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Erschienen in: International Orthopaedics 10/2017

10.03.2017 | Original Paper

Three-dimensional analysis of the proximal anterior femoral flare and torsion. Anatomic bases for metaphyseally fixed short stems design

verfasst von: Elhadi Sariali, Yohan Knaffo

Erschienen in: International Orthopaedics | Ausgabe 10/2017

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Abstract

Purpose

The use of femoral stems with a short metaphyseal fixation may lead to fractures or subsidence. Such failures may be related to a mismatch between the torsions or the sagittal flares of the stem and the femur. The goal of our study was to perform a 3D analysis of the proximal metaphyseal femur anatomy with a special focus on the anterior proximal flare and torsion. Such data may help to detect the outlier patients for whom a short metaphyseal fixation should be avoided.

Methods

A prospective study included 80 consecutive patients who underwent a primary cementless THA with a 3D CT-scan based pre-operative planning. A femoral frame was determined in order to analyse the proximal metaphyseal torsion and flares of the femur.

Results

The mean metaphyseal torsion was 21.6° ± 7° at 5 mm above the lesser trochanter (LT) and 34.7° ± 8.8 at 15 mm under LT generating a differential torsion of 13° around the LT. The mean flare index was 4.3 ± 0.9 medially, 3.7 ± 0.8 laterally, 2 ± 0.6 anteriorly and 3.1 ± 0.6 posteriorly. The anterior flare was the only flare significantly correlated to the bone density, to the age and to the femoral off-set: the higher the anterior flare index, the younger the patient, the higher the bone density and the higher the femoral offset. The anterior flare was not significantly correlated to the femoral anteversion, the metaphyseal torsion and the coronal neck-shaft angle.

Conclusion

The proximal femoral metaphysis presents a highly variable anterior flare and torsion that may explain a mismatch between the femur and the femoral stem, consequently generating a risk of subsidence or fracture when using shortly fixed stems.
Level of Evidence: Level IV
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Metadaten
Titel
Three-dimensional analysis of the proximal anterior femoral flare and torsion. Anatomic bases for metaphyseally fixed short stems design
verfasst von
Elhadi Sariali
Yohan Knaffo
Publikationsdatum
10.03.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 10/2017
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-017-3435-0

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