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The tridimensional geometry of the proximal femur should determine the design of cementless femoral stem in total hip arthroplasty

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Abstract

Purpose

Using a cementless femoral stem in total hip arthroplasty (THA), optimal filling of the proximal femoral metaphyseal volume (PFMV) and restoration of the extramedullary proximal femoral (PF) parameters (i.e., femoral offset (FO), neck length (FNL), and head height (FHH)) constitute key goals for optimal hip biomechanics, functional outcome, and THA survivorship. However, almost 30% of mismatch between the PF anatomy and implant geometry of the most widely implanted non-modular cementless femoral stem has been demonstrated in a computed tomography scan (CT scan) study. Therefore, this anatomic study aimed to evaluate the relationship between the intra- and extramedullary PF parameters using tridimensional CT scan reconstructions.

Methods

One hundred fifty-one CT scans of adult healthy hips were obtained from 151 male Caucasian patients (mean age = 66 ± 11 years) undergoing lower limb CT scan arteriography. Tridimensional PF reconstructions and parameter measurements were performed using a corrected PF coronal plane—defined by the femoral neck and diaphyseal canal longitudinal axes—to avoid influence of PF helitorsion and femoral neck version on extramedullary PF parameters.

Results

Independently of the femoral neck-shaft angle, the PFMV was significantly and positively correlated with the FO, FNL, and FHH (r = 0.407 to 0.420; p < 0.0001).

Conclusion

This study emphasized that the tridimensional PF geometry measurement in the corrected coronal plane of the femoral neck can be useful to determine and optimize the design of a non-modular cementless femoral stem. Particularly, continuous homothetic size progression of the intra- and extramedullary PF parameters should be achieved to assure stem fixation and restore anatomic hip biomechanics.

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Acknowledgements

The authors thank the AXIOM orthopaedic group for providing assistance in CT scan selection and revision of the manuscript content.

Funding

This study was internally funded by the research laboratory INSERM UMR1033, Université de Lyon, Lyon, France.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery – Pavillon T, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5, place d’Arsonval, 69437, Lyon, France

    Julien Wegrzyn & Vincent Pibarot

  2. INSERM UMR 1033, Université de Lyon, Lyon, France

    Julien Wegrzyn, Jean-Paul Roux & Charlotte Loriau

  3. Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Lyon, France

    Nicolas Bonin

Authors
  1. Julien Wegrzyn
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  2. Jean-Paul Roux
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  3. Charlotte Loriau
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  4. Nicolas Bonin
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  5. Vincent Pibarot
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Corresponding author

Correspondence to Julien Wegrzyn.

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Conflict of interest

JPR and CL declare that they have no conflict of interest. JW, NB, and VP declare royalties perceived from Dedienne Santé, Maugio, France. JW serves as paid consultant for Stryker, Mahwah, NJ, USA.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of our institutional and the French national research committees, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

As this study evaluated anonymized data issued from CT scan primarily performed for clinical purpose and not research, informed consent was not required.

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Wegrzyn, J., Roux, JP., Loriau, C. et al. The tridimensional geometry of the proximal femur should determine the design of cementless femoral stem in total hip arthroplasty. International Orthopaedics (SICOT) 42, 2329–2334 (2018). https://doi.org/10.1007/s00264-018-3843-9

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  • DOI: https://doi.org/10.1007/s00264-018-3843-9

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