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Skeletal Radiology
Published in: Skeletal Radiology 12/2020

Open Access 01-12-2020 | Hip-TEP | Scientific Article

Impact of stem design and cementation on postoperative femoral antetorsion in 227 patients with total hip arthroplasty (THA)

Authors: Tim Fischer, Christoph Stern, Benjamin Fritz, Patrick O. Zingg, Christian W. A. Pfirrmann, Reto Sutter

Published in: Skeletal Radiology | Issue 12/2020

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Abstract

Objective

In total hip arthroplasty (THA), surgeons attempt to achieve a physiological antetorsion. However, postoperative antetorsion of the femoral stem is known to show large variabilities. The purpose of this study was to assess whether postoperative antetorsion is influenced by stem design or cementation.

Materials and methods

This retrospective study included 227 patients with a hip prosthesis with five different stem designs (S1: short curved, S2 and S3: standard straight, S4: standard straight collared, S5: cemented straight), who had metal suppressed 1.5T-MRI of the hip between February 2015 and October 2019. Measurement of femoral antetorsion was done independently by two fellowship-trained radiologists on axial images by measuring the angle between the long axis of the femoral neck and the posterior condylar tangent of the knee. Measured angles in the different groups were compared using the t test for independent samples.

Results

The cementless collared stem S4 showed the highest antetorsion with 18.1° (± 10.5°; range –10°–45°), which was significantly higher than the antetorsion of the collarless S3 with 13.3° (± 8.4°; − 4°–29°) and the cemented S5 with 12.7° (± 7.7°; − 3°–27°) with p = 0.012 and p = 0.007, respectively. S1 and S2 showed an antetorsion of 14.8° (± 10.0°; 1°–37°) and 14.1° (± 12.2°; − 20°–41°). The torsional variability of the cementless stems (S1–4) was significantly higher compared with that of the cemented S5 with a combined standard deviation of 10.5° and 7.7° (p = 0.019).

Conclusion

Prosthesis design impacts the postoperative femoral antetorsion, with the cementless collared stem showing the highest antetorsion. Cemented stems demonstrated significantly lower variability, suggesting the lowest rate of inadvertent malrotation.
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Metadata
Title
Impact of stem design and cementation on postoperative femoral antetorsion in 227 patients with total hip arthroplasty (THA)
Authors
Tim Fischer
Christoph Stern
Benjamin Fritz
Patrick O. Zingg
Christian W. A. Pfirrmann
Reto Sutter
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Keywords
Hip-TEP
Hip-TEP
Published in
Skeletal Radiology / Issue 12/2020
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-020-03483-z

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