Abstract
BackgroundCorrect 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.MethodsIn 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.ResultsThe 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.ConclusionReconstruction 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.
Highlights
Total hip arthroplasty (THA) is a very successful and cost-effective surgical management of patients with end-stage osteoarthritis of the hip [1, 2]
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The Dorr types were significantly different in canal flare index (p < 0.001), cortical index (p < 0.001) and canal-to-calcar ratio (p < 0.001)
Summary
Total hip arthroplasty (THA) is a very successful and cost-effective surgical management of patients with end-stage osteoarthritis of the hip [1, 2]. Accurate reconstruction of hip offset (HO) and leg length demonstrated an additive effect on postoperative clinical outcome [8]. Patients with accurate to slightly increased HO combined with balanced leg length show higher increases in delta Harris hip score (HHS) [8]. The anatomical shape of the proximal femur can have a significant impact on postoperative LLD and osseointegration of cementless THA [10]. LLD in cementless straight-stem THA depends on the used implant and its fixation [10]. 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 wanted to evaluate, if this is applicable in THA with a cementless meta-diaphyseal short stem
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