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

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.

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Limb shortening osteotomy in a patient with achondroplasia and leg length difference after total hip arthroplasty

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2250-0685.112 ◽

2013 ◽

Vol 3 (3) ◽

pp. 30-33

Author(s):

Christian Galata ◽

◽

Bertram Rieger ◽

Niklaus Friederich

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Leg Length ◽

Total Hip ◽

Length Difference ◽

Shortening Osteotomy ◽

Leg Length Difference

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High varus stem alignment in short-stem total hip arthroplasty: a risk for reconstruction of femoro-acetabular offset, leg length discrepancy and stem undersizing?

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04176-5 ◽

2021 ◽

Author(s):

Matthias Luger ◽

Julian Stiftinger ◽

Jakob Allerstorfer ◽

Rainer Hochgatterer ◽

Tobias Gotterbarm ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Short Stem ◽

Leg Length ◽

Total Hip ◽

Press Fit ◽

Group A ◽

Leg Length Difference ◽

Group B ◽

Short Stems

Abstract Purpose Short stems are increasingly used in in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Short stems can be inserted in a more varus position compared to conventional straight stems. This poses the risk of final varus misplacement of the femoral component, which is not intended in all femoral short stems. Methods We wanted to evaluate the effect of a high varus stem positioning in MIS THA on hip offset, leg length and femoral canal fill index. A series of 1052 consecutive THAs with a singular cementless femoral short stem and press-fit cup was retrospectively screened for inclusion. One hundred six patients with unilateral THA and a contralateral healthy hip met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior–posterior postoperative radiographs. Patients were divided into Group A (varus stem alignment ≤ 3°) and Group B (varus stem alignment > 3°). Results Hip offset (HO) increased significantly in Group B by 4 mm (p = 0.013). No influence on leg length difference was detected in both groups. Preoperative CCD angle was significantly lower in Group B (p < 0.001). Canal Fill Indices (CFI) were significantly lower in Group B (CFI I: p < 0.001; CFI II p = 0.003; CF III p = 0.002). Conclusion High varus stem alignment > 3° leads to a statistically significant but minor increase in HO and poses the risk of stem undersizing. A preoperatively low genuine CCD angle pose a risk for varus stem positioning.

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The migration pattern and initial stability of the Optimys short stem in total hip arthroplasty: a prospective 2-year follow-up study of 33 patients with RSA

Hip International ◽

10.1177/1120700020901844 ◽

2020 ◽

pp. 112070002090184 ◽

Cited By ~ 1

Author(s):

Sheryl de Waard ◽

Inger N Sierevelt ◽

Renee Jonker ◽

Daniel Hoornenborg ◽

Harm M van der Vis ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Deep Infection ◽

Migration Pattern ◽

Short Stem ◽

Leg Length ◽

Total Hip ◽

Initial Stability ◽

Short Stems

Background and purpose: The consensus that bone stock preservation and optimal restoration of offset and leg length is important in total hip arthroplasty is now widespread, especially for young and active patients. Short stems seem promising in this aspect, though implant stability is still of concern. This study looked at the migration pattern of the Optimys short stem through RSA analysis. Patients and methods: 40 patients were included. RSA images were made directly postoperatively (within 5 days), at 6 weeks and at 3, 6, 12 and 24 months. Double examinations were made for precision measurement. HOOS and pain scores were obtained preoperatively and at 2 years. 4 patients were excluded due to protocol violation and 1 patient was excluded for RSA analysis with a CN number >110. 2 patients were lost to follow-up after 3 and 6 months ( n = 1 lost, n = 1 deep infection, respectively). Results: Mean age was 60 years with a mean BMI of 27. RSA analysis of 34 patients showed a significant initial median proximodistal translation (subsidence) of 0.21 mm (IQR 0.64–0.06) and anteversion-retroversion rotation of 0.59° (IQR 0.01–1.34) at 6 weeks, after which the stem stabilises and showed no further significant movement. Median migration in other directions was small. 4 patients had an initial subsidence of >2 mm, all showed secondary stabilisation. HOOS outcomes were satisfactory, with the domain symptoms and pain showing a median score of 95/100 at 2 years. Conclusions: After initial migration the Optimys achieves secondary stabilisation, suggesting low risk on long-term aseptic loosening. Clinical trials registration: NL47055.048.13.

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More than a feeling?—Overruling the preoperatively templated offset option leads to a minor offset increase in short stem total hip arthroplasty

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04331-y ◽

2022 ◽

Author(s):

Matthias Luger ◽

Christian Stadler ◽

Rainer Hochgatterer ◽

Jakob Allerstorfer ◽

Tobias Gotterbarm ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Short Stem ◽

Leg Length ◽

Digital Templating ◽

Stem Size ◽

Total Hip ◽

Press Fit ◽

A Minor ◽

Short Stems

Abstract Purpose Short stems are increasingly used in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Digital templating is essential in determining the correct offset option and stem size in THA. However, the preoperative template sizes might be intraoperatively overruled. Patients and methods We evaluated the effect of intraoperative overruling of the preoperatively templated offset option of a short curved stem on hip offset, leg length, implant positioning, and femoral canal fill index. The overruling was performed in case of intraoperative instability, telescoping, or both. A series of 1052 consecutive THAs with a cementless short curved stem and press-fit cup was retrospectively screened. One hundred patients with unilateral THA and a contralateral native and morphologically healthy hip as a reference met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior–posterior postoperative radiographs. Patients were divided according to the overruling by offset option or stem size. Results Hip offset was increased in all groups, but only with significant increase if an offset option + 1 was used intraoperatively (p = 0.025). LLD was restored without significance in all groups (p = 0.323; p = 0.157). Conclusion Intraoperative overruling of the preoperative digital template in cementless short stem total hip arthroplasty results in an increase of hip offset compared to a contralateral healthy hip. However, the increase is marginal and clearly under 5 mm compared to the contralateral healthy hip.

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

Hip International ◽

10.1177/112070000301300210 ◽

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.

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Retrospective Clinical and Radiological Outcomes of Total Hip Arthroplasty in 51 Patients After a Mean 8.2 Years Using the Nanos® Short-stem Prosthesis

Surgical Technology Online ◽

10.52198/21.sti.39.os1473 ◽

2021 ◽

Vol 39 ◽

Author(s):

Christian Fischer ◽

◽

Julia Dietz ◽

Karl-Stefan Delank ◽

Alexander Zeh ◽

...

Keyword(s):

Patient Satisfaction ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Survival Rates ◽

Short Stem ◽

Harris Hip Score ◽

Leg Length ◽

Total Hip ◽

The Mean

Introduction: Over the past several years, femoral short-stem hip implants have become more popular as a treatment option in the field of primary hip arthroplasty for younger and more active patients. Current data on clinical outcomes and the implant survival rates in patients with short-stem implants cover a maximum of five to six years. The aim of this study was to assess the survival rates, as well as clinical and functional outcomes, in total hip arthroplasty (THA) using the Nanos® short-stem implant (Smith & Nephew, Marl, Germany) over a follow-up period exceeding 5 y. Materials and Methods: This single-center retrospective study included the first 100 patients who were treated at the Department of Orthopedics at the University Hospital Halle (Saale) between January 2008 and February 2009. Ultimately, the complete data of 51 patients (54 hips) were reviewed. The follow-up period was from May to November 2017. We evaluated patient satisfaction regarding pain and function using a grading system. The Harris Hip Score and Forgotten Joint Score were obtained to evaluate functional outcome after THA. Postoperative radiographic evaluation included the measurement of leg-length discrepancy, changes in the shaft axis, femoral offset and horizontal or vertical center of rotation. Potential postoperative shaft angulation or axial shaft migration was also determined. Radiographic images were checked for radiolucent lines and heterotopic ossification using the classification systems outlined by Green and Brooker. Results: The average follow-up was 97.8 months (8.2 y). The mean patient age at follow-up was 68 y and the body mass index was 28.2 kg/m2. The mean Harris hip score at follow-up was 92.0 and the Forgotten Joint Score was 91.7 %. Survey results showed that patient satisfaction and pain perception were rated very good. No significant change in leg length was observed (mean: 0.1 mm shortening). Overall, a rather varus stem positioning was detected postoperatively (mean: 3.1°). The femoral offset was slightly reduced on average in the entire patient group (mean: -1.8 mm). In the horizontal plane, lateralization of the center of rotation was detected overall (mean: 0.7 mm). In the vertical plane, cranialization was noted (mean: 1.4 mm). The CCD angle did not change. There was no further stem migration postoperatively. Radiolucent lines occurred in 10 cases in Gruen zones 1 and 7. Heterotopic ossification occurred in stages 1 to 3 according to the Brooker classification system. We found no cases of aseptic loosening or other reasons for revision. Conclusion: The outcomes after a mean follow-up of 97.8 months (8.2 y) showed that high levels of patient satisfaction and functional outcome can be achieved with the use of a short-stem endoprosthesis. Sufficient restoration of the patient's individual anatomy paired with high survival rates makes this short-stem prosthesis a reliable implant in total hip arthroplasty.

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Value of 3D Preoperative Planning for Primary Total Hip Arthroplasty Based on Biplanar Weightbearing Radiographs

BioMed Research International ◽

10.1155/2019/1932191 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Y. Knafo ◽

F. Houfani ◽

B. Zaharia ◽

F. Egrise ◽

I. Clerc-Urmès ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Preoperative Planning ◽

Femoral Stem ◽

Leg Length ◽

Femoral Offset ◽

Postoperative Result ◽

Total Hip ◽

Planning Software ◽

Navigated Surgery

Two-dimensional (2D) planning on standard radiographs for total hip arthroplasty may not be sufficiently accurate to predict implant sizing or restore leg length and femoral offset, whereas 3D planning avoids magnification and projection errors. Furthermore, weightbearing measures are not available with computed tomography (CT) and leg length and offset are rarely checked postoperatively using any imaging modality. Navigation can usually achieve a surgical plan precisely, but the choice of that plan remains key, which is best guided by preoperative planning. The study objectives were therefore to (1) evaluate the accuracy of stem/cup size prediction using dedicated 3D planning software based on biplanar radiographic imaging under weightbearing and (2) compare the preplanned leg length and femoral offset with the postoperative result. This single-centre, single-surgeon prospective study consisted of a cohort of 33 patients operated on over 24 months. The routine clinical workflow consisted of preoperative biplanar weightbearing imaging, 3D surgical planning, navigated surgery to execute the plan, and postoperative biplanar imaging to verify the radiological outcomes in 3D weightbearing. 3D planning was performed with the dedicated hipEOS® planning software to determine stem and cup size and position, plus 3D anatomical and functional parameters, in particular variations in leg length and femoral offset. Component size planning accuracy was 94% (31/33) within one size for the femoral stem and 100% (33/33) within one size for the acetabular cup. There were no significant differences between planned versus implanted femoral stem size or planned versus measured changes in leg length or offset. Cup size did differ significantly, tending towards implanting one size larger when there was a difference. Biplanar radiographs plus hipEOS planning software showed good reliability for predicting implant size, leg length, and femoral offset and postoperatively provided a check on the navigated surgery. Compared to previous studies, the predictive results were better than 2D planning on conventional radiography and equal to 3D planning on CT images, with lower radiation dose, and in the weightbearing position.

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Staged reconstruction of unilateral neglected hip dislocation through total hip arthroplasty and subsequent intramedullary femoral lengthening

International Orthopaedics ◽

10.1007/s00264-021-05099-x ◽

2021 ◽

Author(s):

Bjoern Vogt ◽

Christoph Theil ◽

Georg Gosheger ◽

Adrien Frommer ◽

Burkhard Moellenbeck ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Plate Fixation ◽

Hip Dislocation ◽

Leg Length ◽

Total Hip ◽

Femoral Lengthening ◽

Shortening Osteotomy ◽

Successful Approach ◽

Staged Reconstruction

Abstract Background and purpose Total hip arthroplasty (THA) is a successful approach to treat unilateral symptomatic neglected hip dislocation (NHD). However, the extensive leg length discrepancy (LLD) can hereby only be partially corrected. In case of residual LLD of more than 2 cm, subsequent femoral lengthening can be considered. Patients/material/methods Retrospective analysis of clinical data and radiographs of five patients (age 38.1 (28–51) years) with unilateral NHD who underwent THA with (n = 3) or without (n = 2) subtrochanteric shortening osteotomy (SSO) and secondary intramedullary femoral lengthening through a retrograde magnetically-driven lengthening nail (follow-up 18.4 (15–27) months). Results LLD was 51.0 (45–60) mm before and 37.0 (30–45) mm after THA. Delayed bone union at one SSO site healed after revision with autologous bone grafting and plate fixation. Subsequent lengthening led to leg length equalisation in all patients. Complete consolidation was documented in all lengthened segments. Conclusion Staged reconstruction via THA and secondary femoral lengthening can successfully be used to reconstruct the hip joint and equalise LLD. The specific anatomical conditions have to be taken into consideration when planning treatment, and patients ought to be closely monitored.

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