Skip to main content

Advertisement

SpringerLink
Log in

Biomechanical reconstruction of the hip: comparison between modular short-stem hip arthroplasty and conventional total hip arthroplasty

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

Abstract

Purpose

Short-stem hip arthroplasty preserves femoral bone stock which includes the femoral neck. This implies that the stem has to follow the anatomy of the femoral neck. Therefore, it has been questioned whether biomechanical reconstruction of the hip can be safely achieved with SHA.

Methods

Biomechanical reconstruction of the hip was analysed for 50 modular short-stem hip arthroplasties (SHA) and compared to 50 conventional total hip arthroplasties (THA). Biomechanical parameters were analysed on pre- and postoperative pelvic overviews and compared to those of the contralateral side.

Results

The position of the acetabular cup (vertical and horizontal hip centre of rotation) changed slightly and was comparable for both groups. Horizontal femoral offset increased more in SHA (6.2 mm) than in THA (2.0 mm). Compared to the contralateral side it was significantly greater after SHA (+3.6 mm) but almost balanced after THA (−0.2 mm). Limb length increased with both procedures (8.0 mm SHA, 9.1 mm THA), but showed a significantly greater discrepancy after SHA (3.3 mm) as compared to THA (1.3 mm). According to the different implant designs, the stem-shaft axis showed a wider varus-valgus range for SHA (6.2° varus to 8.8° valgus) than for THA (2.6° varus to 3.3° valgus).

Conclusion

Horizontal femoral offset increased more with modular SHA than with conventional THA, but was within a beneficial range. Restoration of limb length appears more difficult in SHA and has a tendency to prolong limb length, which is probably related to the higher femoral resection level. This should be taken into consideration when considering SHA for a patient as well as during implantation.

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

Similar content being viewed by others

References

  1. Kiyama T, Naito M, Shinoda T, Maeyama A (2010) Hip abductor strengths after total hip arthroplasty via the lateral and posterolateral approaches. J Arthroplasty 25(1):76–80

    Article  PubMed  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. McGrory BJ, Morrey BF, Cahalan TD, An KN, Cabanela ME (1995) Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg Br 77(6):865–869

    PubMed  CAS  Google Scholar 

  4. Erceg M (2009) The influence of femoral head shift on hip biomechanics: additional parameters accounted. Int Orthop 33(1):95–100

    Article  PubMed  Google Scholar 

  5. Bourne RB, Rorabeck CH (2002) Soft tissue balancing: the hip. J Arthroplasty 17(4 Suppl 1):17–22

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  CAS  Google Scholar 

  8. Briem D, Schneider M, Bogner N, Botha N, Gebauer M, Gehrke T, Schwantes B (2011) Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis. Int Orthop 35(5):655–660

    Article  PubMed  Google Scholar 

  9. Lerch M, von der Har-Tran A, Windhagen H, Behrens BA, Wefstaedt P, Stukenborg-Colsman CM (2011) Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study. Int Orthop. Sep 21 [Epub ahead of print]

  10. Kim YH, Kim JS, Park JW, Joo JH (2011) Total hip replacement with a short metaphyseal-fitting anatomical cementless femoral component in patients aged 70 years or older. J Bone Joint Surg Br 93(5):587–592

    Article  PubMed  Google Scholar 

  11. Morrey BF, Adams RA, Kessler M (2000) A conservative femoral replacement for total hip arthroplasty. A prospective study. J Bone Joint Surg Br 82(7):952–958

    Article  PubMed  CAS  Google Scholar 

  12. Jerosch J, Grasselli C, Kothny PC, Litzkow D, Hennecke T (2011) Reproduction of the anatomy (offset, CCD, leg length) with a modern short stem hip design—a radiological study. Z Orthop Unfall. Apr 12 [Epub ahead of print]

  13. Confalonieri N, Manzotti A, Montironi F, Pullen C (2008) Leg length discrepancy, dislocation rate, and offset in total hip replacement using a short modular stem: navigation vs conventional freehand. Orthopedics 31(10 Suppl 1)

  14. 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

    PubMed  Google Scholar 

  15. Traina F, De Fine M, Tassinari E, Sudanese A, Calderoni PP, Toni A (2011) Modular neck prostheses in DDH patients: 11-year results. J Orthop Sci 16(1):14–20

    Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. Yamaguchi T, Naito M, Asayama I, Ishiko T (2004) Total hip arthroplasty: the relationship between posterolateral reconstruction, abductor muscle strength, and femoral offset. J Orthop Surg (Hong Kong) 12(2):164–167

    CAS  Google Scholar 

  18. Bicanic G, Delimar D, Delimar M, Pecina M (2009) Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop 33(2):397–402

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  CAS  Google Scholar 

  20. 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

    Article  PubMed  CAS  Google Scholar 

  21. Kamada S, Naito M, Nakamura Y, Kiyama T (2011) Hip abductor muscle strength after total hip arthroplasty with short stems. Arch Orthop Trauma Surg 131(12):1723–1729

    Google Scholar 

  22. Massin P, Geais L, Astoin E, Simondi M, Lavaste F (2000) The anatomic basis for the concept of lateralized femoral stems: a frontal plane radiographic study of the proximal femur. J Arthroplasty 15(1):93–101

    Article  PubMed  CAS  Google Scholar 

  23. Thien TM, Karrholm J (2010) Design-related risk factors for revision of primary cemented stems. Acta Orthop 81(4):407–412

    Article  PubMed  Google Scholar 

  24. Lazovic D, Dunai F, Zigan R (2010) The impact of navigation on a modular short stem prosthesis. J Bone Joint Surg (Proceedings) 92-B (SUPP_IV):523–552 d

  25. Traina F, De Clerico M, Biondi F, Pilla F, Tassinari E, Toni A (2009) Sex differences in hip morphology: is stem modularity effective for total hip replacement? J Bone Joint Surg Am 91(Suppl 6):121–128

    Article  PubMed  Google Scholar 

  26. Traina F, De FM, Biondi F, Tassinari E, Galvani A, Toni A (2009) The influence of the centre of rotation on implant survival using a modular stem hip prosthesis. Int Orthop 33(6):1513–1518

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

The first author gratefully thanks Nora Goudsouzian for the careful proofreading of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany

    Florian Schmidutz, Patrick Weber, Farhad Mazoochian, Andreas Fottner & Volkmar Jansson

  2. Department of Trauma Surgery, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany

    Marc Beirer

Authors
  1. Florian Schmidutz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc Beirer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Farhad Mazoochian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas Fottner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Volkmar Jansson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Florian Schmidutz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schmidutz, F., Beirer, M., Weber, P. et al. Biomechanical reconstruction of the hip: comparison between modular short-stem hip arthroplasty and conventional total hip arthroplasty. International Orthopaedics (SICOT) 36, 1341–1347 (2012). https://doi.org/10.1007/s00264-011-1477-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-011-1477-2

Keywords

Search

Navigation