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European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

07.07.2020 | Original Article

Achievement of optimal implant alignment using taper wedge stems with cup-first THA through the MIS antero-lateral approach

verfasst von: Taishi Okada, Shigeo Fukunishi, Shinichi Yoshiya, Toshiya Tachibana, Yuki Fujihara, Yoshinobu Masumoto, Makoto Kanto, Yu Takeda

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 8/2020

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Abstract

Purpose

Combined anteversion (CA) technique (stem-first procedure) has become generally accepted as an ideal means to achieve optimal CA value in THA. However, we hypothesized that CA technique for patients with various native femoral anteversions could pose a risk of anterior or posterior cup protrusion. In the present study, we examined whether it is possible to use the taper wedge stem to change the stem version to achieve optimal CA while avoiding cup protrusions with the cup-first procedure through minimally invasive (MIS) antero-lateral approach.

Methods

Eighty-one patients underwent cup-first THA with a taper wedge stem. The acetabular cup was placed following the preoperative planning of the cup alignment to avoid anterior cup protrusions using CT-based navigation. Following the CA theory, anteversion of the taper wedge stem was changed to the target anteversion from the patient’s native femoral anteversion. The native femoral anteversion, the change in version angle of the stem, postoperative CA and the length of anterior cup protrusions were evaluated in postoperative CT measurements.

Results

The native femoral anteversion averaged 25.7° ± 8.9° (range 8°–45°). Cases with increased and decreased stem anteversion were observed in 42 hips (51.8%) and 33 hips (40.7%), respectively. The amount of increased and decreased version angles averaged 7.7° ± 4.8° (range 2°–21°) and 7.8° ± 5.1° (range 2°–20°), respectively. Postoperative CA values averaged 36.7° ± 3.4° (range 29.4°–44.2°) and anterior cup protrusion length averaged 2.0 mm ± 2.6 mm (0 ~ 8.8 mm) in axial view and 0.4 mm ± 1.0 mm (0 ~ 3.6 mm) in sagittal view. Anterior cup protrusion of more than 10 mm was not observed in any hips.

Conclusion

This procedure can be considered as an option to achieve optimal CA anteversion while avoiding anterior cup protrusion in THA.

Ranawat CS, Maynard MJ (1991) Modern techniques of cemented total hip arthroplasty. Tech Orthop 6:17–25CrossRef

Jolles BM, Zangger P, Leyvraz PF (2007) Factors predisposing to dislocation after primary total hip arthroplasty. J Arthroplasty 17(3):282–288CrossRef

Amuwa C, Dorr LD (2008) The combined anteversion technique for acetabular component anteversion. J Arthroplasty 23(7):1068–1070CrossRef

Dorr LD, Malik A, Dastane M, Wan Z (2009) Combined anteversion technique for total hip arthroplasty. Clini Ortop Relat Res 467(1):119–127CrossRef

Ueno T, Kabata T, Kajino Y, Inoue D, Ohmori T, Tsuchiya H (2018) Risk factors and cup protrusion thresholds for symptomatic iliopsoas impingement after total hip arthroplasty: a retrospective case-control study. J Arthroplasty 33(10):3288–3296CrossRef

Okada T, Fukunishi S, Takeda Y, Fukui T, Fujihara Y, Okahisa S, Masumoto Y, Yoshiya S (2019) Total hip arthroplasty using stem first technique with navigation: the potential achievement of the optimal combined anteversion being a risk factor for anterior cup protrusion. Eur J Orthop Surg Traumatol 29(4):807–812CrossRef

Trousadale RT, Cabanela ME, Berry DJ (1995) Anterior iliopsas impingent after total hip arthroplasty. J Arthroplasty 10(4):546–549CrossRef

Henderson RA, Lachiewicz PF (2012) Groin pain after replacement of the hip: aetiology, evaluation and treatment. J Bone Joint Surg Br 94(2):145–151CrossRef

Cyteval C, Sarrabere MP, Cottin A, Assi C, Morcos L, Maury P, Taourel P (2003) Iliopsoas impingement on the acetabular component: radiologic and computed tomography findings of a rare hip prosthesis complication in eight cases. J Comput Assist Tomogr 27(2):183–188CrossRef

10.

Lachiewicz PF, Kauk JR (2009) Anterior iliopsoas impingement and tendinitis after total hip arthroplasty. J Am Acad Orthop Surg 17(6):337–344CrossRef

11.

Park KK, Tsai T-Y, Dimitriou D, Kwon Y-M (2016) Three-dimensional in vivo difference between native acetabular version and acetabularcomponent version influences iliopsoas impingement after total hip arthroplasty. Int Orthop 40(9):1807–1812CrossRef

12.

Dora C, Houweling M, Koch P, Sierra RJ (2008) Iliopsoas impingement after total hip replacement. The results of non-operative management, tenotomy or acetebular revision. J Bone Joint Surg Br 89(8):1031–1036CrossRef

13.

Masumoto Y, Fukunishi S, Fukui T, Yoshiya S, Nishio S, Yuki Fujihara Y, Okahisa S, Okada T, Kanto M, Goshi A, Morio F, Takeda Y (2019) New combined anteversion technique in hybrid THA: cup first procedure with CT-based navigation. Eur J Orthop Surg Traumatol. (Online ahead of print)

14.

Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS (1988) The anatomic basis of femoral component design. Clini Orthop Relat Res 235:148–165

15.

Kingsley PC, Olmsted KL (1948) A study to determine the angle of anteversion of the neck of the femur. J Bone Joint Surg Am 30(3):745CrossRef

16.

Sugano N, Noble PC, Kamaric E (1998) A comparison of alternative methods of measuring femoral anteversion. J Comput Assist Tomogr 22(4):610–614CrossRef

17.

Miki H, Yamanashi W, Nishi T, Sato Y, Yoshikawa H, Sugano N (2007) Anatomic hip range of motion after implantation during total hip arthroplasty as measured by navigation system. J Arthroplasty 22(7):946–952CrossRef

18.

Widmer KH, Zurfluh B (2004) Compliant positioning of total hip components for optimal range of motion. J Orthop Res 22(4):815–821CrossRef

19.

Fujihara Y, Fukunishi S, Nishio S, Takeda Y, Fukui T, Okahisa S, Yoshiya S (2016) Clinical study for the use of G-guide in measurement of stem antetorsion during total hip arthroplasty. Orthopedics 39(2):e271–e275CrossRef

20.

Fujihara Y, Fukunishi S, Fukui T, Nishio S, Takeda Y, Okahisa S, Yoshiya S (2019) Comparison of G-guide and image-free navigation system in accuracy of stem anteversion assessment during total hip arthroplasty. Open Orthop J 13:109–116CrossRef

21.

Kajino Y, Kabata T, Maeda T, Iwai S, Kuroda K, Tsuchiya T (2012) Dose degree of pelvic deformity affect the accuracy of computed tomography-based hip navigation? J Arthroplasty 27(9):1651–1657CrossRef

22.

Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Joint Surg Br 75(2):228–232CrossRef

23.

Zhang J, Wang L, Mao Y, Li H, Ding H, Zhu Z (2014) The use of combined anteversion in total hip arthroplasty for patients with developmental dysplasia of the hip. J Arthroplasty 29(3):621–625CrossRef

24.

Sugano N, Noble PC, Kamaric E, Salama JK, Ochi T, Tullos HS (1998) The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br 80(4):711–719CrossRef

25.

Malik A, Dorr LD (2007) The science of minimally invasive total hip arthroplasty. Clini Ortop Relat Res 463:74–84CrossRef

26.

Woolson ST (2006) In the absence of evidence-Why bother? A literature review of minimally invasive total hip replacement surgery. Instr Course Lect 55:189–193PubMed

27.

Ling RSM, Charity J, Lee AJC, Whitehouse SL, Timperiey AJ, Gie GA (2009) The long-term results of the original Exeter polished cemented femoral component: a follow-up report. J Arthroplasty 24(4):511–517CrossRef

28.

Carrington NC, Sierra RJ, Gie GA, Hubble MJW, Timperiey AJ, Howell JR (2009) The Exeter universal cemented femoral component at 15 to 17 years. J Bone joint Surg (Br) 91(6):730–737CrossRef

29.

Petheram TG, Whitehouse SL, Kazi HA, Hubble MJW, Timperiey AJ, Wilson MJ, Howell JR (2016) The Exeter universal cemented femoral stem at 20 to 25 years: a report of 382 hips. Bone Joint J 98(11):1411–1449

30.

Keeling P, Howell JR, Kassam AM,Sathu A, Timperiey AJ, Hubble MJW, Wilson MJ, Whitehouse SL (2019) Long-term survival of the cemented Exeter universal stem in patients 50 years and younger: an update on 130 hips. J Arthroplasty (Online ahead of print)

31.

Macpherson GJ, Hank C, Schneider M, Trayner M, Elton R, Howie CR, Breusch SJ (2010) The posterior approach reduce the risk of thin cement mantles with a straight femoral stem design. Acta Orthop 81(3):292–295CrossRef

32.

Wroblewski BM, Siney PD, Fleming PA, Bobak P (2000) The calcar femorale in cemented stem fixation in total hip arthroplasty. J Bone Joint Surg (Br) 82(6):842–845CrossRef

33.

Hirata M, Nakashima Y, Itokawa T, Ohishi M, Sato T, Akiyama M, Hara D, Iwamoto Y (2014) Influencing factors for the increased stem version compared to the native femur in cementless total hip arthroplasty. Int Orthop 38:1341–1346CrossRef

34.

Yoshitani J, Kabata T, Kajino Y, Takagi T, Ohmori T, Ueno T, Ueoka K, Tsuchiya H (2018) The effect of flexion alignment in total hip arthroplasty with cementless taper-wedge femoral stem. Eur J Orthop Surg Traumatol 28:1625–1632CrossRef

35.

Taniguchi N, Jinno T, Koga D, Hagino T, Okawa A, Haro H (2017) Cementless hip stem anteversion in dysplastic hip: a comparison of tapered wedge vs metaphyseal filling. J Arthroplasty 32:1547–1552CrossRef

36.

Taniguchi N, Jinno T, Koga D, Ochiai S, Haro H (2019) Comparative study of stem anteversion using a cementless taper wedge stem in dysplastic hips between the posterolateral and anterolateral approaches. Ortho Traumatol Surg Res 105(7):1271–1276CrossRef

37.

Cooper HJ, Jacob AP, Rodrigues JA (2011) Distal fixation of proximally coated taper wedged stems may predispose to a failure of osteointegration. J Arthroplasty 26(6):78–83CrossRef

38.

Tokuhara Y, Kadoya Y, Kim M, Shoundou M, Kanno T, Masuda T (2011) Anterior knee pain after total hip arthroplasty in developmental dysplasia. J Arthroplasty 26(6):955–960CrossRef

39.

Liska F, Deimling C, Otto A, Willinger L, Kellner R, Imhoff AB, Burgkart R, Voss A (2018) Distal femoral torsional osteotomy increases the contact pressure of the medial patellofemoral joint in biomechanical analysis. Knee Surg Sports Traumatol Arthrosc Accessed 29 Sep 2018

Titel: Achievement of optimal implant alignment using taper wedge stems with cup-first THA through the MIS antero-lateral approach
verfasst von: Taishi Okada
Shigeo Fukunishi
Shinichi Yoshiya
Toshiya Tachibana
Yuki Fujihara
Yoshinobu Masumoto
Makoto Kanto
Yu Takeda
Publikationsdatum: 07.07.2020
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 8/2020
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-020-02696-1

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