
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Total Hip Replacement ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Hip Replacement ◽  
Recurrent Dislocation ◽  
Soft Tissue Balance ◽  
Low Friction ◽  
Total Hip

Dislocation is a serious complication of total hip arthroplasty occurring in up to 9% of cases. Recurrent dislocation accounts for 4% of revisions in the Swedish Hip Arthroplasty Study. Soft tissue balancing is one of the factors, independent of the surgical approach used, that is involved in producing a stable total hip replacement. We describe a proximal referencing system for use with the Charnley low friction arthrosplasty (LFA), which optimises this factor. The dislocation rate, using this method, is 0.3% (in 333 cases performed by a single surgeon over a 5 year period). This system should prove valuable to orthopaedic surgeons in training, ensuring they achieve correct soft tissue balance in total hip arthroplasty.

scholarly journals Limb length discrepancy after total hip arthroplasty: a systematic review

2018 ◽  
Vol 4 (5) ◽  
pp. 690 ◽  
Author(s):  
Pradeep Kumar Pathak ◽  
Rakesh Kumar Gupta ◽  
Hari Singh Meena ◽  
Rajendra Fiske
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Total Hip ◽  
Patient Dissatisfaction ◽  
Length Discrepancy ◽  
Hip Stability ◽  
Combined Use ◽  
Limb Length Inequality

<p class="abstract">Correcting limb length inequality without compromising hip stability is one of the major intraoperative challenges in Total hip arthroplasty (THA) as it is a major cause of patient dissatisfaction and litigation against surgeon. Surgeons performing THA should aim to minimize Limb Length Discrepancy (LLD), and therefore should adopt a reliable method of doing so. Thus a reproducible technique which effectively reduces postoperative LLD without increasing operative time and is easy to apply is a need of time. Although various preoperative and intraoperative techniques are described in literature, none is universally applicable and is without limitations. We are presenting a review of 50 articles on limb length discrepancy after total hip arthroplasty, its implications and several techniques to avoid it. We suggest that every effort should be made to minimise postoperative Limb Length Discrepancy by combined use of preoperative and intraoperative techniques.</p>

Correction of limb-length inequality during total hip arthroplasty

2001 ◽  
Vol 16 (6) ◽  
pp. 715-720 ◽  
Author(s):  
Chitranjan S. Ranawat ◽  
Rajesh R. Rao ◽  
Jose A. Rodriguez ◽  
Harish S. Bhende
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Limb Length ◽  
Total Hip ◽  
Limb Length Inequality

scholarly journals The intraoperative use of a calliper predicts leg length and offset after total hip arthroplasty. Component subsidence influences the leg length

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maliha Fansur ◽  
Nagib A. Yurdi ◽  
Reinhard Stoewe
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Limb Length ◽  
Leg Length Discrepancy ◽  
Long Term Results ◽  
Leg Length ◽  
X Ray ◽  
Total Hip ◽  
Length Discrepancy ◽  
Post Surgery

Abstract Background The purpose of total hip arthroplasty (THA) post-surgery and proper physiotherapy is positive recovery for the patient. Consideration is given to hip replacement biomechanics by ensuring no discrepancies in limb length (LL) and a stable prosthesis. Therefore, the patient must have proper preoperative planning and communication and a clear understanding of what to expect. Methods A prospective series of 59 THA operated by a single surgeon via Hardinge approach was studied, using an intraoperative calliper (CAL) to predict the change of LL and offset. We compared the results of the intraoperative changes before and after THA implantation with the reference of these values on anteroposterior x-ray pelvis. The importance of leg length balance and a good offset restoration is questioned, and the effect of component subsidence on leg length is considered. Results The average preoperative leg length discrepancy was −6.0 mm, postoperatively +3.6 mm. There was a strong correlation between the CAL measurements and the values on the x-ray (LL, r=0.873, p<0.01; offset, r=0.542, p<0.01). Reliability is better for limb length than for offset. These results are comparable within the literature and the statistical results from other studies reviewed. In addition, we evaluate the importance of subsidence of the prosthesis components for long-term results. Conclusion The intraoperative use of CAL gives excellent results in predicting the final LL and offset after THA. Considering subsidence of prosthesis components, a target zone around +5 mm might be more suitable for leg length directly postoperatively. Moreover, surgeons must discuss the topic of leg length discrepancy (LLD) intensively with the patient pre-operatively. Level of evidence Level 4, prospective cohort study

scholarly journals Leg Length and Offset After Total Hip Arthroplasty: The Intraoperative use of a Calliper Improves the Results. Should Component Subsidence Influence the Target for Leg Length?

2021 ◽  
Author(s):  
Maliha Fansur ◽  
Nagib Atallah Yurdi ◽  
Reinhard Bernhard Josef Stoewe
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Limb Length ◽  
Leg Length Discrepancy ◽  
Long Term Results ◽  
Leg Length ◽  
X Ray ◽  
Total Hip ◽  
Length Discrepancy ◽  
Post Surgery

Abstract BackgroundThe purpose of total hip arthroplasty (THA) post-surgery and proper physiotherapy is positive recovery for the patient. Consideration is given to hip replacement biomechanics by ensuring no discrepancies in limb length (LL) and a stable prosthesis. Therefore, the patient must have proper preoperative planning and communication and a clear understanding of what to expect.MethodsA prospective series of 59 THA operated by a single surgeon via Hardinge approach was studied, using an intraoperative calliper (CAL) to predict the change of LL and offset. We compared the results of the intraoperative changes before and after THA implantation with the reference of these values on antero-posterior x-ray pelvis. The importance of leg length balance and a good offset restoration is questioned, and the effect of component subsidence on leg length is considered.ResultsThe average preoperative leg length discrepancy was -6.0 mm, postoperatively +3.6 mm. There was a strong correlation between the CAL measurements and the values on the x-ray (LL, r=0.873, p<0.01; offset, r=0.542, p<0.01). Reliability is better for limb-length than for offset. These results are comparable within the literature and the statistical results from other studies reviewed. In addition, we evaluate the importance of subsidence of the prosthesis components for long term results.ConclusionThe intraoperative use of CAL gives excellent results in predicting the final LL and offset after THA. Considering subsidence of prosthesis components, a target zone around +5 mm might be more suitable for leg length directly postoperatively. Moreover, surgeons must discuss the topic of leg length discrepancy (LLD) intensively with the patient pre-operatively.Level of evidence: Level 4, prospective cohort study

scholarly journals The morphology of the proximal femur in cementless short-stem total hip arthroplasty: No negative effect on offset reconstruction, leg length difference and implant positioning

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Matthias Luger ◽  
Sandra Feldler ◽  
Antonio Klasan ◽  
Tobias Gotterbarm ◽  
Clemens Schopper
Keyword(s):  
Logistic Regression ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Proximal Femur ◽  
Short Stem ◽  
Leg Length ◽  
Total Hip ◽  
Implant Positioning ◽  
Length Difference ◽  
Leg Length Difference

Abstract Background Correct reconstruction of hip offset (HO) and leg length are important for clinical–functional outcome and patient satisfaction in total hip arthroplasty (THA). The morphology of the proximal femur can pose a risk for increased leg length difference (LLD) in cementless straight-stem THA. We therefore wanted to evaluate, if this is also applicable in THA with a cementless meta-diaphyseal short stem. Methods In a retrospective study, 106 patients (index surgery 2014–2019) with unilateral THA and a morphologically healthy hip as a reference (Kellgren–Lawrence ≤ 1) were included. The same cementless short stem with meta-diaphyseal fixation and cementless press-fit cup was implanted. The proximal femur was rated by Dorr’s classification, and subgroups were formed afterward. Measurements were carried out on preoperative and 3 months postoperative anterior–posterior radiographs of the pelvis. Kruskal–Wallis test, Fisher’s exact test and binary logistic regression were performed to evaluate the influence of the anatomical shape on postoperative leg length difference and offset reconstruction. Results The Dorr type did not show any significance influence on LLD (p = 0.532), or postoperative difference in femoral offset (p = 0.243), acetabular offset (p = 0.106) and hip offset (p = 0.698). Stem alignment (p = 0.705) and canal fill indices (CFI I: p = 0.321; CFI II: p = 0.411; CFI III: p = 0.478) were also without significant differences. Logistic regression did not show any significant increased risk for a LLD ≥ 5 mm or ≥ 10 mm as well as HO ≥ 5 mm or ≥ 10 mm. Conclusion Reconstruction of hip offset and postoperative leg length difference is not negatively influenced by Dorr type, canal flare index, cortical index and canal-to-calcar ratio in cementless short-stem THA. Implant positioning and canal fill are also not negatively affected by the anatomical shape of the proximal femur. Level of evidence: Level IV.

Sign in / Sign up

Export Citation Format

Share Document