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The Accuracy and Ability of Preoperative Templating to Restore Femoral Offset in Calcar-Guided Short-Stem Total Hip Prosthesis through Direct Anterior ApproachSource of Funding No funding.
The aim of this study was to assess the applicability and ability of preoperative templating to restore femoral offset and hip length with a calcar-guided short-stem implant design in total hip arthroplasty through the direct anterior approach. Preoperative measurements were performed of femoral offset, hip length, and stem size and compared with the perioperative placed prosthesis in 100 patients undergoing primary total hip replacement through direct anterior approach. Additionally, the pre- and postoperative femoral offset and hip length were compared to evaluate the ability to restore the offset and hip length with this kind of femoral short stem. With an acceptance of 1 size difference pre- and postoperatively, a 94% accuracy of predicting the size of the calcar-guided short stem was achieved with templating. Femoral offset was within means of 5 mm in 82.2% of the patients. Postoperative hip length was within 6 mm in 90% of the patients compared with the preoperative length.
The use of preoperative templating for total hip arthroplasty with calcar-guided short-stem implants was proven to be a useful tool to predict the definite implanted size of the femoral prosthesis. Our results show that this new stem design does not significantly differ from previous reported outcomes with other stem designs and is competent to restore the femoral offset and hip length within clinical acceptable range.
Level of evidence Level 3 retrospective case study.
This study was conducted in accordance with the 2013 version of the Declaration of Helsinki. The study protocol was approved by AZ Herentals Commission (Ethische Commissie OG 150 zitting 14.05.2018).
Received: 20 June 2020
Accepted: 12 October 2020
09 June 2021 (online)
© 2021. Thieme. All rights reserved.
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- 1 Galia CR, Diesel CV, Guimarães MR, Ribeiro TA. Total hip arthroplasty: a still evolving technique. Rev Bras Ortop 2017; 52 (05) 521-527
- 2 Schmidutz F, Beirer M, Weber P, Mazoochian F, Fottner A, Jansson V. Biomechanical reconstruction of the hip: comparison between modular short-stem hip arthroplasty and conventional total hip arthroplasty. Int Orthop 2012; 36 (07) 1341-1347
- 3 Kutzner KP, Donner S, Schneider M, Pfeil J, Rehbein P. One-stage bilateral implantation of a calcar-guided short-stem in total hip arthroplasty: minimally invasive modified anterolateral approach in supine position. Oper Orthop Traumatol 2017; 29 (02) 180-192
- 4 Kutzner KP, Pfeil J. Individualized stem-positioning in calcar-guided short-stem total hip arthroplasty. J Vis Exp 2018; (132) x
- 5 Lecerf G, Fessy MH, Philippot R. et al. Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res 2009; 95 (03) 210-219
- 6 Flecher X, Ollivier M, Argenson JN. Lower limb length and offset in total hip arthroplasty. Orthop Traumatol Surg Res 2016; 102 (1, Suppl): S9-S20
- 7 Ozaki Y, Homma Y, Sano K. et al. Small femoral offset is a risk factor for lateral femoral cutaneous nerve injury during total hip arthroplasty using a direct anterior approach. Orthop Traumatol Surg Res 2016; 102 (08) 1043-1047
- 8 Kutzner KP, Kovacevic MP, Roeder C, Rehbein P, Pfeil J. Reconstruction of femoro-acetabular offsets using a short-stem. Int Orthop 2015; 39 (07) 1269-1275
- 9 Innmann MM, Maier MW, Streit MR. et al. Additive influence of hip offset and leg length reconstruction on postoperative improvement in clinical outcome after total hip arthroplasty. J Arthroplasty 2018; 33 (01) 156-161
- 10 Desai AS, Dramis A, Board TN. Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med 2013; 6 (04) 336-341
- 11 Scheerlinck T. Primary hip arthroplasty templating on standard radiographs. A stepwise approach. Acta Orthop Belg 2010; 76 (04) 432-442
- 12 Schmidutz F, Steinbrück A, Wanke-Jellinek L, Pietschmann M, Jansson V, Fottner A. The accuracy of digital templating: a comparison of short-stem total hip arthroplasty and conventional total hip arthroplasty. Int Orthop 2012; 36 (09) 1767-1772
- 13 Pachter CS, Garfinkel JH, Romness DW, Gladnick BP. Radiographic calibration with a prosthetic femoral head allows accurate preoperative templating for total hip arthroplasty. Orthopedics 2019; 42 (03) e346-e349
- 14 Kutzner KP, Pfeil J, Kovacevic MP. Preoperative digital planning versus postoperative outcomes in total hip arthroplasty using a calcar-guided short stem: frequent valgization can be avoided. Eur J Orthop Surg Traumatol 2017; 27 (05) 643-651
- 15 Mahmood SS, Mukka SS, Crnalic S, Wretenberg P, Sayed-Noor AS. Association between changes in global femoral offset after total hip arthroplasty and function, quality of life, and abductor muscle strength. A prospective cohort study of 222 patients. Acta Orthop 2016; 87 (01) 36-41
- 16 Renkawitz T, Weber T, Dullien S. et al. Leg length and offset differences above 5mm after total hip arthroplasty are associated with altered gait kinematics. Gait Posture 2016; 49: 196-201
- 17 Brun OL, Sund HN, Nordsletten L, Röhrl SM, Mjaaland KE. Component placement in direct lateral vs minimally invasive anterior approach in total hip arthroplasty: radiographic outcomes from a prospective randomized controlled trial. J Arthroplasty 2019; 34 (08) 1718-1722
- 18 Mahmood SS, Mukka SS, Crnalic S, Sayed-Noor AS. The influence of leg length discrepancy after total hip arthroplasty on function and quality of life: a prospective cohort study. J Arthroplasty 2015; 30 (09) 1638-1642
- 19 Gamble P, de Beer J, Petruccelli D, Winemaker M. The accuracy of digital templating in uncemented total hip arthroplasty. J Arthroplasty 2010; 25 (04) 529-532
- 20 Gustke K. Use of short stems for total hip arthroplasty: is it a Napoleonic solution?. YSART 2012; 23: 159-162