Skip to main content

Advertisement

SpringerLink
Log in

Restoring femoral medial offset could reduce pelvic obliquity following primary total hip arthroplasty, an observational study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Since femoral and horizontal offsets may be contributing factors to hip and pelvic balance, this study seeks to determine whether there is a correlation between pelvic obliquity (PO) after unilateral total hip arthroplasty (THA) and horizontal/vertical offset differences of the replaced and contralateral natural joints.

Methods

A cross-sectional study was performed on adult patients who underwent unilateral THA between 2017 and 2020. An expert orthopaedic resident measured PO angles and offset parameters. “Delta medial offset” is considered medial offset of the replaced hip minus the medial offset of the contralateral side. “Absolute delta medial offset” is considered the absolute value of the “Delta medial offset.”

Results

Finally, 133 patients were included in the study with a mean (SD) age of 45.3 ± 14.8 years and 57.9% female. The PO values (median, IQR) changed from 3.2 (1.7–5.7) before THA to 3.0 (1.50–5.6) after THA, not significantly decreased (P = 0.31). The PO after THA is significantly correlated with PO before THA (correlation coefficient of 0.457, P < 0.001), the delta medial offset after THA (correlation coefficient of − 0.24, P = 0.006), and the absolute delta medial offset after THA (correlation coefficient of 0.284, P = 0.001). The amount of changes of delta medial offset, before and after surgery, was not significantly correlated to PO or PO changes after surgery.

Conclusion

PO before the THA and medial offset discrepancy after THA are two important contributing factors for post-operative PO. Restoring the medial offset of the affected side and lowering the delta medial offset between the two sides can significantly decrease post-operative PO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Data availability

Not applicable.

Abbreviations

PO:

Pelvic obliquity

THA:

Total hip arthroplasty

FOR:

Femoral offset ratio

LLD:

Leg length discrepancy

PACS:

Picture Archiving and Communication System

ROM:

Range of motion

References

  1. Madsen MS, Ritter MA, Morris HH, Meding JB, Berend ME, Faris PM, Vardaxis VG (2004) The effect of total hip arthroplasty surgical approach on gait. J Orthop Res 22:44–50. https://doi.org/10.1016/s0736-0266(03)00151-7

    Article  PubMed  Google Scholar 

  2. Sheikhbahaei E, Mirghaderi SP, Moharrami A, Habibi D, Motififard M, Javad Mortazavi SM (2022) Incidence of symptomatic COVID-19 in unvaccinated patients within one month after elective total joint arthroplasty: a multicentre study. Arthroplasty Today. https://doi.org/10.1016/j.artd.2022.01.024

    Article  PubMed  PubMed Central  Google Scholar 

  3. Vasavada AN, Delp SL, Maloney WJ, Schurman DJ, Zajac FE (1994) Compensating for changes in muscle length in total hip arthroplasty. Effects on the moment generating capacity of the muscles. Clin Orthop Relat Res 302:121–133

  4. Salimi A, Mirghaderi SP, Gholamzadeh MJ, Qahremani R, Hadizadeh A, Shahriarirad R, Jelodari Mamaghani H, Dehghani J, Salimi M (2022) Evaluation of crossover sign in pelvis models made with a three-dimensional printer. Adv Orthop 2022:4665342. https://doi.org/10.1155/2022/4665342

    Article  PubMed  PubMed Central  Google Scholar 

  5. Abe Y, Sato S, Abe S, Masuda T, Yamada K (2015) The impact of the leg-lengthening total hip arthroplasty on the coronal alignment of the spine. Scoliosis 10:S4. https://doi.org/10.1186/1748-7161-10-s2-s4

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dubousset J (1991) Pelvic obliquity: a review. Orthopedics 14:479–481. https://doi.org/10.3928/0147-7447-19910401-13

    Article  CAS  PubMed  Google Scholar 

  7. Dubousset J (1990) CD instrumentation in pelvic tilt. Orthopade 19:300–308

    CAS  PubMed  Google Scholar 

  8. Zhou X, Wang Q, Zhang X, Chen Y, Shen H, Jiang Y (2012) Effect of pelvic obliquity on the orientation of the acetabular component in total hip arthroplasty. J Arthroplasty 27:299–304. https://doi.org/10.1016/j.arth.2011.09.022

    Article  PubMed  Google Scholar 

  9. Winter RB, Pinto WC (1986) Pelvic obliquity. Its causes and its treatment. Spine (Phila Pa 1976) 11:225–234

    Article  CAS  Google Scholar 

  10. Lee DY, Choi IH, Chung CY, Cho TJ, Lee JC (1997) Fixed pelvic obliquity after poliomyelitis: classification and management. J Bone Joint Surg Br 79:190–196. https://doi.org/10.1302/0301-620x.79b2.7052

    Article  CAS  PubMed  Google Scholar 

  11. Maloney WJ, Rinsky LA, Gamble JG (1990) Simultaneous correction of pelvic obliquity, frontal plane, and sagittal plane deformities in neuromuscular scoliosis using a unit rod with segmental sublaminar wires: a preliminary report. J Pediatr Orthop 10:742–749

    Article  CAS  PubMed  Google Scholar 

  12. Osebold WR, Mayfield JK, Winter R, Moe J (1982) Surgical treatment of paralytic scoliosis associated with myelomeningocele. J Bone Joint Surg Am 64:841–856

    Article  CAS  PubMed  Google Scholar 

  13. Allen B Jr, Ferguson R (1984) The Galveston technique of pelvic fixation with L-rod instrumentation of the spine. Spine 9:388–394

    Article  PubMed  Google Scholar 

  14. Lindseth R (1978) Posterior iliac osteotomy for fixed pelvic obliquity. J Bone Joint Surg Am 60:17–22

    Article  CAS  PubMed  Google Scholar 

  15. O’Brien M, Kuklo T, Blanke K, Lenke L (2008) Spinal deformity study group radiographic measurement manual. Medtronic Sofamor Danek USA. Inc: Memphis, TN, USA. https://www.oref.org/docs/default-source/default-document-library/sdsg-radiographic-measuremnt-manual.pdf

  16. Shrader MW, Andrisevic EM, Belthur MV, White GR, Boan C, Wood W (2018) Inter- and intraobserver reliability of pelvic obliquity measurement methods in patients with cerebral palsy. Spine Deformity 6:257–262. https://doi.org/10.1016/j.jspd.2017.10.001

    Article  PubMed  Google Scholar 

  17. Hägglund G, Goldring M, Hermanson M, Rodby-Bousquet E (2018) Pelvic obliquity and measurement of hip displacement in children with cerebral palsy. Acta Orthop 89:652–655. https://doi.org/10.1080/17453674.2018.1519104

    Article  PubMed  PubMed Central  Google Scholar 

  18. Zhang Y, Cheng T, Zhang XL (2015) Changes in intra-pelvic obliquity angle 0–2 years after total hip arthroplasty and its effects on leg length discrepancy: a retrospective study. Chin Med J (Engl) 128:1346–1350. https://doi.org/10.4103/0366-6999.156780

    Article  Google Scholar 

  19. Zhou X, Wang Q, Zhang X, Chen Y, Peng X, Mao Y, Yang Y, Fu B, Wang X, Tang T (2015) Severe pelvic obliquity affects femoral offset in patients with total hip arthroplasty but not leg-length inequality. PLoS ONE 10:e0144863–e0144863. https://doi.org/10.1371/journal.pone.0144863

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Moazen Jamshidi MM, Moharrami A, Mirghaderi SP, Sharifpour S, Mafi AR, Mortazavi SJ (2022) The role of spinopelvic parameters in total hip arthroplasty: a current concept review. J Orthop Spine Trauma 8(2):40–43. https://doi.org/10.18502/jost.v8i2.9308

  21. Grammatopoulos G, Pandit HG, da Assunção R, Taylor A, McLardy-Smith P, De Smet KA, Murray DW, Gill HS (2014) Pelvic position and movement during hip replacement. Bone Joint J 96-b:876–883. https://doi.org/10.1302/0301-620x.96b7.32107

    Article  CAS  PubMed  Google Scholar 

  22. Wu P, Fu M, Mao Y, Kang Y, Yang Z, Fang S, Liao W (2011) Effect of femoral offset reconstruction on pelvic stability during gait after total hip arthroplasty. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 25:513–516

    PubMed  Google Scholar 

  23. Lakshmanan P, Ahmed SM, Hansford RG, Woodnutt DJ (2008) Achieving the required medial offset and limb length in total hip arthroplasty. Acta Orthop Belg 74:49–53

    PubMed  Google Scholar 

  24. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2014) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg 12:1495–1499. https://doi.org/10.1016/j.ijsu.2014.07.013

    Article  Google Scholar 

  25. Mirghaderi SP, Sharifpour S, Moharrami A, Ahmadi N, Makuku R, Salimi M, Mortazavi SMJ (2022) Determining the accuracy of preoperative total hip replacement 2D templating using the mediCAD® software. J Orthop Surg Res 17:222. https://doi.org/10.1186/s13018-022-03086-5

    Article  PubMed  PubMed Central  Google Scholar 

  26. Osebold WR, Mayfield JK, Winter RB, Moe JH (1982) Surgical treatment of paralytic scoliosis associated with myelomeningocele. J Bone Joint Surg Am 64:841–856

    Article  CAS  PubMed  Google Scholar 

  27. Tani T, Ando W, Hamada H, Takao M, Sugano N (2021) Hip subluxation and osteophye morphology are related to coronal contracture of the hip. J Orthop Res 39:1691–1699. https://doi.org/10.1002/jor.24891

    Article  PubMed  Google Scholar 

  28. Kechagias VA, Grivas TB, Papagelopoulos PJ, Kontogeorgakos VA, Vlasis K (2019) Truncal changes in patients after total hip or knee arthroplasty: a surface topography study. Cureus 11:e4260. https://doi.org/10.7759/cureus.4260

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gomez PF, Morcuende JA (2005) Early attempts at hip arthroplasty: 1700s to 1950s. Iowa Orthop J 25:25

    PubMed  PubMed Central  Google Scholar 

  30. Xt S, Cf Li, Han Y, Song Y, Sx Li, Jg L (2019) Total hip arthroplasty for Crowe type IV hip dysplasia: surgical techniques and postoperative complications. Orthop Surg 11:966–973

    Article  Google Scholar 

  31. Alnahhal A, Aslam-Pervez N, Sheikh HQ (2019) Templating hip arthroplasty. Open Access Maced J Med Sci 7:672

    Article  PubMed  PubMed Central  Google Scholar 

  32. Schmidutz F, Steinbrück A, Wanke-Jellinek L, Pietschmann M, Jansson V, Fottner A (2012) The accuracy of digital templating: a comparison of short-stem total hip arthroplasty and conventional total hip arthroplasty. Int Orthop 36:1767–1772

    Article  PubMed  PubMed Central  Google Scholar 

  33. Della Valle AG, Slullitel G, Piccaluga F, Salvati EA (2005) The precision and usefulness of preoperative planning for cemented and hybrid primary total hip arthroplasty. J Arthroplasty 20:51–58

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Alireza Moharrami and Seyed Peyman Mirghaderi contributed equally to this work (co-first authors).

Authors and Affiliations

  1. Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Alireza Moharrami, Seyed Peyman Mirghaderi, Nima Hoseini-Zare & Ahmed Kareem Mansour

  2. Knee Surgery Fellowship, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Hasan Kaseb

  3. Fellowship of Hip and Pelvic Surgery, Zanjan University of Medical Science, Zanjan, Iran

    Seyed Mir Mansour Moazen-Jamshidi

  4. Joint Reconstruction Research Center, End of Keshavarz Blvd, Imam Khomeini Hospital, Tehran University of Medical Science, Keshavarz Blvd, Tehran, Iran

    Seyed Mohammad Javad Mortazavi

Authors
  1. Alireza Moharrami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seyed Peyman Mirghaderi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nima Hoseini-Zare
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammad Hasan Kaseb
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seyed Mir Mansour Moazen-Jamshidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ahmed Kareem Mansour
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seyed Mohammad Javad Mortazavi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

A.Moharrami, SP.Mirghaderi, and SMJ.Mortazavi contributed to the study’s conception and design. Material preparation and data collection were performed by N. Hoseini-Zare, A. Kareem Mansour, and SMM.Moazen-Jamshidi. Data were analyzed by SP.Mirghaderi. The first draft of the manuscript was written by SP.Mirghaderi. SMJ.Mortazavi, MH. Kaseb, and A. Moharrami edited the draft and revised it. All the authors commented on previous versions of the manuscript and revised it. All the authors read and approved the final manuscript. A.Moharrami and SP.Mirghaderi contributed equally to this work.

Corresponding author

Correspondence to Seyed Mohammad Javad Mortazavi.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards (Ethic committee code: IR.TUMS.IKHC.REC.1400.508).

Consent to participate

Not applicable.

Consent to publish

Not applicable.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Level of evidence: Prognostic Level 3.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moharrami, A., Mirghaderi, S.P., Hoseini-Zare, N. et al. Restoring femoral medial offset could reduce pelvic obliquity following primary total hip arthroplasty, an observational study. International Orthopaedics (SICOT) 46, 2765–2774 (2022). https://doi.org/10.1007/s00264-022-05506-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-022-05506-x

Keywords

Search

Navigation