Abstract
Despite strongly positive results of total hip arthroplasty (THA), patients remain at risk for complications including dislocation. Spinopelvic motion and the hip-spine relationship have been recognized as important factors in surgical planning and implant positioning in THA. Periarticular osteophytes are one of the hallmark pathoanatomic features of osteoarthritis and may influence implant positioning and joint stability; residual osteophytes at the anterior femoral neck may cause anterior impingement and posterior instability. No studies have been identified which establish the prevalence of anterior femoral neck osteophyte for incorporation into THA planning. 413 consecutive patients scheduled for THA underwent preoperative planning taking into account spinopelvic motion to establish optimal component position. Each surgical plan was reviewed retrospectively by four independent raters who were blinded to other imaging and intraoperative findings. Anterior femoral neck osteophytes were rated as being absent, minor, or extensive for each case. A single outlying rater was excluded. Inter-rater reliability was calculated manually. The patient group comprised 197 male and 216 female hips, with a mean age of 63 years (range 32–91). The presence of anterior femoral neck osteophytes was identified in a mean of 82% of cases (range 78–86%). A significant number of patients were found to have large or extensive osteophytes present in this location (mean 27%; range 23–31%). Inter-rater reliability was 70%. A large majority of our THA patients were found to have anterior femoral neck osteophytes. These must be considered during preoperative planning with respect to the spinopelvic relationship. Failure to identify and address osteophytes intraoperatively may increase the risk of impingement in flexion and/or internal rotation, leading to decreased range of motion, joint instability, and possibly dislocation. Planned future directions include incorporation of an impingement and instability model into preoperative planning for THA.
Highlights
Total hip arthroplasty (THA) is a common surgical procedure to treat osteoarthritis (OA) and other hip conditions, with over 91,000 cases reported in the UK in 2017 [1]
Surgical plans were retrospectively reviewed for all patients who underwent primary THA using the OPS6 system at a single hospital in Australia between November, 2015, and December, 2016
This study identified the presence of anterior femoral neck osteophyte in the large majority of this Australian cohort of THA patients
Summary
Total hip arthroplasty (THA) is a common surgical procedure to treat osteoarthritis (OA) and other hip conditions, with over 91,000 cases reported in the UK in 2017 [1]. Despite significant advances in surgical technique and implant design, patients remain at risk of joint instability and dislocation following THA. Impingement is defined as the abnormal contact between the femoral and acetabular sides during physiologic hip range of motion. Among the multiple causes of dislocation following THA, impingement may be a significant contributing factor [7]. THA impingement may lead to restricted range of motion, Advances in Orthopedics subluxation, edge loading, accelerated wear, and increased pain [7]. Anterior impingement following THA is often caused by residual anterior osteophyte on the femoral or acetabular side. Anterior impingement tends to cause increased edge loading and asymmetric wear at the posterior aspect of the acetabulum, as well as posterior subluxation or dislocation
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