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Coxa valga and antetorta configuration leads to underestimation of the femoral component size: a matched case-control study of patients undergoing cementless total hip arthroplasty

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

Abstract

Background

Total hip arthroplasty (THA) is the gold standard procedure for patients with end-stage osteoarthritis after failed conservative therapy. Digital templating is commonly employed in preoperative preparation for THA and contributes positively to its outcome. However, the impact of coxa valga and antetorta (CVA) configurations on stem size prediction accuracy remains not reported. Previous studies demonstrated that the size of the lesser trochanter (LT) can be used to determine femoral anteversion on pelvis radiographs. This study investigates the accuracy of preoperative digital templating in predicting stem size in patients with CVA undergoing cementless THA.

Methods

Preoperative radiographs of 620 patients undergoing cementless THA were retrospectively investigated. Radiographs were standardized with patients standing and the leg internally rotated by 15°. A CVA group was established including patients with a CCD angle greater than 140° and a lesser trochanter (LT) size of at least 10 mm for men and 8 mm for women. For the control group, radiographs with a CCD angle ranging from 125–135° and LT size 3–10 mm for men and 3–8 mm for women were selected. Preoperative templating was performed using mediCAD. To reduce confounding factors, case-control matching was carried out for BMI and body height.

Results

After case-control matching, a total of thirty-one matches were analyzed. Stem size was underestimated in 74% (23/31) in the CVA and 13% (4/31) in the control group (p < 0.001). Moreover, patients with CVA were more likely to be underestimated by two sizes compared to controls (p < 0.004). In contrast, the exact stem size was predicted more frequently in the control group (p < 0.001).

Conclusion

Stem size in patients with a CVA configuration are at high risk of being underestimated when using digital templating. These findings can be valuable for guiding in intraoperative decisions and lowering the risk of complications associated with an undersized femoral component.

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Abbreviations

ANOVA:

Analysis of Variance

BMI:

Body Mass Index

CCD:

Centrum Collum Diaphysis

CT:

Computer Tomography

CVA:

Coxa Valga and Antetorta

LT:

Lesser Trochanter

MRI:

Magnetic Resonance Imaging

THA:

Total Hip Arthroplasty

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tabea Hospital, K?sterbergstra?e 32, 22587, Hamburg, Germany

    Conradin Schweizer, Oliver Niggemeyer, Jan-Hauke Jens & Marius Junker

  2. Department of Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Oliver Niggemeyer

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  1. Conradin Schweizer
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Contributions

Conradin Schweizer: Conceptualization, Investigation, data curation, formal analysis, writing—original draft, writing—review & editing Oliver Niggemeyer: writing—review & editing, supervision Jan-Hauke Jens: writing—review & editing Marius Junker: Conceptualization, methodology, investigation, data curation, writing—original draft, writing—review& editing, visualization, project administration. All authors read and approved the final manuscript.

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Correspondence to Marius Junker.

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This study was approved by the local ethics committee (2024-300433-WF).

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Schweizer, C., Niggemeyer, O., Jens, JH. et al. Coxa valga and antetorta configuration leads to underestimation of the femoral component size: a matched case-control study of patients undergoing cementless total hip arthroplasty. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05373-8

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