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Extended offset stems are infrequently required in anterior approach total hip arthroplasty and low usage does not compromise stability

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Extended offset (EO) stems are commonly used in posterior approach (PA) total hip arthroplasty (THA), but usage rates and complications are not well studied with anterior approach (AA) THA. This study evaluated usage rates, radiographic outcomes and complications following AA THA between patients receiving EO stems and a matched cohort receiving standard offset (SO) stems.

Materials and methods

This retrospective review evaluated 1515 consecutive AA THA performed between 2014 and 2021. The recent 100 EO were included in radiographic and complication analysis and were matched to 100 SO stems based on stem size, procedure (unilateral/bilateral), sex, body mass index (BMI), and age. Data collection included patient demographics; pre- and postoperative radiographic measurements of leg length difference (LLD) and global hip offset difference (GHOD); and complications within 1 year. Independent t-tests and Chi-squared analyses compared EO and SO groups.

Results

EO was utilized in 8% of all AA THA. Despite matching procedures, the distribution of racial groups was different between EO and SO groups, respectively: Caucasian (75% vs. 43%), Asian (12% vs. 35%), Native Hawaiian/Pacific Islander (NHPI) (9% vs. 13%), and other (4% vs. 9%) (p < 0.001). No fractures, dislocations, or revisions occurred within 1 year after surgery in either group. One deep infection was noted in the SO group. The proportions of patients following surgery who had a GHOD < 6 mm (76% vs. 82%; p = 0.193) and LLD < 6 mm (81% vs. 86%; p = 0.223) were not significantly different between EO and SO groups, respectively.

Conclusions

Prioritizing hip symmetry over stability results in a high proportion of patients achieving hip symmetry without high usage of EO stems in AA THA. Furthermore, low use of EO stems did not result in increased dislocations. Due to racial anatomical differences, Caucasian patients required EO stems to achieve hip symmetry more frequently than Asian and NHPI patients.

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Data availability

Data associated with this study is kept in a data repository and can be accessed for appropriate inquiries.

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Acknowledgements

The authors would like to thank Samantha N. Andrews PhD, ATC, for her contributions regarding statistical analysis and help with student mentoring and manuscript preparation.

Funding

This research received no specific grant from any funding agency in the public, commercial or non-for-profit sectors.

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Authors and Affiliations

  1. John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA

    Edward Weldon, Keinan Agonias, James DeJesus & Cass K. Nakasone

  2. Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA

    Donna Lyn M. T. Au & Cass K. Nakasone

  3. University of Hawaii at Manoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, 96822, USA

    Rosana Hernandez Weldon

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  1. Edward Weldon
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Contributions

Conceptualization: Cass K. Nakasone. Methodology: Cass K. Nakasone. Formal statistical analysis: Samantha Andrews. Writing—original draft preparation: Edward Weldon, Keinan Agonias, James DeJesus. Writing—reviewing and editing: Edward Weldon, Keinan Agonias, James DeJesus, Rosana Hernandez Weldon, Donna Lyn Au, Cass K. Nakasone. Supervision—Cass K. Nakasone, Donna Lyn Au. Project administration—Donna Lyn Au, Cass K. Nakasone.

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Correspondence to Cass K. Nakasone.

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Conflict of interest

Author Cass K. Nakasone is a consultant and receives royalties from Ortho Development Inc. but not related to the subject matter discussed in this manuscript. All other authors certify that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Hawaii Pacific Health Research Institute (local Western Institutional Review Board) approved this study.

Informed consent

This was a retrospective chart review and data collected were deidentified and presented as large scale, aggregate data. Therefore, no informed consent was obtained or required by the IRB.

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Weldon, E., Agonias, K., DeJesus, J. et al. Extended offset stems are infrequently required in anterior approach total hip arthroplasty and low usage does not compromise stability. Arch Orthop Trauma Surg 144, 2365–2372 (2024). https://doi.org/10.1007/s00402-024-05239-z

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