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Archives of Orthopaedic and Trauma Surgery

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30.05.2020 | Orthopaedic Surgery

The direct anterior approach provokes varus stem alignment when using a collarless straight tapered stem

verfasst von: Marcel Haversath, Martin Lichetzki, Sebastian Serong, André Busch, Stefan Landgraeber, Marcus Jäger, Tjark Tassemeier

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 6/2021

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Abstract

Introduction

Inaccurate stem implantation can cause unsatisfactory offset reconstruction and may result in insufficient gluteal muscle function or aseptic loosening. In this study, stem alignment of a collarless straight tapered HA-coated stem was retrospectively analyzed during the learning phase of the direct anterior approach (DAA) for primary total hip arthroplasty (THA).

Material and methods

From Jan 2013 to Jun 2015, a total of 93 cementless THA were implanted in patients with unilateral coxarthrosis via the DAA in a two surgeon setting using the Corail^® or Trendhip^® stem (DePuy Synthes or Aesculap). Varus(+)/Valgus(−) stem alignment was analyzed in postoperative anteroposterior pelvic radiographs. Effects on femoral offset reconstruction and correlation to patient’s individual clinical and radiological parameters were evaluated.

Results

55 stems were implanted in varus (59%), 32 in neutral (34%) and 6 in valgus alignment (7%). Mean stem alignment in varus position was + 2.2° (SD ± 1.4°). Varus alignment was associated with male gender and preoperative coxa vara deformity: low CCD, high femoral offset and long thigh neck (p ≤ 0.001). Alignment was not correlated to femoral offset restoration, BMI or leg length difference. Mean cup inclination was 44° (SD ± 4.7°) and 90% matched the coronal Lewinnek safe zone.

Conclusion

In the learning curve, the DAA can be associated with a high incidence of varus stem alignment when using a straight tapered stem, especially in men with coxa vara deformity: low CCD, high femoral offset and long thigh neck. An insufficient capsule release makes femur exposure more difficult and might be an additional factor for this finding. We recommend intraoperative X-ray in the learning phase of the DAA to verify correct implant positioning and to adjust offset options.

Hallert O, Li Y, Brismar H, Lindgren U (2012) The direct anterior approach: initial experience of a minimally invasive technique for total hip arthroplasty. J Orthop Surg Res 7:17. https://doi.org/10.1186/1749-799X-7-17CrossRefPubMedPubMedCentral

Homma Y, Baba T, Ochi H, Ozaki Y, Kobayashi H, Matsumoto M, Yuasa T, Kaneko K (2016) Greater trochanter chip fractures in the direct anterior approach for total hip arthroplasty. Eur J Orthop Surg Traumatol. https://doi.org/10.1007/s00590-016-1798-3CrossRefPubMed

Soderquist MC, Scully R, Unger AS (2017) Acetabular placement accuracy with the direct anterior approach freehand technique. J Arthroplasty 32(9):2748–2754. https://doi.org/10.1016/j.arth.2017.04.011CrossRefPubMed

Lum ZC, Dorr LD (2018) Restoration of center of rotation and balance of THR. J Orthop 15(4):992–996. https://doi.org/10.1016/j.jor.2018.08.040CrossRefPubMedPubMedCentral

Shishido T, Tateiwa T, Takahashi Y, Masaoka T, Ishida T, Yamamoto K (2018) Effect of stem alignment on long-term outcomes of total hip arthroplasty with cementless Bi-Metric femoral components. J Orthop 15(1):134–137. https://doi.org/10.1016/j.jor.2018.01.008CrossRefPubMedPubMedCentral

Bender B, Nogler M, Hozack WJ (2009) Direct anterior approach for total hip arthroplasty. Orthop Clin North Am 40(3):321–328. https://doi.org/10.1016/j.ocl.2009.01.003CrossRefPubMed

Doria C, De Santis V, Falcone G, Proietti L, De Santis E (2003) Osseointegration in hip prostheses: experimental study in sheep. Int Orthop 27(5):272–277. https://doi.org/10.1007/s00264-003-0474-5CrossRefPubMedPubMedCentral

Zang J, Uchiyama K, Moriya M, Li Z, Fukushima K, Yamamoto T, Takahira N, Takaso M, Liu J, Feng W (2018) Long-term clinical and radiographic results of the cementless Spotorno stem in Japanese patients: a more than 15-year follow-up. J Orthop Surg (Hong Kong) 26(1):2309499017750310. https://doi.org/10.1177/2309499017750310CrossRef

Fottner A, Woiczinski M, Kistler M, Schroder C, Schmidutz TF, Jansson V, Schmidutz F (2018) Varus malalignment of cementless hip stems provides sufficient primary stability but highly increases distal strain distribution. Clin Biomech (Bristol, Avon) 58:14–20. https://doi.org/10.1016/j.clinbiomech.2018.07.006CrossRef

10.

Chambers B, St Clair SF, Froimson MI (2007) Hydroxyapatite-coated tapered cementless femoral components in total hip arthroplasty. J Arthroplasty 22(4 Suppl 1):71–74. https://doi.org/10.1016/j.arth.2007.01.019CrossRefPubMed

11.

Al-Dirini RMA, O'Rourke D, Huff D, Martelli S, Taylor M (2018) Biomechanical robustness of a contemporary cementless stem to surgical variation in stem size and position. J Biomech Eng. https://doi.org/10.1115/1.4039824CrossRefPubMed

12.

Jahnke A, Wiesmair AK, Fonseca Ulloa CA, Ahmed GA, Rickert M, Ishaque BA (2020) Outcome of short- to medium-term migration analysis of a cementless short stem total hip arthroplasty using EBRA-FCA: a radiological and clinical study. Arch Orthop Trauma Surg 140(2):247–253. https://doi.org/10.1007/s00402-019-03315-3CrossRefPubMed

13.

Louboutin L, Viste A, Desmarchelier R, Fessy MH (2017) Long-term survivorship of the Corail standard stem. Orthop Traumatol Surg Res 103(7):987–992. https://doi.org/10.1016/j.otsr.2017.06.010CrossRefPubMed

14.

Boldt JG, Cartillier JC, Machenaud A, Vidalain JP (2015) Long-term bone remodeling in HA-coated stems: a radiographic review of 208 total hip arthroplasties (THAs) with 15–20 years follow-up. Surg Technol Int 27:279–286PubMed

15.

Hailer NP, Lazarinis S, Makela KT, Eskelinen A, Fenstad AM, Hallan G, Havelin L, Overgaard S, Pedersen AB, Mehnert F, Karrholm J (2015) Hydroxyapatite coating does not improve uncemented stem survival after total hip arthroplasty! Acta Orthop 86(1):18–25. https://doi.org/10.3109/17453674.2014.957088CrossRefPubMedPubMedCentral

16.

Lazarinis S, Makela KT, Eskelinen A, Havelin L, Hallan G, Overgaard S, Pedersen AB, Karrholm J, Hailer NP (2017) Does hydroxyapatite coating of uncemented cups improve long-term survival? An analysis of 28,605 primary total hip arthroplasty procedures from the Nordic Arthroplasty Register Association (NARA). Osteoarthritis Cartilage 25(12):1980–1987. https://doi.org/10.1016/j.joca.2017.08.001CrossRefPubMed

17.

Batailler C, Fary C, Servien E, Lustig S (2018) Influence of femoral broach shape on stem alignment using anterior approach for total hip arthroplasty: a radiologic comparative study of 3 different stems. PLoS ONE 13(10):e0204591. https://doi.org/10.1371/journal.pone.0204591CrossRefPubMedPubMedCentral

18.

Murphy CG, Bonnin MP, Desbiolles AH, Carrillon Y, Aїt Si Selmi T (2016) Varus will have varus; a radiological study to assess and predict varus stem placement in uncemented femoral stems. Hip Int 26(6):554–560. https://doi.org/10.5301/hipint.5000412CrossRefPubMed

19.

Thaler M, Lechner R, Putzer D, Mayr E, Huber DC, Liebensteiner MC, Nogler M (2018) Two-year gait analysis controls of the minimally invasive total hip arthroplasty by the direct anterior approach. Clin Biomech (Bristol, Avon) 58:34–38. https://doi.org/10.1016/j.clinbiomech.2018.06.018CrossRef

20.

Nogler M, Krismer M, Hozack WJ, Merritt P, Rachbauer F, Mayr E (2006) A double offset broach handle for preparation of the femoral cavity in minimally invasive direct anterior total hip arthroplasty. J Arthroplasty 21(8):1206–1208. https://doi.org/10.1016/j.arth.2006.08.003CrossRefPubMed

21.

Bjordal F, Bjorgul K (2015) The role of femoral offset and abductor lever arm in total hip arthroplasty. J Orthop Traumatol 16(4):325–330. https://doi.org/10.1007/s10195-015-0358-7CrossRefPubMedPubMedCentral

22.

Holzer LA, Scholler G, Wagner S, Friesenbichler J, Maurer-Ertl W, Leithner A (2019) The accuracy of digital templating in uncemented total hip arthroplasty. Arch Orthop Trauma Surg 139(2):263–268. https://doi.org/10.1007/s00402-018-3080-0CrossRefPubMed

23.

Cech A, Kase M, Kobayashi H, Pagenstert G, Carrillon Y, O'Loughlin PF, Ait-Si-Selmi T, Bothorel H, Bonnin MP (2020) Pre-operative planning in THA. Part III: do implant size prediction and offset restoration influence functional outcomes after THA? Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03342-5CrossRefPubMed

24.

Haversath M, Wendelborn C, Jager M, Schmidt B, Kowalczyk W, Landgraeber S (2017) Geometric analysis and clinical outcome of two cemented stems for primary total hip replacement with and without modular necks. Arch Orthop Trauma Surg 137(11):1571–1578. https://doi.org/10.1007/s00402-017-2785-9CrossRefPubMed

25.

Worlicek M, Weber M, Worner M, Schwarz T, Zeman F, Grifka J, Renkawitz T, Craiovan B (2018) The final implant position of a commonly used collarless straight tapered stem design (Corail((R))) does not correlate with femoral neck resection height in cement-free total hip arthroplasty: a retrospective computed tomography analysis. J Orthop Traumatol 19(1):20. https://doi.org/10.1186/s10195-018-0513-zCrossRefPubMedPubMedCentral

26.

Kase M, O'Loughlin PF, Ait-Si-Selmi T, Pagenstert G, Langlois J, Bothorel H, Bonnin MP (2020) Pre-operative templating in THA. Part I: a classification of architectural hip deformities. Arch Orthop Trauma Surg. 140(1):129–137. https://doi.org/10.1007/s00402-019-03298-1CrossRefPubMed

Titel: The direct anterior approach provokes varus stem alignment when using a collarless straight tapered stem
verfasst von: Marcel Haversath
Martin Lichetzki
Sebastian Serong
André Busch
Stefan Landgraeber
Marcus Jäger
Tjark Tassemeier
Publikationsdatum: 30.05.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 6/2021
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03457-9

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