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Archives of Orthopaedic and Trauma Surgery

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01-09-2011 | Hip Arthroplasty

Intraoperative estimation of femoral anteversion in cementless total hip arthroplasty using the lesser trochanter

Authors: Mehmet C. Unlu, Hayrettin Kesmezacar, Fatih Kantarci, Burcin Unlu, Huseyin Botanlioglu

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2011

Abstract

Introduction

The intraoperative estimation of the anteversion of the femoral component of a total hip arthroplasty is generally made by the surgeon’s visual assessment of the stem position relative to the condylar plane of the femur.

Aim

The aim of this study was to evaluate the femoral component anteversion relative to lesser trochanter during cementless total hip arthroplasty. The intraoperative estimation of the anteversion of the femoral component of a total hip arthroplasty is generally made by the surgeon’s visual assessment of the stem position relative to the condylar plane of the femur. The aim of this study was to evaluate the femoral component anteversion relative to lesser trochanter during cementless total hip arthroplasty.

Method

The authors investigated the version of the lesser trochanter (LTV) relative to the posterior femoral condyles. Fifty-seven patients (59 hips) scheduled for primary cementless total hip arthroplasty underwent preoperative computed tomography and it was measured the LTV and collo-femoral version at the level of the proximal-most portion of the inferior neck, with respect to the lesser trochanter (native collo-trochanteric angle, NCTA). During surgery, the operative collo-trochanteric angle (OCTA) was measured.

Results

The mean LTV was 34.1 ± 3.0°, the mean NCTA was 49.1 ± 5.6°, and the mean OCTA was 48.8 ± 6.0°, which did not differ significantly from the NCTA (p = 0.495); the correlation coefficient was 0.872 (p < 0.0001). Based on the data, there was a constant relationship between the lesser trochanter and posterior femoral condyles and a good correlation between NCTA and OCTA.

Conclusion

The authors recommend first estimating the anteversion of the femoral component relative to lesser trochanter and then adjusting the position of the acetabular component to that anteversion of the femoral component to improve stability and reduce impingement.

Trousdale RT, Cabanela ME, Berry DJ (1995) Anterior iliopsoas impingement after total hip arthroplasty. J Arthroplasty 10(4):546PubMedCrossRef

Yoshimine F (2006) The safe-zones for combined cup and neck anteversions that fulfill the essential range of motion and their optimum combination in total hip replacements. J Biomech 39(7):1315PubMedCrossRef

Dorr LD, Malik A, Wan Z, Long WT, Harris M (2007) Precision and bias of imageless computer navigation and surgeon estimates for acetabular component position. Clin Orthop Relat Res 465:92PubMed

Pierchon F, Pasquier G, Cotten A, Fontaine C, Clarisse J, Duquennoy A (1994) Causes of dislocation of total hip arthroplasty CT study of component alignment. J Bone Joint Surg [Br] 76-B(1):45

Wines AP, McNicol D (2006) Computed tomography measurement of the accuracy of component version in total hip arthroplasty. J Arthroplasty 21(5):696–701PubMedCrossRef

Dorr LD, Malik A, Dastane M, Wan Z (2009) Combined anteversion technique for total hip arthroplasty. Clin Orthop Relat Res 467(1):119PubMedCrossRef

Crowe JF, Mani VJ, Ranawat CS (1979) Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 61-A(1):15

Jamali AA, Deuel C, Perreira A, Salgado CJ, Hunter JC, Strong EB (2007) Linear and angular measurements of computer-generated models: are they accurate, valid, and reliable? Comput Aided Surg 12(5):278PubMed

Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT (1987) Femoral anteversion. J Bone Joint Surg Am 69-A(8):1169

10.

Sugano N, Noble PC, Kamaric E (1998) A comparison of alternative methods of measuring femoral anteversion. J Comput Assist Tomogr 22(4):610PubMedCrossRef

11.

Inaba Y, Dorr LD, Wan Z, Sirianni L, Boutary M (2005) Operative and patient care techniques for posterior mini-incision total hip arthroplasty. Clin Orthop Relat Res 441:104PubMedCrossRef

12.

Lucas DH, Scott RB (1994) The Ranawat Sign: a specific maneuver to assess component positioning in total hip arthroplasty. J Orthop Techn 2(2):59

13.

Kalteis T, Handel M, Bathis H, Perlick L, Tingart M, Grifka J (2006) Imageless navigation for insertion of the acetabular component in total hip arthroplasty: is it as accurate as CT-based navigation? J Bone Joint Surg [Br] 88(7):163

14.

Dorr LD, Wan Z, Malik A, Zhu J, Dastane M, Deshmane P (2009) A comparison of surgeon estimation and computed tomographic measurement of femoral component anteversion in cementless total hip arthroplasty. J Bone Joint Surg Am 91-A(11):2598CrossRef

15.

Bargar WL, Jamali AA, Nejad AH (2010) Femoral anteversion in THA and its lack of correlation with native acetabular anteversion. Clin Orthop Relat Res 468(2):527PubMedCrossRef

16.

Barrack RL (2003) Dislocation after total hip arthroplasty: implant design and orientation. J Am Acad Orthop Surg 11(2):89PubMed

17.

Unnanuntana A, Toogood P, Hart D, Cooperman D, Grant RE (2010) The evaluation of two references for restoring proximal femoral anatomy during total hip arthroplasty. Clin Anat 23(3):312PubMed

18.

Charnley J, Feagin JA (1973) Low-friction arthroplasty in congenital subluxation of the hip. Clin Orthop 91:98PubMedCrossRef

19.

Dunn HK, Hess WE (1976) Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg Am 58-A(6):838

20.

Woolson ST, Harris WH (1983) Complex total hip replacement for dysplastic or hypoplastic hips using miniature or microminiature components. J Bone Joint Surg Am 65-A(8):1099

21.

Giunti A, Moroni A, Olmi R, Rimondi E, Soldati D, Vicenzi G (1985) The importance of the angle of anteversion in the development of arthritis of the hip. Ital J Orthop Traumatol 11(1):23PubMed

22.

Reikerås O, Høiseth A (1982) Femoral neck angles in osteoarthritis of the hip. Acta Orthop Scand 53(5):781PubMedCrossRef

23.

Reikerås O, Bjerkreim I, Kolbenstvedt A (1983) Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip. Acta Orthop Scand 54(1):18PubMedCrossRef

24.

Terjesen T, Benum P, Anda S, Svenningsen S (1982) Increased femoral anteversion and osteoarthritis of the hip joint. Acta Orthop Scand 53(4):571PubMedCrossRef

25.

Hubbard DD, Staheli LT, Chew DE, Mosca VS (1988) Medial femoral torsion and osteoarthritis. J Pediatr Orthop 8(5):540PubMedCrossRef

26.

Kitaoka HB, Weiner DS, Cook AJ, Hoyt WA Jr, Askew MJ (1989) Relationship between femoral anteversion and osteoarthritis of the hip. J Pediatr Orthop 9(4):396PubMed

27.

Swanson AB, Greene PW Jr, Allis HD (1963) Rotational deformities of the lower extremity in children, their clinical significance. Clin Orthop Relat Res 27:157PubMed

28.

Noble PC, Box GG, Kamaric E et al (1995) The effect of aging on the shape of the proximal femur. Clin Orthop 3163:1

29.

Komeno M, Hasegawa M, Sudo A, Uchida A (2006) Computed tomographic evaluation of component position on dislocation after total hip arthroplasty. Orthopedics 29(12):1104PubMed

Title: Intraoperative estimation of femoral anteversion in cementless total hip arthroplasty using the lesser trochanter
Authors: Mehmet C. Unlu
Hayrettin Kesmezacar
Fatih Kantarci
Burcin Unlu
Huseyin Botanlioglu
Publication date: 01-09-2011
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 9/2011
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-011-1282-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Intraoperative estimation of femoral anteversion in cementless total hip arthroplasty using the lesser trochanter

Abstract

Introduction

Aim

Method

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Aim

Method

Results

Conclusion

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