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International Orthopaedics

, Volume 36, Issue 7, pp 1341–1347 | Cite as

Biomechanical reconstruction of the hip: comparison between modular short-stem hip arthroplasty and conventional total hip arthroplasty

  • Florian SchmidutzEmail author
  • Marc Beirer
  • Patrick Weber
  • Farhad Mazoochian
  • Andreas Fottner
  • Volkmar Jansson
Original Paper

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Contralateral Side Limb Length Resection Level Postoperative Difference Biomechanical Reconstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgement

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.

References

  1. 1.
    Kiyama T, Naito M, Shinoda T, Maeyama A (2010) Hip abductor strengths after total hip arthroplasty via the lateral and posterolateral approaches. J Arthroplasty 25(1):76–80PubMedCrossRefGoogle Scholar
  2. 2.
    Asayama I, Chamnongkich S, Simpson KJ, Kinsey TL, Mahoney OM (2005) Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty. J Arthroplasty 20(4):414–420PubMedCrossRefGoogle Scholar
  3. 3.
    McGrory BJ, Morrey BF, Cahalan TD, An KN, Cabanela ME (1995) Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg Br 77(6):865–869PubMedGoogle Scholar
  4. 4.
    Erceg M (2009) The influence of femoral head shift on hip biomechanics: additional parameters accounted. Int Orthop 33(1):95–100PubMedCrossRefGoogle Scholar
  5. 5.
    Bourne RB, Rorabeck CH (2002) Soft tissue balancing: the hip. J Arthroplasty 17(4 Suppl 1):17–22PubMedCrossRefGoogle Scholar
  6. 6.
    Little NJ, Busch CA, Gallagher JA, Rorabeck CH, Bourne RB (2009) Acetabular polyethylene wear and acetabular inclination and femoral offset. Clin Orthop Relat Res 467(11):2895–2900PubMedCrossRefGoogle Scholar
  7. 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
  8. 8.
    Briem D, Schneider M, Bogner N, Botha N, Gebauer M, Gehrke T, Schwantes B (2011) Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis. Int Orthop 35(5):655–660PubMedCrossRefGoogle Scholar
  9. 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
  10. 10.
    Kim YH, Kim JS, Park JW, Joo JH (2011) Total hip replacement with a short metaphyseal-fitting anatomical cementless femoral component in patients aged 70 years or older. J Bone Joint Surg Br 93(5):587–592PubMedCrossRefGoogle Scholar
  11. 11.
    Morrey BF, Adams RA, Kessler M (2000) A conservative femoral replacement for total hip arthroplasty. A prospective study. J Bone Joint Surg Br 82(7):952–958PubMedCrossRefGoogle Scholar
  12. 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. 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
  14. 14.
    Silva M, Lee KH, Heisel C, dela Rosa MA, Schmalzried TP (2004) The biomechanical results of total hip resurfacing arthroplasty. J Bone Joint Surg Am 86-A(1):40–46PubMedGoogle Scholar
  15. 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
  16. 16.
    Sakalkale DP, Sharkey PF, Eng K, Hozack WJ, Rothman RH (2001) Effect of femoral component offset on polyethylene wear in total hip arthroplasty. Clin Orthop Relat Res 388:125–134PubMedCrossRefGoogle Scholar
  17. 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
  18. 18.
    Bicanic G, Delimar D, Delimar M, Pecina M (2009) Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop 33(2):397–402PubMedCrossRefGoogle Scholar
  19. 19.
    Girard J, Lavigne M, Vendittoli PA, Roy AG (2006) Biomechanical reconstruction of the hip: a randomised study comparing total hip resurfacing and total hip arthroplasty. J Bone Joint Surg Br 88(6):721–726PubMedCrossRefGoogle Scholar
  20. 20.
    Loughead JM, Chesney D, Holland JP, McCaskie AW (2005) Comparison of offset in Birmingham hip resurfacing and hybrid total hip arthroplasty. J Bone Joint Surg Br 87(2):163–166PubMedCrossRefGoogle Scholar
  21. 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
  22. 22.
    Massin P, Geais L, Astoin E, Simondi M, Lavaste F (2000) The anatomic basis for the concept of lateralized femoral stems: a frontal plane radiographic study of the proximal femur. J Arthroplasty 15(1):93–101PubMedCrossRefGoogle Scholar
  23. 23.
    Thien TM, Karrholm J (2010) Design-related risk factors for revision of primary cemented stems. Acta Orthop 81(4):407–412PubMedCrossRefGoogle Scholar
  24. 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
  25. 25.
    Traina F, De Clerico M, Biondi F, Pilla F, Tassinari E, Toni A (2009) Sex differences in hip morphology: is stem modularity effective for total hip replacement? J Bone Joint Surg Am 91(Suppl 6):121–128PubMedCrossRefGoogle Scholar
  26. 26.
    Traina F, De FM, Biondi F, Tassinari E, Galvani A, Toni A (2009) The influence of the centre of rotation on implant survival using a modular stem hip prosthesis. Int Orthop 33(6):1513–1518PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Florian Schmidutz
    • 1
    Email author
  • Marc Beirer
    • 2
  • Patrick Weber
    • 1
  • Farhad Mazoochian
    • 1
  • Andreas Fottner
    • 1
  • Volkmar Jansson
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity Hospital of Munich (LMU), Campus GrosshadernMunichGermany
  2. 2.Department of Trauma SurgeryTechnical University of Munich (TUM)MunichGermany

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