Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2015 | Research article

Low femoral antetorsion as a risk factor for bony impingement after bipolar hemiarthroplasty

Authors: Takeshi Shoji, Yuji Yasunaga, Takuma Yamasaki, Soutarou Izumi, Susumu Hachisuka, Mitsuo Ochi

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2015

Abstract

Introduction

Reports of dislocation after bipolar hemiarthroplasty (BHA) abound in literature, and several studies have mentioned the factors that are associated with an increased risk of dislocation. However, there is no report detailing the pattern of impingement in BHA and how femoral antetorsion can affect the range of motion (ROM) after BHA.

Purpose

The purpose of this study was to evaluate the pattern of impingement in BHA and whether femoral antetorsion affects the ROM after BHA using three-dimensional (3D) dynamic motion analysis.

Methods

Using the computed tomography (CT) data of 60 patients (60 hips), including 31 men and 29 women who underwent BHA for the treatment of idiopathic osteonecrosis (ION) of the femoral head, we calculated the antetorsion of the femoral neck, ROM of flexion (Flex), internal rotation (Int-R), and external rotation (Ext-R) using a CT-based 3D simulation software. We evaluated the pattern of impingement and the relationship between femoral antetorsion and ROM in BHA. As for the implant position in the 3D simulation software, the anteversion of the femoral implant was set to be the same as the natural antetorsion of the femoral neck and neck length was set to be the standard neck in all cases.

Results

This study revealed the mechanism of impingement in BHA: (1) bone to bone impingement and (2) implant to bone impingement. We found a significant decrease in the ROM of Flex and Int-R inversely proportional to the femoral antetorsion. In patients with lower femoral antetorsion, the ROM of Flex and Int-R decreased due to bony impingement (the anterior great trochanteric region of the femur impinges on the anteroinferior edge of the anteroinferior iliac spine). Whereas, high anteversion of the femoral implant may decrease the ROM of Ext-R; however, our results also showed that even the lowest ROM of Ext-R with 10° hip extension was over 40°.

Conclusions

We demonstrated that lower femoral antetorsion substantially affects the ROM of Flex and Int-R due to bony impingement. For these patients, there should be consideration given to retaining femoral “anterior offset” in BHA.

Pajarinen J, Savolainen V, Tulikoura I, Lindahl J, Hirvensalo E. Factors predisposing to dislocation of the Thompson hemiarthroplasty. Acta Orthop. 2003;74:45–8.CrossRef

Frihagen F, Nordsletten L, Madsen JE. Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ. 2007;335:1251–4.PubMedCentralPubMedCrossRef

Parker MJ, Gurusamy K. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;4:CD001708.PubMed

Enocson A, Hedbeck CJ, Törnkvist H, Tidermark J, Lapidus LJ. Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures. Int Orthop. 2012;36(4):711–7.PubMedCentralPubMedCrossRef

Moriya M, Uchiyama K, Takahira N, Fukushima K, Yamamoto T, Hoshi K, et al. Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head. Int Orthop. 2012;36(10):2041–7.PubMedCentralPubMedCrossRef

Parvizi J, Morrey BF. Bipolar hip arthroplasty as a salvage treatment for instability of the hip. J Bone Joint Surg Am. 2001;82:1132–9.

Varley J, Parker MJ. Stability of hip hemiarthroplasties. Int Orthop. 2004;28:274–7.PubMedCentralPubMedCrossRef

Madanat R, Mäkinen T, Ovaska M, Soiva M, Vahlberg T, Haapala J. Dislocation of hip hemiarthroplasty following posterolateral surgical approach: a nested case-control study. Int Orthop. 2012;36:935–40.PubMedCentralPubMedCrossRef

Rogmark C, Fenstad A, Leonardsson O, Engesæter L, Kärrholm J, Furnes O, et al. Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients. Acta Orthop. 2014;85(1):18–25.PubMedCentralPubMedCrossRef

10.

Barnes C, Berry D, Sledge C. Dislocation after bipolar hemiarthroplasty of the hip. J Arthroplasty. 1995;10(5):667–9.PubMedCrossRef

11.

Enocson A, Tidermark J, Törnkvist H, Lapidus LJ. Dislocation of hemiarthroplasty after femoral neck fracture: better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips. Acta Orthop. 2008;79:211–7.PubMedCrossRef

12.

Widmer KH, Zurfluh B. Compliant positioning of total hip components for optimal range of motion. J Orthop Res. 2004;22:815–21.PubMedCrossRef

13.

Kessler O, Patil S, Stefan W, Mayr E, Colwell CW, Darryl D, et al. Bony impingement affects range of motion after total hip arthroplasty: a subject-specific approach. J Orthop Res. 2008;26(4):443–52.PubMedCrossRef

14.

Rousseau MA, Lazennec JY, Boyer P, Mora N, Gorin M, Catonné Y. Optimization of total hip arthroplasty implantation: is the anterior pelvic plane concept valid? J Arthroplasty. 2009;24(1):22–6.PubMedCrossRef

15.

Incavo SJ, Thompson MT, Gold JE, Patel RV, Icenogle KD, Noble PC. Which procedure better restores intact hip range of motion: total hip arthroplasty or resurfacing? A combined cadaveric and computer simulation study. J Arthroplasty. 2011;26(3):391–7.PubMedCrossRef

16.

van Egmond PW, Taminiau AH, van der Heide HJ. Hemiarthroplasties in young patients with osteonecrosis or a tumour of the proximal femur; an observational cohort study. BMC Musculoskelet Disord. 2013;14:31. doi:10.1186/1471-2474-14-31.PubMedCentralPubMedCrossRef

17.

Sugano N, Kubo T, Takaoka K, Ohzono K, Hotokebuchi T, Matsumoto T, et al. Diagnostic criteria for non-traumatic osteonecrosis of the femoral head: a multicenter study. J Bone Joint Surg (Br). 1999;81(4):590–5.CrossRef

18.

Sugano N, Atsumi T, Ohzono K, Kubo T, Hotokebuchi T, Takaoka K. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci. 2002;7:601–5.PubMedCrossRef

19.

Shoji T, Yasunaga Y, Yamasaki T, Mori R, Hamanishi M, Ochi M. Bony impingement depends on the bone morphology of the hip after total hip arthroplasty. Int Orthop. 2013;37:1897–903.PubMedCentralPubMedCrossRef

20.

Fabry G, MacEwen GD, Shands Jr AR. Torsion of the femur. A follow-up study in normal and abnormal conditions. J Bone Joint Surg Am. 1973;55(8):1726–38.PubMed

21.

Hwang K, Kim Y, Kim Y, Choi I. Is bipolar hemiarthroplasty a reliable option for Ficat stage III osteonecrosis of the femoral head? 15- to 24-year follow-up study. Arch Orthop Trauma Surg. 2012;132:1789–96.PubMedCrossRef

22.

Lung HR. The role of prosthetic replacement of the head of the femur as primary treatment for subcapital fractures. Injury. 1971;3(2):107–13.PubMed

23.

Chana R, Mansouri R, Jack C, Edwards MR, Singh R, Keller C, et al. The suitability of an uncemented hydroxyapatite coated (HAC) hip hemiarthroplasty stem for intra-capsular femoral neck fractures in osteoporotic elderly patients: the Metaphyseal-Diaphyseal Index, a solution to preventing intra-operative periprosthetic fracture. J Orthop Surg Res. 2011; doi:10.1186/1749-799X-6-59.

24.

Christopher C, Sethi N, Hatahet M, Clifford L, Morandi M, Vaidya R. Hip dislocation after modular unipolar hemiarthroplasty. J Arthroplasty. 2009;24(5):768–74.CrossRef

25.

Bartz RL, Nobel PC, Kadakia NR, Tullos HS. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg Am. 2000;82:1300–7.PubMed

26.

Miki H, Yamanashi W, Nishii T, Sato Y, Yoshikawa H, Sugano N. Anatomic hip range of motion after implantation during total hip arthroplasty as measured by a navigation system. J Arthroplasty. 2007;22(7):946–52.PubMedCrossRef

Title: Low femoral antetorsion as a risk factor for bony impingement after bipolar hemiarthroplasty
Authors: Takeshi Shoji
Yuji Yasunaga
Takuma Yamasaki
Soutarou Izumi
Susumu Hachisuka
Mitsuo Ochi
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2015
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-015-0248-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Low femoral antetorsion as a risk factor for bony impingement after bipolar hemiarthroplasty

Abstract

Introduction

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Clinical and radiological outcomes following hybrid surgery in the treatment of multi-level cervical spondylosis: over a 2-year follow-up

Erratum to: A biomechanical comparison between cortical bone trajectory fixation and pedicle screw fixation

Augmentation with an ovine forestomach matrix scaffold improves histological outcomes of rotator cuff repair in a rat model

Complications are reduced with a protocol to standardize timing of fixation based on response to resuscitation

Bunnell or cross-lock Bunnell suture for tendon repair? Defining the biomechanical role of suture pretension

Comparison of radiological spino-pelvic sagittal parameters in skiers and non-athletes