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Archives of Orthopaedic and Trauma Surgery

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06.11.2019 | Hip Arthroplasty

Pre-operative templating in THA. Part I: a classification of architectural hip deformities

verfasst von: Masanori Kase, Padhraig F. O’Loughlin, Tarik Aït-Si-Selmi, Geert Pagenstert, Jean Langlois, Hugo Bothorel, Michel P. Bonnin

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 1/2020

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Abstract

Introduction

While numerous classifications of hip arthritis have been proposed, none considered the magnitude and direction of femoral head translation relative to the native acetabulum. A more precise classification of architectural hip deformities is necessary to improve preoperative templating and anticipate surgical challenges of total hip arthroplasty (THA). The purpose of the present study was to introduce a classification system to distinguish different types of architectural hip deformities, based on femoral head translation patterns, and to evaluate its repeatability using plain radiographs (qualitative) and Computed Tomography (CT) measurements (quantitative).

Materials and methods

We studied pre-operative frontal and lateral hip radiographs and CT scans of 191 hips (184 patients) that received primary THA. The distance between the femoral head center (FC) and the acetabular center (AC) was measured, as well as femoral offset, acetabular offset, head center height, acetabular floor distance and femoral neck angle. The hips were classified qualitatively using frontal plain radiographs, and then quantitatively using CT scans (with an arbitrary threshold of 3 mm as Centered, Medialized, Lateralized, Proximalized or Proximo-lateralized. The agreement between qualitative and quantitative classification methods was compared for applying the same classification.

Results

Qualitative classification identified 120 centered (63%), 8 medialized (4%), 49 lateralized (26%), 3 proximalized (2%), and 11 proximo-lateralized (6%) hips, while quantitative classification identified 116 centered (61%), 8 medialized (4%), 51 lateralized (27%), 5 proximalized (3%), and 11 proximo-lateralized (6%) hips. The agreement between the two methods was excellent (0.94; CI 0.90–0.98). Medialization reached 9.7 mm, while lateralization reached 10.9 mm, and proximalization reached 8.5 mm. Proximalized and proximo-lateralized hips had more valgus necks, while medialized hips had more varus necks (p = 0.003).

Conclusions

The classification system enabled repeatable distinction of 5 types of architectural hip deformities. The excellent agreement between quantitative and qualitative methods suggests that plain radiographs are sufficient to classify architectural hip deformities.

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Titel: Pre-operative templating in THA. Part I: a classification of architectural hip deformities
verfasst von: Masanori Kase
Padhraig F. O’Loughlin
Tarik Aït-Si-Selmi
Geert Pagenstert
Jean Langlois
Hugo Bothorel
Michel P. Bonnin
Publikationsdatum: 06.11.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 1/2020
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03298-1

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Pre-operative templating in THA. Part I: a classification of architectural hip deformities