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Influence of femoral bowing on range of motion after total hip arthroplasty

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Abstract

Purpose

The influence of physiologic femoral bowing on range of motion (ROM) after total hip arthroplasty (THA) remains unknown. The purpose of this study was to investigate the morphology of the femur in patients who underwent THA, and to analyze the influence of femoral bowing on ROM due to implant impingement after THA.

Methods

The ROM was calculated from 100 hips in 90 patients who underwent THA using computed tomography data with a 3D dynamic analysis software. Lateral and anterior bowing angles of the femur were measured. A modular implant (Modulus system, Lima Corporate, Villanova di San Daniele del Friuli, Italy) was used for simulation. In all subjects, cup inclination, anteversion, and stem anteversion were set to 40°, 15°, and 30°, respectively. Multiple linear regression analyses were performed to assess the relationship between the morphology of the femur and ROM.

Results

Lateral bowing of the femur was demonstrated to be significantly correlated with age (r = 0.361, p < 0.001) and female sex (r = 0.315, p = 0.001). Lateral bowing of the femur was significantly positively correlated with flexion and internal rotation (Int-R) with 90° flexion. Anterior bowing was significantly associated with decreasing flexion, decreasing Int-R with 90° flexion and increasing Int-R with 45° flexion and 15° adduction.

Conclusions

A ROM-optimized cup position cannot be calculated from femoral stem anteversion values alone; therefore, when surgeons position the cup in relation to the femoral stem anteversion, the influence of femoral bowing may also require consideration.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano City, Osaka, 586-0008, Japan

    Keisuke Akiyama

  2. Department of Orthopaedic Surgery, Sumitomo Hospital, 5-3-20, Nakanoshima, Kita-ku, Osaka City, 530-0005, Japan

    Takaaki Shibuya

Authors
  1. Keisuke Akiyama
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  2. Takaaki Shibuya
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Corresponding author

Correspondence to Keisuke Akiyama.

Ethics declarations

All authors certify that our institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Conflict of interest

The authors declare that they have no conflict of interest.

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Akiyama, K., Shibuya, T. Influence of femoral bowing on range of motion after total hip arthroplasty. International Orthopaedics (SICOT) 42, 1795–1802 (2018). https://doi.org/10.1007/s00264-017-3732-7

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  • DOI: https://doi.org/10.1007/s00264-017-3732-7

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