Preoperative digital planning versus postoperative outcomes in total hip arthroplasty using a calcar-guided short stem: frequent valgization can be avoided

  • Karl Philipp KutznerEmail author
  • Joachim Pfeil
  • Mark Predrag Kovacevic
Original Article • HIP - ARTHROPLASTY



Modern total hip arthroplasty is largely dependent on the successful preservation of hip geometry. Thus, a successful implementation of the preoperative planning is of great importance. The present study evaluates the accuracy of anatomic hip reconstruction predicted by 2D digital planning using a calcar-guided short stem of the newest generation.


A calcar-guided short stem was implanted in 109 patients in combination with a cementless cup using the modified anterolateral approach. Preoperative digital planning was performed including implant size, caput–collum–diaphyseal angle, offset, and leg length using mediCAD II software. A coordinate system and individual scale factors were implemented. Postoperative outcome was evaluated accordingly and was compared to the planning.


Intraoperatively used stem sizes were within one unit of the planned stem sizes. The postoperative stem alignment showed a minor and insignificant (p = 0.159) mean valgization of 0.5° (SD 3.79°) compared to the planned caput–collum–diaphyseal angles. Compared to the planning, mean femoral offset gained 2.18 (SD 4.24) mm, while acetabular offset was reduced by 0.78 (SD 4.36) mm during implantation resulting in an increased global offset of 1.40 (SD 5.51) mm (p = 0.0094). Postoperative femoroacetabular height increased by a mean of 5.00 (SD 5.98) mm (p < 0.0001) compared to preoperative measures.


Two-dimensional digital preoperative planning in calcar-guided short-stem total hip arthroplasty assures a satisfying implementation of the intended anatomy. Valgization, which has been frequently observed in previous short-stem designs, negatively affecting offset, can be avoided. However, surgeons have to be aware of a possible leg lengthening.


Total hip arthroplasty Short stem Stem alignment Offset Valgization Digital planning Optimys 



We thank Dominik Pfluger (numeric data GmbH) for supporting statistical analysis.

Compliance with ethical standards

Conflict of interest

JP has received and may further receive payments or benefits from Mathys Ltd., Switzerland. KPK and MPK certify that they have no conflict of interest (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements) in connection with this article.


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Copyright information

© Springer-Verlag France 2017

Authors and Affiliations

  • Karl Philipp Kutzner
    • 1
    Email author
  • Joachim Pfeil
    • 1
  • Mark Predrag Kovacevic
    • 2
  1. 1.Department for Orthopaedic Surgery and TraumatologySt. Josefs Hospital WiesbadenWiesbadenGermany
  2. 2.Clinic for Traumatology, Hand- and Orthopaedic SurgeryHELIOS Dr. Horst Schmidt Clinics WiesbadenWiesbadenGermany

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