Biomechanical reconstruction of the hip: comparison between modular short-stem hip arthroplasty and conventional total hip arthroplasty
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Short-stem hip arthroplasty preserves femoral bone stock which includes the femoral neck. This implies that the stem has to follow the anatomy of the femoral neck. Therefore, it has been questioned whether biomechanical reconstruction of the hip can be safely achieved with SHA.
Biomechanical reconstruction of the hip was analysed for 50 modular short-stem hip arthroplasties (SHA) and compared to 50 conventional total hip arthroplasties (THA). Biomechanical parameters were analysed on pre- and postoperative pelvic overviews and compared to those of the contralateral side.
The position of the acetabular cup (vertical and horizontal hip centre of rotation) changed slightly and was comparable for both groups. Horizontal femoral offset increased more in SHA (6.2 mm) than in THA (2.0 mm). Compared to the contralateral side it was significantly greater after SHA (+3.6 mm) but almost balanced after THA (−0.2 mm). Limb length increased with both procedures (8.0 mm SHA, 9.1 mm THA), but showed a significantly greater discrepancy after SHA (3.3 mm) as compared to THA (1.3 mm). According to the different implant designs, the stem-shaft axis showed a wider varus-valgus range for SHA (6.2° varus to 8.8° valgus) than for THA (2.6° varus to 3.3° valgus).
Horizontal femoral offset increased more with modular SHA than with conventional THA, but was within a beneficial range. Restoration of limb length appears more difficult in SHA and has a tendency to prolong limb length, which is probably related to the higher femoral resection level. This should be taken into consideration when considering SHA for a patient as well as during implantation.
KeywordsContralateral Side Limb Length Resection Level Postoperative Difference Biomechanical Reconstruction
The first author gratefully thanks Nora Goudsouzian for the careful proofreading of the manuscript.
Conflict of interest
The authors declare that they have no conflict of interest.
- 7.Lecerf G, Fessy MH, Philippot R, Massin P, Giraud F, Flecher X, Girard J, Mertl P, Marchetti E, Stindel E (2009) Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res 95(3):210–219PubMedCrossRefGoogle Scholar
- 9.Lerch M, von der Har-Tran A, Windhagen H, Behrens BA, Wefstaedt P, Stukenborg-Colsman CM (2011) Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study. Int Orthop. Sep 21 [Epub ahead of print]Google Scholar
- 12.Jerosch J, Grasselli C, Kothny PC, Litzkow D, Hennecke T (2011) Reproduction of the anatomy (offset, CCD, leg length) with a modern short stem hip design—a radiological study. Z Orthop Unfall. Apr 12 [Epub ahead of print]Google Scholar
- 13.Confalonieri N, Manzotti A, Montironi F, Pullen C (2008) Leg length discrepancy, dislocation rate, and offset in total hip replacement using a short modular stem: navigation vs conventional freehand. Orthopedics 31(10 Suppl 1)Google Scholar
- 15.Traina F, De Fine M, Tassinari E, Sudanese A, Calderoni PP, Toni A (2011) Modular neck prostheses in DDH patients: 11-year results. J Orthop Sci 16(1):14–20Google Scholar
- 17.Yamaguchi T, Naito M, Asayama I, Ishiko T (2004) Total hip arthroplasty: the relationship between posterolateral reconstruction, abductor muscle strength, and femoral offset. J Orthop Surg (Hong Kong) 12(2):164–167Google Scholar
- 21.Kamada S, Naito M, Nakamura Y, Kiyama T (2011) Hip abductor muscle strength after total hip arthroplasty with short stems. Arch Orthop Trauma Surg 131(12):1723–1729Google Scholar
- 24.Lazovic D, Dunai F, Zigan R (2010) The impact of navigation on a modular short stem prosthesis. J Bone Joint Surg (Proceedings) 92-B (SUPP_IV):523–552 dGoogle Scholar