scholarly journals Effect of Biomechanical and Anatomic Characteristics on Patient-Reported Outcomes Following Total Hip Arthroplasty

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Lauren Pitz, BS ◽  
Braeden W. Estes, BS ◽  
Evan R. Deckard, BSE ◽  
R. Michael Meneghini, MD
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Stem ◽  
Activity Level ◽  
Lumbar Pain ◽  
Leg Length ◽  
Acetabular Cup ◽  
Femoral Offset ◽  
Primary Thas ◽  
Patient Reported ◽  
High Bmi

Background and Hypothesis: The success of total hip arthroplasty (THA) is often reported in terms of infection and dislocation rates. While studies have examined the effect of acetabular cup position, anteroposterior (AP) femoral stem alignment, changes in leg length and femoral stem offset on dislocation rates, few studies have investigated the effect of these biomechanical parameters on patient-reported outcome measures (PROMS). The purpose of this study was to evaluate how PROMS may differ by THA component placement in a consecutive series of primary THAs. Awareness of the importance of implant positioning may lead to improved surgical technique and optimized PROMS. Experimental Design or Project Methods: 933 consecutive posterolateral approach primary THAs performed between 2011 and 2018 by one surgeon were retrospectively reviewed. Acetabular cup abduction, femoral stem alignment, changes in leg length and total femoral offset were measured on APview radiographs. Prospectively collected Hip Disability and Osteoarthritis Outcome Score/HOOS Jr., University of California Los Angeles/UCLA Activity Level, and satisfaction (5-point Likert scale) were evaluated at minimum one-year. Results: 743 THAs were analyzed. Mean age and BMI were 64 years and 31 kg/m2, respectively. After multivariate analysis, females with neutral to valgus stem placement (p=0.020) and patients with neutral to valgus stem placement regardless of lumbar pain (p=0.034) were more satisfied. In addition, patients with lumbar pain (p<0.001) and patients with high BMI in combination with increased change in femoral offset (p=0.056) had lower overall HOOS Jr. scores. Interestingly, change in leg length was not a significant predictor of any PROMS (power [1-β]≥88.4%). Conclusion and Potential Impact: AP stem alignment may play a role in increased activity level and satisfaction. In addition, high BMI in combination with increased change in femoral offset negatively influenced HOOS Jr. scores. Unsurprisingly, the presence of lumbar pain continues to negatively affect PROMS. Further research is warranted on the influence of THA component placement, spinopelvic parameters, and PROMS.

Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem – stem or cup positioning?

2017 ◽  
Vol 58 (9) ◽  
pp. 1125-1131 ◽  
Author(s):  
Bariq Al-Amiry ◽  
Sarwar Mahmood ◽  
Ferid Krupic ◽  
Arkan Sayed-Noor
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Contralateral Side ◽  
Leg Length ◽  
Acetabular Cup ◽  
Femoral Offset ◽  
Leg Lengthening ◽  
Observer Reliability ◽  
Cup Positioning

Background Restoration of femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA) as it improves functional outcome. Purpose To analyze whether the problem of postoperative leg lengthening and FO reduction is related to the femoral stem or acetabular cup positioning or both. Material and Methods Between September 2010 and April 2013, 172 patients with unilateral primary osteoarthritis treated with THA were included. Postoperative leg-length discrepancy (LLD) and global FO (summation of cup and FO) were measured by two observers using a standardized protocol for evaluation of antero-posterior plain hip radiographs. Patients with postoperative leg lengthening ≥10 mm (n = 41) or with reduced global FO >5 mm (n = 58) were further studied by comparing the stem and cup length of the operated side with the contralateral side in the lengthening group, and by comparing the stem and cup offset of the operated side with the contralateral side in the FO reduction group. We evaluated also the inter-observer and intra-observer reliability of the radiological measurements. Results Both observers found that leg lengthening was related to the stem positioning while FO reduction was related to the positioning of both the femoral stem and acetabular cup. Both inter-observer reliability and intra-observer reproducibility were moderate to excellent (intra-class correlation co-efficient, ICC ≥0.69). Conclusion Post THA leg lengthening was mainly caused by improper femoral stem positioning while global FO reduction resulted from improper positioning of both the femoral stem and the acetabular cup.

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

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
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.

scholarly journals The accuracy of digital templating in cementless total hip arthroplasty in dysplastic hips

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Emelie Kristoffersson ◽  
Volker Otten ◽  
Sead Crnalic
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Developmental Dysplasia ◽  
Leg Length ◽  
Acetabular Cup ◽  
Digital Templating ◽  
Total Hip ◽  
Implant Size ◽  
Crowe Classification

Abstract Background Total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) is a complex procedure due to associated anatomical abnormalities. We studied the extent to which preoperative digital templating is reliable when performing cementless THA in patients with DDH. Methods We templated and compared the pre- and postoperative sizes of the acetabular and femoral components and the center of rotation (COR), and analysed the postoperative cup coverage, leg length discrepancy (LLD), and stem alignment in 50 patients (56 hips) with DDH treated with THA. Results The implant size exactly matched the template size in 42.9% of cases for the acetabular component and in 38.2% of cases for the femoral component, whereas the templated ±1 size was used in 80.4 and 81.8% of cases for the acetabular and femoral components, respectively. There were no statistically significant differences between templated and used component sizes among different DDH severity levels (acetabular cup: p = 0.30 under the Crowe classification and p = 0.94 under the Hartofilakidis classification; femoral stem: p = 0.98 and p = 0.74, respectively). There were no statistically significant differences between the planned and postoperative COR (p = 0.14 horizontally and p = 0.52 vertically). The median postoperative LLD was 7 (range 0–37) mm. Conclusion Digital preoperative templating is reliable in the planning of cementless THA in patients with DDH.

scholarly journals Does body mass index affect restoration of femoral offset, leg length and cup positioning after total hip arthroplasty? A prospective cohort study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Bariq Al-Amiry ◽  
Georgios Pantelakis ◽  
Sarwar Mahmood ◽  
Bakir Kadum ◽  
Torkel B. Brismar ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cohort Study ◽  
Total Hip Arthroplasty ◽  
Prospective Cohort Study ◽  
Hip Arthroplasty ◽  
Prospective Cohort ◽  
Leg Length ◽  
Acetabular Cup ◽  
Femoral Offset ◽  
Cup Positioning

Abstract Background In obese patients, total hip arthroplasty (THA) can be technically demanding with increased perioperative risks. The aim of this prospective cohort study is to evaluate the effect of body mass index (BMI) on radiological restoration of femoral offset (FO) and leg length as well as acetabular cup positioning. Methods In this prospective study, patients with unilateral primary osteoarthritis (OA) treated with THA between September 2010 and December 2013 were considered for inclusion. The perioperative plain radiographs were standardised and used to measure the preoperative degree of hip osteoarthritis, postoperative FO, leg length discrepancy (LLD), acetabular component inclination and anteversion. Results We included 213 patients (74.5% of those considered for inclusion) with a mean BMI of 27.7 (SD 4.5) in the final analysis. The postoperative FO was improper in 55% and the LLD in 15%, while the cup inclination and anteversion were improper in 13 and 23% of patients respectively. A multivariable logistic regression model identified BMI as the only factor that affected LLD. Increased BMI increased the risk of LLD (OR 1.14, 95% CI 1.04 to 1.25). No other factors included in the model affected any of the primary or secondary outcomes. Conclusion Increased BMI showed a negative effect on restoration of post-THA leg length but not on restoration of FO or positioning of the acetabular cup. Age, gender, OA duration or radiological severity and surgeon’s experience showed no relation to post-THA restoration of FO, leg length or cup positioning.

Relative Contribution of Acetabular and Femoral Reconstruction to Prosthetic Joint Instability Risk after Primary Total Hip Arthroplasty

2019 ◽  
Vol 03 (03) ◽  
pp. 130-135
Author(s):  
Felipe Ituarte ◽  
Ajay Aggarwal ◽  
Emily V. Leary ◽  
Benjamin J. Hansen ◽  
James A. Keeney
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Joint Instability ◽  
Safe Zone ◽  
Acetabular Anteversion ◽  
Femoral Offset ◽  
Femoral Length ◽  
Primary Thas ◽  
Relative Contribution ◽  
Prosthetic Joint

AbstractProsthetic joint instability is a challenging concern for a minority of total hip arthroplasty (THA) patients. Placement of the acetabular component within the traditional safe zone does not eliminate dislocation, and the relative contribution of femoral length and offset to instability risk has not been well defined. The authors compared 53 dislocated primary THAs treated against an age- and gender-matched cohort of 134 stable primary THAs. Anteroposterior and cross-table lateral radiographs were used to determine whether reconstructions met targets for acetabular inclination (30–50 degrees), acetabular anteversion (5–30 degrees), femoral length (0–9.9 mm) and femoral offset (0–9.9 mm). Statistical analysis was performed to assess univariate and multivariate relationships with an instability event; statistical significance was set using a two-sided p-value < 0.05. Forty-seven (88.7%) of the dislocating hips had nonoptimal acetabular or femoral reconstructions. While a similar proportion of patients in the study and control groups had acetabular reconstruction within the safe zone (51.5 vs. 47.2%, p = 0.63) patients with unstable hips were more likely to have acetabular component inclination outside of the target zone (30.2 vs. 7.5%, p < 0.01), acetabular anteversion < 15 degrees (30.2 vs. 3.7%, p < 0.0001), reduced femoral length (35.9 vs. 3.7%, p < 0.0001), and reduced femoral offset (41.5 vs. 7.46%, p < 0.0001). Stepwise multivariate logistic regression was performed and identified femoral head size less than 32 mm (OR 2.9, 95% CI 1.4–6.2) and higher inclination angle (OR 1.1, 95% CI 1.04–1.2) as significant independent risk factors for hip instability. The authors' study findings suggest that insufficient acetabular anteversion, femoral length, and femoral offset reconstruction contribute significantly to instability risk following THA. Using a larger femoral head is protective, but should be balanced against long-term volumetric wear risk.

The learning curve of robotic-arm assisted acetabular cup positioning during total hip arthroplasty

2019 ◽  
pp. 112070001988933 ◽  
Author(s):  
Babar Kayani ◽  
Sujith Konan ◽  
Sumon S Huq ◽  
Mazin S Ibrahim ◽  
Atif Ayuob ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Hip Arthroplasty ◽  
Robotic Arm ◽  
Surgical Team ◽  
Leg Length ◽  
Acetabular Cup ◽  
Confidence Levels ◽  
Length Discrepancy ◽  
Cup Positioning

Background: Robotic-arm assisted surgery aims to reduce manual errors and improve the accuracy of implant positioning and orientation during total hip arthroplasty (THA). The objective of this study was to assess the surgical team’s learning curve for robotic-arm assisted acetabular cup positioning during THA. Methods: This prospective cohort study included 100 patients with symptomatic hip osteoarthritis undergoing primary total THA performed by a single surgeon. This included 50 patients receiving conventional manual THA and 50 patients undergoing robotic-arm assisted acetabular cup positioning during THA. Independent observers recorded surrogate markers of the learning curve including operative times, confidence levels amongst the surgical team using the state-trait anxiety inventory (STAI) questionnaire, accuracy in restoring native hip biomechanics, acetabular cup positioning, leg-length discrepancy, and complications within 90 days of surgery. Results: Cumulative summation (CUSUM) analysis revealed robotic-arm assisted acetabular cup positioning during THA was associated with a learning curve of 12 cases for achieving operative times ( p < 0.001) and surgical team confidence levels ( p < 0.001) comparable to conventional manual THA. There was no learning curve of robotic-arm assisted THA for accuracy of achieving the planned horizontal ( p = 0.83) and vertical ( p = 0.71) centres of rotation, combined offset ( p = 0.67), cup inclination ( p = 0.68), cup anteversion ( p = 0.72), and correction of leg-length discrepancy ( p = 0.61). There was no difference in postoperative complications between the two treatment groups. Conclusions: Integration of robotic-arm assisted acetabular cup positioning during THA was associated with a learning curve of 12 cases for operative times and surgical team confidence levels but there was no learning curve effect for accuracy in restoring native hip biomechanics or achieving planned acetabular cup positioning and orientation.

Gender-specific difference of in-vivo kinematics in patients with unilateral total hip arthroplasty

2020 ◽  
pp. 112070002090349
Author(s):  
Yun Peng ◽  
Paul Arauz ◽  
Young-Min Kwon
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Imaging System ◽  
Femoral Stem ◽  
Frontal Plane ◽  
Femoral Offset ◽  
Total Hip ◽  
Gait Asymmetry ◽  
Bilateral Difference ◽  
Gender Specific

Purpose: Asymmetric gait patterns are known to persist in patients with unilateral total hip arthroplasty (THA). Little is known about the effect of gender on gait asymmetry. This study aimed to determine whether gait asymmetry differs between genders in unilateral THA patients and can be explained by component positioning. Methods: 23 female and 10 male unilateral THA patients were included. Asymmetric hip kinematics during gait and component positioning were quantified using a combined computed tomography-based modelling and dual fluoroscopic imaging system. Multiple regression was performed to examine the unique and mediated contribution of gender to observed gait asymmetry. Results: Female and male patients differed most significantly in frontal plane gait asymmetry ( p = 0.001) and bilateral difference of vertical femoral offset ( p = 0.048). Compared with the native hip, the implanted hip exhibited significantly increased adduction ( p = 0.007) in females but significantly increased abduction ( p = 0.001) in males. The stem head of the implanted hip was more superiorly positioned compared to the native femoral head in female but more inferiorly positioned in male. Gender accounted for 41.5% variance of frontal plane gait asymmetry and was partially mediated by the bilateral difference of vertical femoral offset. Conclusions: Female unilateral THA patients exhibited significantly increased adduction in the implanted hip compared to the native hip, which is partially attributable to a more superiorly positioned femoral stem centre of rotation. The understanding of gender-specific differences of kinematic patterns may benefit female patients through targeted preoperative planning and postoperative rehabilitation.

scholarly journals Long-Term results of total Hip Arthroplasty performed using a cementless expansive Acetabular Cup and Spotorno Femoral Stem

2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Engin Çarkçı ◽  
Ayse Esin Polat ◽  
Yusuf Öztürkmen ◽  
Tolga Tüzüner
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Survival Rates ◽  
Femoral Stem ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Acetabular Cup ◽  
Total Hip ◽  
Kaplan Meier

Objective: In this study we aimed to investigate the long-term clinical and radiological results, revision rates and causes, and the rate of implant survival in total hip arthroplasty performed using CLS® expansion cup and Spotorno® cementless femoral stem. Methods: Clinical results of total hip arthroplasty performed on 131 hips of 114 patients in Istanbul Training and Research Hospital between 1993 and 2003 were retrospectively evaluated according to the Harris Hip Score. Revision rates were determined and implant survival rates were identified using the Kaplan-Meier estimator. Results: Of the patients, 39 were males and 75 were females. The average age of the patients at surgery was 48.7±11.3 years. Patients were followed up for a mean period of 13.9±2.4 years. The mean Harris Hip Score was 34.35±6.09 preoperatively and 88.20±7.11 at the final follow-up (p<0.001). The Kaplan-Meier survivorship estimate for the cup at 13.9 years, taking revision for any reason as the end point was 95.6% (95% CI), while the 15th and 17th year survival rates were 90% and 85%, respectively. Conclusion: In total hip arthroplasty using a cementless expansive acetabular cup, a 95.6% survival rate is achieved after an average of 14 years, whereas the rate decreases to 85% after 17 years. Even if the incidence of cup breakage is reduced with proper implantation, particle disease and periacetabular osteolysis remains a problem for the long-term survival. doi: https://doi.org/10.12669/pjms.37.1.3089 How to cite this:Carkci E, Polat AE, Ozturkmen Y, Tuzuner T. Long-Term results of total Hip Arthroplasty performed using a cementless expansive Acetabular Cup and Spotorno Femoral Stem. Pak J Med Sci. 2021;37(1):52-58. doi: https://doi.org/10.12669/pjms.37.1.3089 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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