Abstract
Introduction
While numerous classifications of hip arthritis have been proposed, none considered the magnitude and direction of femoral head translation relative to the native acetabulum. A more precise classification of architectural hip deformities is necessary to improve preoperative templating and anticipate surgical challenges of total hip arthroplasty (THA). The purpose of the present study was to introduce a classification system to distinguish different types of architectural hip deformities, based on femoral head translation patterns, and to evaluate its repeatability using plain radiographs (qualitative) and Computed Tomography (CT) measurements (quantitative).
Materials and methods
We studied pre-operative frontal and lateral hip radiographs and CT scans of 191 hips (184 patients) that received primary THA. The distance between the femoral head center (FC) and the acetabular center (AC) was measured, as well as femoral offset, acetabular offset, head center height, acetabular floor distance and femoral neck angle. The hips were classified qualitatively using frontal plain radiographs, and then quantitatively using CT scans (with an arbitrary threshold of 3 mm as Centered, Medialized, Lateralized, Proximalized or Proximo-lateralized. The agreement between qualitative and quantitative classification methods was compared for applying the same classification.
Results
Qualitative classification identified 120 centered (63%), 8 medialized (4%), 49 lateralized (26%), 3 proximalized (2%), and 11 proximo-lateralized (6%) hips, while quantitative classification identified 116 centered (61%), 8 medialized (4%), 51 lateralized (27%), 5 proximalized (3%), and 11 proximo-lateralized (6%) hips. The agreement between the two methods was excellent (0.94; CI 0.90–0.98). Medialization reached 9.7 mm, while lateralization reached 10.9 mm, and proximalization reached 8.5 mm. Proximalized and proximo-lateralized hips had more valgus necks, while medialized hips had more varus necks (p = 0.003).
Conclusions
The classification system enabled repeatable distinction of 5 types of architectural hip deformities. The excellent agreement between quantitative and qualitative methods suggests that plain radiographs are sufficient to classify architectural hip deformities.
Similar content being viewed by others
References
Berry DJ, Harmsen WS, Cabanela ME, Morrey BF (2002) Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements: factors affecting survivorship of acetabular and femoral components. J Bone Joint Surg Am 84-A(2):171–177
Jacquot L, Bonnin MP, Machenaud A, Chouteau J, Saffarini M, Vidalain JP (2017) Clinical and radiographic outcomes at 25–30 years of a hip stem fully coated with hydroxylapatite. J Arthroplasty. https://doi.org/10.1016/j.arth.2017.09.040
Geesink RG, Hoefnagels NH (1995) Six-year results of hydroxyapatite-coated total hip replacement. J Bone Joint Surg Br 77(4):534–547
McKellop H, Shen FW, Lu B, Campbell P, Salovey R (1999) Development of an extremely wear-resistant ultra high molecular weight polyethylene for total hip replacements. J Orthop Res 17(2):157–167. https://doi.org/10.1002/jor.1100170203
Bourne RB, Chesworth B, Davis A, Mahomed N, Charron K (2010) Comparing patient outcomes after THA and TKA: is there a difference? Clin Orthop Relat Res 468(2):542–546. https://doi.org/10.1007/s11999-009-1046-9
Tang H, Du H, Tang Q, Yang D, Shao H, Zhou Y (2014) Chinese patients’ satisfaction with total hip arthroplasty: what is important and dissatisfactory? J Arthroplasty 29(12):2245–2250. https://doi.org/10.1016/j.arth.2013.12.032
Parvizi J, Sharkey PF, Bissett GA, Rothman RH, Hozack WJ (2003) Surgical treatment of limb-length discrepancy following total hip arthroplasty. J Bone Joint Surg Am 85(12):2310–2317
Wylde V, Whitehouse SL, Taylor AH, Pattison GT, Bannister GC, Blom AW (2009) Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement. Int Orthop 33(4):905–909. https://doi.org/10.1007/s00264-008-0563-6
Bjarnason JA, Reikeras O (2015) Changes of center of rotation and femoral offset in total hip arthroplasty. Ann Transl Med 3(22):355. https://doi.org/10.3978/j.issn.2305-5839.2015.12.37
Bourne RB, Rorabeck CH (2002) Soft tissue balancing: the hip. J Arthroplasty 17(4 Suppl 1):17–22
Della Valle AG, Padgett DE, Salvati EA (2005) Preoperative planning for primary total hip arthroplasty. J Am Acad Orthop Surg 13(7):455–462
Gonzalez Della Valle A, 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(1):51–58. https://doi.org/10.1016/j.arth.2004.04.016
Sariali E, Mouttet A, Pasquier G, Durante E, Catone Y (2009) Accuracy of reconstruction of the hip using computerised three-dimensional pre-operative planning and a cementless modular neck. J Bone Joint Surg Br 91(3):333–340. https://doi.org/10.1302/0301-620X.91B3.21390
Brumat P, Pompe B, Antolic V, Mavcic B (2018) The impact of canal flare index on leg length discrepancy after total hip arthroplasty. Arch Orthop Trauma Surg 138(1):123–129. https://doi.org/10.1007/s00402-017-2840-6
Holzer LA, Scholler G, Wagner S, Friesenbichler J, Maurer-Ertl W, Leithner A (2019) The accuracy of digital templating in uncemented total hip arthroplasty. Arch Orthop Trauma Surg 139(2):263–268. https://doi.org/10.1007/s00402-018-3080-0
Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466(2):264–272. https://doi.org/10.1007/s11999-007-0060-z
Hamilton HW, Jamieson J (2012) The classification of degenerative hip disease. J Bone Joint Surg Br 94(9):1193–1201. https://doi.org/10.1302/0301-620X.94B9.28964
Wroblewski BM, Charnley J (1982) Radiographic morphology of the osteoarthritic hip. J Bone Joint Surg Br 64(5):568–569
Liu R, Li Y, Bai C, Song Q, Wang K (2014) Effect of preoperative limb-length discrepancy on abductor strength after total hip arthroplasty in patients with developmental dysplasia of the hip. Arch Orthop Trauma Surg 134(1):113–119. https://doi.org/10.1007/s00402-013-1899-y
Charles MN, Bourne RB, Davey JR, Greenwald AS, Morrey BF, Rorabeck CH (2005) Soft-tissue balancing of the hip: the role of femoral offset restoration. Instr Course Lect 54:131–141
Fottner A, Woiczinski M, Kistler M, Schroder C, Schmidutz TF, Jansson V, Schmidutz F (2017) Influence of undersized cementless hip stems on primary stability and strain distribution. Arch Orthop Trauma Surg 137(10):1435–1441. https://doi.org/10.1007/s00402-017-2784-x
Bonnin MP, Neto CC, Aitsiselmi T, Murphy CG, Bossard N, Roche S (2015) Increased incidence of femoral fractures in small femurs and women undergoing uncemented total hip arthroplasty—why? Bone Joint J 97-B(6):741–748. https://doi.org/10.1302/0301-620x.97b6.35022
Bonnin MP, Archbold PH, Basiglini L, Fessy MH, Beverland DE (2012) Do we medialise the hip centre of rotation in total hip arthroplasty? Influence of acetabular offset and surgical technique. Hip Int 22(4):371–378. https://doi.org/10.5301/HIP.2012.9350
Durand-Hill M, Henckel J, Satchithananda K, Sabah S, Hua J, Hothi H, Langstaff RJ, Skinner J, Hart A (2016) Calculating the hip center of rotation using contralateral pelvic anatomy. J Orthop Res 34(6):1077–1083. https://doi.org/10.1002/jor.23118
Ehrig RM, Taylor WR, Duda GN, Heller MO (2006) A survey of formal methods for determining the centre of rotation of ball joints. J Biomech 39(15):2798–2809. https://doi.org/10.1016/j.jbiomech.2005.10.002
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):210–219. https://doi.org/10.1016/j.otsr.2009.03.010
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174
Cicchetti D (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6(4):284–290
Takao M, Nishii T, Sakai T, Sugano N (2016) Postoperative limb-offset discrepancy notably affects soft-tissue tension in total hip arthroplasty. J Bone Joint Surg Am 98(18):1548–1554. https://doi.org/10.2106/JBJS.15.01073
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):2895–2900. https://doi.org/10.1007/s11999-009-0845-3
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 388:125–134
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):414–420. https://doi.org/10.1016/j.arth.2004.01.016
Rudiger HA, Guillemin M, Latypova A, Terrier A (2017) Effect of changes of femoral offset on abductor and joint reaction forces in total hip arthroplasty. Arch Orthop Trauma Surg 137(11):1579–1585. https://doi.org/10.1007/s00402-017-2788-6
Flecher X, Ollivier M, Argenson JN (2016) Lower limb length and offset in total hip arthroplasty. Orthop Traumatol Surg Res 102(1 Suppl):S9–S20. https://doi.org/10.1016/j.otsr.2015.11.001
Bonnin MP, Archbold PH, Basiglini L, Selmi TA, Beverland DE (2011) Should the acetabular cup be medialised in total hip arthroplasty. Hip Int 21(4):428–435. https://doi.org/10.5301/HIP.2011.8582
Magill P, Blaney J, Hill JC, Bonnin MP, Beverland DE (2016) Impact of a learning curve on the survivorship of 4802 cementless total hip arthroplasties. Bone Joint J 98-B(12):1589–1596. https://doi.org/10.1302/0301-620x.98b12.bjj-2016-0203.r1
Liebs TR, Nasser L, Herzberg W, Ruther W, Hassenpflug J (2014) The influence of femoral offset on health-related quality of life after total hip replacement. Bone Joint J 96-B(1):36–42. https://doi.org/10.1302/0301-620x.96b1.31530
Weber M, Woerner M, Springorum R, Sendtner E, Hapfelmeier A, Grifka J, Renkawitz T (2014) Fluoroscopy and imageless navigation enable an equivalent reconstruction of leg length and global and femoral offset in THA. Clin Orthop Relat Res 472(10):3150–3158. https://doi.org/10.1007/s11999-014-3740-5
Kubo Y, Motomura G, Ikemura S, Sonoda K, Yamamoto T, Nakashima Y (2017) Effect of collapse on the deformity of the femoral head-neck junction in osteonecrosis of the femoral head. Arch Orthop Trauma Surg 137(7):933–938. https://doi.org/10.1007/s00402-017-2720-0
Cassidy KA, Noticewala MS, Macaulay W, Lee JH, Geller JA (2012) Effect of femoral offset on pain and function after total hip arthroplasty. J Arthroplasty 27(10):1863–1869. https://doi.org/10.1016/j.arth.2012.05.001
Dastane M, Dorr LD, Tarwala R, Wan Z (2011) Hip offset in total hip arthroplasty: quantitative measurement with navigation. Clin Orthop Relat Res 469(2):429–436. https://doi.org/10.1007/s11999-010-1554-7
Mahmood SS, Mukka SS, Crnalic S, Wretenberg P, Sayed-Noor AS (2016) Association between changes in global femoral offset after total hip arthroplasty and function, quality of life, and abductor muscle strength. A prospective cohort study of 222 patients. Acta Orthop 87(1):36–41. https://doi.org/10.3109/17453674.2015.1091955
Meermans G, Doorn JV, Kats JJ (2016) Restoration of the centre of rotation in primary total hip arthroplasty: the influence of acetabular floor depth and reaming technique. Bone Joint J 98-B(12):1597–1603. https://doi.org/10.1302/0301-620x.98b12.bjj-2016-0345.r1
Kurtz WB, Ecker TM, Reichmann WM, Murphy SB (2010) Factors affecting bony impingement in hip arthroplasty. J Arthroplasty 25(4):624–634. https://doi.org/10.1016/j.arth.2009.03.024(e621–622)
Baghdadi YM, Larson AN, Sierra RJ (2013) Restoration of the hip center during THA performed for protrusio acetabuli is associated with better implant survival. Clin Orthop Relat Res 471(10):3251–3259. https://doi.org/10.1007/s11999-013-3072-x
Sariali E, Klouche S, Mouttet A, Pascal-Moussellard H (2014) The effect of femoral offset modification on gait after total hip arthroplasty. Acta Orthop 85(2):123–127. https://doi.org/10.3109/17453674.2014.889980
Lazennec JY, Folinais D, Florequin C, Pour AE (2017) Does patients’ perception of leg length after total hip arthroplasty correlate with anatomical leg length? J Arthroplasty. https://doi.org/10.1016/j.arth.2017.12.004
Karimi D, Kallemose T, Troelsen A, Klit J (2018) Hip malformation is a very common finding in young patients scheduled for total hip arthroplasty. Arch Orthop Trauma Surg 138(4):581–589. https://doi.org/10.1007/s00402-018-2900-6
Verbeek DO, van der List JP, Helfet DL (2019) Computed tomography versus plain radiography assessment of acetabular fracture reduction is more predictive for native hip survivorship. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-019-03192-w
Huppertz A, Radmer S, Asbach P, Juran R, Schwenke C, Diederichs G, Hamm B, Sparmann M (2011) Computed tomography for preoperative planning in minimal-invasive total hip arthroplasty: radiation exposure and cost analysis. Eur J Radiol 78(3):406–413. https://doi.org/10.1016/j.ejrad.2009.11.024
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):40–46
Wegner A, Kauther MD, Landgraeber S, von Knoch M (2012) Fixation method does not affect restoration of rotation center in hip replacements: a single-site retrospective study. J Orthop Surg Res 7:25. https://doi.org/10.1186/1749-799X-7-25
Patel S, Thakrar RR, Bhamra J, Hossain F, Tengrootenhuysen M, Haddad FS (2011) Are leg length and hip offset comparable after hip resurfacing and cementless total hip arthroplasty? Ann R Coll Surg Engl 93(6):465–469. https://doi.org/10.1308/003588411X586731
Parry MC, Povey J, Blom AW, Whitehouse MR (2015) Comparison of acetabular bone resection, offset, leg length and post operative function between hip resurfacing arthroplasty and total hip arthroplasty. J Arthroplasty 30(10):1799–1803. https://doi.org/10.1016/j.arth.2015.04.030
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):163–166
Kanawade V, Dorr LD, Banks SA, Zhang Z, Wan Z (2015) Precision of robotic guided instrumentation for acetabular component positioning. J Arthroplasty 30(3):392–397. https://doi.org/10.1016/j.arth.2014.10.021
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):721–726. https://doi.org/10.1302/0301-620X.88B6.17447
De Thomasson E, Mazel C, Guingand O, Terracher R (2002) Value of preoperative planning in total hip arthroplasty. Rev Chir Orthop Reparatrice Appar Mot 88(3):229–235
Ahmad R, Gillespie G, Annamalai S, Barakat MJ, Ahmed SM, Smith LK, Spencer RF (2009) Leg length and offset following hip resurfacing and hip replacement. Hip Int 19(2):136–140
Waldstein W, Merle C, Schmidt-Braekling T, Boettner F (2014) Does stem design influence component positioning in total hip arthroplasty using a minimal invasive posterolateral approach? Int Orthop 38(7):1347–1352. https://doi.org/10.1007/s00264-014-2299-9
Dolhain P, Tsigaras H, Bourne RB, Rorabeck CH, Mac Donald S, Mc Calden R (2002) The effectiveness of dual offset stems in restoring offset during total hip replacement. Acta Orthop Belg 68(5):490–499
Acknowledgements
The authors are grateful to the Research and Education Department of Ramsay Santé for their financial support with statistical analysis and manuscript preparation and to Mr. Mo Saffarini for his assistance with manuscript writing and illustrations.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Authors MK, PFOL, JL and HB declare that they have no conflict of interest. TASS receives royalties and or consulting fees from DePuy-Synthes, Symbios, and Corin-Tornier. MPB receives royalties and or consulting fees from DePuy-Synthes, Symbios, Corin-Tornier, Wright-Tornier, and Integra.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board (IRB) who approved this study in advance (COS-RGDS-2019-05-003-BONNIN-M) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kase, M., O’Loughlin, P.F., Aït-Si-Selmi, T. et al. Pre-operative templating in THA. Part I: a classification of architectural hip deformities. Arch Orthop Trauma Surg 140, 129–137 (2020). https://doi.org/10.1007/s00402-019-03298-1
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-019-03298-1