Relationships between the femoral neck-preserving ratio and radiologic and clinical outcomes in patients undergoing total-hip arthroplasty with a collum femoris-preserving stem.

Abstract

The femoral neck-preserving ratio is crucial in arthroplasty with a collum femoris-preserving (CFP) stem. The aim of our study was to analyze the relationships between the neck-preserving ratio and the short-term radiologic and clinical outcomes of patients who underwent total-hip arthroplasty (THA) with a CFP stem.The data of 325 hips from January 2015 to December 2016 were retrospectively reviewed. The demographic and radiologic data before and after surgery were obtained from patients. The neck-preserving ratio was defined as the ratio of the preserved femoral neck length to the preoperative femoral neck length. Correlations between the neck-preserving ratio and the radiologic and clinical outcomes of patients were analyzed.The mean neck-preserving ratio was 66.38 ± 6.91% in the current study. We divided patients into 3 groups according to the neck-preserving ratio: group A (neck-preserving ratio ≤60.00%), group B (60.00% < neck-preserving ratio < 70.00%), group C (neck-preserving ratio ≥70.00%). Radiologic features, including the neck-shaft angle ratio (0.96 ± 0.05), canal fill ratio (0.64 ± 0.07), anterior-posterior offset ratio (1.04 ± 0.10), and lateral offset ratio (2.55 ± 1.56) (ratios of the postoperative values to the preoperative values), and the prevalence of complications was significantly different among the groups (χ2 = 21.173, P < .001). In the correlation analysis, we found a moderate negative correlation between the neck-preserving ratio and neck-shaft angle ratio (r = −0.308, P < .001) and a slight positive correlation of the neck-preserving ratio with the anterior-posterior offset ratio (r = 0.415, P < .001) and the lateral offset ratio (r = 0.164, P = .003). In the linear regression analyses, the neck-preserving ratio was significantly linearly correlated with the neck-shaft angle ratio (B = −0.232, 95% confidence interval [CI] = −0.311 to −0.154, P < .001), anterior-posterior offset ratio (B = 0.589, 95% CI = 0.447–0.730, P < .001), and lateral offset ratio (B = 3.693, 95% CI = 1.256–6.131, P = .003). However, there was no significant linear correlation between the neck-preserving ratio and the canal fill ratio (B = 0.073, 95% CI = −0.033 to 0.180, P = .174). Logistic regression analyses also showed that a sufficient neck-preserving ratio was a protective factor for periprosthetic femoral fractures (odds ratio [OR] = 0.924, 95% CI = 0.859–0.994, P = .035), dislocations (OR = 0.892, 95% CI = 0.796–0.999, P = .048), and thigh pain (OR = 0.886, 95% CI = 0.818–0.960, P = .003).For CFP stems, an insufficient neck-preserving ratio is significantly correlated with poor radiologic and clinical outcomes. Therefore, surgeons should be cognizant to preserve a sufficient femoral neck length during surgery to improve the outcomes for patients undergoing THA with CFP stems.