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International Orthopaedics

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01-04-2021 | Periprosthetic Fracture | Review

Cementless femoral stem fixation and leg-length discrepancy after total hip arthroplasty in different proximal femoral morphological types

Authors: Blaž Mavčič, Vane Antolič

Published in: International Orthopaedics | Issue 4/2021

Abstract

Purpose

Leg-length changes at total hip arthroplasty (THA) may result from too proximal position of the femoral component, i.e. not being sunk deep enough into the femoral canal due to the size and shape of both medullary canal and implant. Some femoral implants are designed to achieve such fixation in the mediolateral dimension, while others also engage the bone anteroposteriorly. Our aim was to examine the relationship between proximal femoral morphology, osseointegration and leg-length equalization at THA. We asked whether the Dorr classification, femoral cortical index and canal flare index on preoperative radiographs had significant impact on THA aseptic loosening rates and post-operative leg-length discrepancy (LLD).

Methods

Literature review included original articles on proximal femoral morphology with post-operative LLD and other clinical outcomes of THA, published in the last decade. Case reports and biomechanical studies without clinical data were excluded.

Results

Higher femoral cortical index and/or canal flare index (corresponding to the Dorr type A) increases the risk of leg lengthening at THA. This is particularly notable in femoral stems with metaphyseal fixation, where high canal flare index has also been linked to osseointegration failure and implant loosening. On the other hand, lower canal flare index (corresponding to the Dorr type C) is more prevalent in the elderly population and increases late periprosthetic fracture rates and stress shielding. Even the most commonly used cementless femoral stems cannot offer optimal fit to intra-/extramedullary geometry or offset restoration in up to 30% of clinical cases.

Conclusions

Femoral morphology can have significant impact on post-operative LLD and osseointegration of cementless THA. Quantitative measurements of the proximal femoral canal may improve the choice of a particular implant and fixation method.

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Title: Cementless femoral stem fixation and leg-length discrepancy after total hip arthroplasty in different proximal femoral morphological types
Authors: Blaž Mavčič
Vane Antolič
Publication date: 01-04-2021
Publisher: Springer Berlin Heidelberg
Keywords: Periprosthetic Fracture
Hip-TEP
Hip-TEP
Published in: International Orthopaedics / Issue 4/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04671-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cementless femoral stem fixation and leg-length discrepancy after total hip arthroplasty in different proximal femoral morphological types

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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