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Published in: Journal of Orthopaedics and Traumatology 4/2015

Open Access 01-12-2015 | Original Article

The role of femoral offset and abductor lever arm in total hip arthroplasty

Authors: Filip Bjørdal, Kristian Bjørgul

Published in: Journal of Orthopaedics and Traumatology | Issue 4/2015

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Abstract

Background

In order to create a well-functioning total hip arthroplasty (THA), it is important to restore femoral off-set and thus the abductor lever arm. The aim of this study was to investigate the clinical effect of increasing the abductor lever arm to and beyond the anatomical native lever arm in minimally invasive total hip arthroplasty performed through a direct anterior approach.

Materials and methods

We compared the lever arm of the operated hip to the lever arm of the contralateral native hip on radiographs in 148 patients following THA. The patients were divided in two groups based on whether they kept their anatomical lever arm or had an increased lever arm. The clinical outcome was assessed using hip osteoarthritis outcome score (HOOS), Harris hip score and UCLA activity score.

Results

Patients who kept their anatomical lever arm did not experience a significantly better clinical outcome than the patients with an increased abductor lever arm. We found no significant difference in clinical scores at any of the follow-ups during the first year after THA.

Conclusion

The results of this study suggest that an increase in the abductor lever arm does not have major effects on the clinical outcome after THA. To avoid the potential negative effects of decreasing the lever arm, the surgeon should aim for an equal or slightly increased lever arm.
Level of evidence Level 3, prospective cohort study.
Literature
1.
go back to reference Rorabeck CH, Bourne RB, Laupacis A et al (1994) A double-blind study of 250 cases comparing cemented with cementless total hip arthroplasty. Cost-effectiveness and its impact on health-related quality of life. Clin Orthop Relat Res 298:156–164PubMed Rorabeck CH, Bourne RB, Laupacis A et al (1994) A double-blind study of 250 cases comparing cemented with cementless total hip arthroplasty. Cost-effectiveness and its impact on health-related quality of life. Clin Orthop Relat Res 298:156–164PubMed
2.
go back to reference Karachalios T, Hartofilakidis G, Zacharakis N, Tsekoura M (1993) A 12- to 18-year radiographic follow-up study of Charnley low-friction arthroplasty. The role of the center of rotation. Clin Orthop Relat Res 296:140–147PubMed Karachalios T, Hartofilakidis G, Zacharakis N, Tsekoura M (1993) A 12- to 18-year radiographic follow-up study of Charnley low-friction arthroplasty. The role of the center of rotation. Clin Orthop Relat Res 296:140–147PubMed
3.
go back to reference Kurtz WB, Ecker TM, Reichmann WM, Murphy SB (2010) Factors affecting bony impingement in hip arthroplasty. J Arthroplast 25:624–634CrossRef Kurtz WB, Ecker TM, Reichmann WM, Murphy SB (2010) Factors affecting bony impingement in hip arthroplasty. J Arthroplast 25:624–634CrossRef
4.
go back to reference Maruyama M, Feinberg JR, Capello WN, D’Antonio JA (2001) The Frank Stinchfield Award: morphologic features of the acetabulum and femur: anteversion angle and implant positioning. Clin Orthop Relat Res 393:52–65CrossRefPubMed Maruyama M, Feinberg JR, Capello WN, D’Antonio JA (2001) The Frank Stinchfield Award: morphologic features of the acetabulum and femur: anteversion angle and implant positioning. Clin Orthop Relat Res 393:52–65CrossRefPubMed
5.
go back to reference Bonnin MP, Archbold PH, Basiglini L, Fessy MH, Beverland DE (2012) Do we medialise the hip centre of rotation in total hip arthroplasty? Influence of acetabular offset and surgical technique. Hip Int 22(4):371–378 Bonnin MP, Archbold PH, Basiglini L, Fessy MH, Beverland DE (2012) Do we medialise the hip centre of rotation in total hip arthroplasty? Influence of acetabular offset and surgical technique. Hip Int 22(4):371–378
6.
go back to reference Asayama I, Chamnongkich S, Simpson KJ, Kinsey TL, Mahoney OM (2005) Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty. J Arthroplast 20:414–420CrossRef Asayama I, Chamnongkich S, Simpson KJ, Kinsey TL, Mahoney OM (2005) Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty. J Arthroplast 20:414–420CrossRef
7.
go back to reference Dastane M, Dorr LD, Tarwala R, Wan Z (2010) Hip offset in total hip arthroplasty: quantitative measurement with navigation. Clin Orthop Relat Res 469(2):429–436 Dastane M, Dorr LD, Tarwala R, Wan Z (2010) Hip offset in total hip arthroplasty: quantitative measurement with navigation. Clin Orthop Relat Res 469(2):429–436
8.
go back to reference Delp SL, Wixson RL, Komattu AV, Kocmond JH (1996) How superior placement of the joint center in hip arthroplasty affects the abductor muscles. Clin Orthop Relat Res 328:137–146CrossRefPubMed Delp SL, Wixson RL, Komattu AV, Kocmond JH (1996) How superior placement of the joint center in hip arthroplasty affects the abductor muscles. Clin Orthop Relat Res 328:137–146CrossRefPubMed
9.
go back to reference Klassbo M, Larsson E, Mannevik E (2003) Hip disability and osteoarthritis outcome score. an extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol 32:46–51CrossRefPubMed Klassbo M, Larsson E, Mannevik E (2003) Hip disability and osteoarthritis outcome score. an extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol 32:46–51CrossRefPubMed
10.
11.
go back to reference Matta JM, Ferguson TA (2005) The anterior approach for hip replacement. Orthopedics 28:927–928PubMed Matta JM, Ferguson TA (2005) The anterior approach for hip replacement. Orthopedics 28:927–928PubMed
12.
go back to reference McGrory BJ, Morrey BF, Cahalan TD, An KN, Cabanela ME (1995) Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg Br 77:865–869PubMed McGrory BJ, Morrey BF, Cahalan TD, An KN, Cabanela ME (1995) Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg Br 77:865–869PubMed
13.
go back to reference Matsushita A, Nakashima Y, Jingushi S, Yamamoto T, Kuraoka A, Iwamoto Y (2009) Effects of the femoral offset and the head size on the safe range of motion in total hip arthroplasty. J Arthroplast 24:646–651CrossRef Matsushita A, Nakashima Y, Jingushi S, Yamamoto T, Kuraoka A, Iwamoto Y (2009) Effects of the femoral offset and the head size on the safe range of motion in total hip arthroplasty. J Arthroplast 24:646–651CrossRef
14.
go back to reference Sakalkale DP, Sharkey PF, Eng K, Hozack WJ, Rothman RH (2001) Effect of femoral component offset on polyethylene wear in total hip arthroplasty. Clin Orthop Relat Res 388:125–134CrossRefPubMed Sakalkale DP, Sharkey PF, Eng K, Hozack WJ, Rothman RH (2001) Effect of femoral component offset on polyethylene wear in total hip arthroplasty. Clin Orthop Relat Res 388:125–134CrossRefPubMed
15.
go back to reference Devane PA, Horne JG (1999) Assessment of polyethylene wear in total hip replacement. Clin Orthop Relat Res 369:59–72CrossRefPubMed Devane PA, Horne JG (1999) Assessment of polyethylene wear in total hip replacement. Clin Orthop Relat Res 369:59–72CrossRefPubMed
16.
go back to reference Barrack RL (1998) Factors influencing polyethylene wear in total joint arthroplasty. Orthopedics 21:937–940PubMed Barrack RL (1998) Factors influencing polyethylene wear in total joint arthroplasty. Orthopedics 21:937–940PubMed
17.
go back to reference Little NJ, Busch CA, Gallagher JA, Rorabeck CH, Bourne RB (2009) Acetabular polyethylene wear and acetabular inclination and femoral offset. Clin Orthop Relat Res 467:2895–2900PubMedCentralCrossRefPubMed Little NJ, Busch CA, Gallagher JA, Rorabeck CH, Bourne RB (2009) Acetabular polyethylene wear and acetabular inclination and femoral offset. Clin Orthop Relat Res 467:2895–2900PubMedCentralCrossRefPubMed
18.
go back to reference Terrier A, Levrero FF, Rudiger HA (2014) Benefit of cup medialization in total hip arthroplasty is associated with femoral anatomy. Clin Orthop Relat Res 472:3159–3165PubMedCentralCrossRefPubMed Terrier A, Levrero FF, Rudiger HA (2014) Benefit of cup medialization in total hip arthroplasty is associated with femoral anatomy. Clin Orthop Relat Res 472:3159–3165PubMedCentralCrossRefPubMed
19.
go back to reference Nilsdotter AK, Lohmander LS, Klassbo M, Roos EM (2003) Hip disability and osteoarthritis outcome score (HOOS)––validity and responsiveness in total hip replacement. BMC Musculoskelet Disord 4:10PubMedCentralCrossRefPubMed Nilsdotter AK, Lohmander LS, Klassbo M, Roos EM (2003) Hip disability and osteoarthritis outcome score (HOOS)––validity and responsiveness in total hip replacement. BMC Musculoskelet Disord 4:10PubMedCentralCrossRefPubMed
20.
go back to reference Soderman P, Malchau H (2001) Is the Harris hip score system useful to study the outcome of total hip replacement? Clin Orthop Relat Res 384:189–197CrossRefPubMed Soderman P, Malchau H (2001) Is the Harris hip score system useful to study the outcome of total hip replacement? Clin Orthop Relat Res 384:189–197CrossRefPubMed
21.
go back to reference Bourne RB, Rorabeck CH (2002) Soft tissue balancing: the hip. J Arthroplast 17:17–22CrossRef Bourne RB, Rorabeck CH (2002) Soft tissue balancing: the hip. J Arthroplast 17:17–22CrossRef
Metadata
Title
The role of femoral offset and abductor lever arm in total hip arthroplasty
Authors
Filip Bjørdal
Kristian Bjørgul
Publication date
01-12-2015
Publisher
Springer International Publishing
Published in
Journal of Orthopaedics and Traumatology / Issue 4/2015
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI
https://doi.org/10.1007/s10195-015-0358-7

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