Marcel Haversath1, Martin Lichetzki2, Sebastian Serong3,4, André Busch5, Stefan Landgraeber3,4, Marcus Jäger5, Tjark Tassemeier6. 1. Department of Orthopaedics, St. Vinzenz-Krankenhaus, Schloßstraße 85, 40477, Düsseldorf, Germany. marcel.haversath@vkkd-kliniken.de. 2. Medical Faculty, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany. 3. Department of Orthopaedics, St. Vinzenz-Krankenhaus, Schloßstraße 85, 40477, Düsseldorf, Germany. 4. Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany. 5. Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien-Hospital Mülheim a.d. Ruhr, 45468, Mülheim an der Ruhr, Germany. 6. Gelenkzentrum Bergisch Land, Freiheitstraße 203, 42853, Remscheid, Germany.
Abstract
INTRODUCTION: Inaccurate stem implantation can cause unsatisfactory offset reconstruction and may result in insufficient gluteal muscle function or aseptic loosening. In this study, stem alignment of a collarless straight tapered HA-coated stem was retrospectively analyzed during the learning phase of the direct anterior approach (DAA) for primary total hip arthroplasty (THA). MATERIAL AND METHODS: From Jan 2013 to Jun 2015, a total of 93 cementless THA were implanted in patients with unilateral coxarthrosis via the DAA in a two surgeon setting using the Corail® or Trendhip® stem (DePuy Synthes or Aesculap). Varus(+)/Valgus(-) stem alignment was analyzed in postoperative anteroposterior pelvic radiographs. Effects on femoral offset reconstruction and correlation to patient's individual clinical and radiological parameters were evaluated. RESULTS: 55 stems were implanted in varus (59%), 32 in neutral (34%) and 6 in valgus alignment (7%). Mean stem alignment in varus position was + 2.2° (SD ± 1.4°). Varus alignment was associated with male gender and preoperative coxa vara deformity: low CCD, high femoral offset and long thigh neck (p ≤ 0.001). Alignment was not correlated to femoral offset restoration, BMI or leg length difference. Mean cup inclination was 44° (SD ± 4.7°) and 90% matched the coronal Lewinnek safe zone. CONCLUSION: In the learning curve, the DAA can be associated with a high incidence of varus stem alignment when using a straight tapered stem, especially in men with coxa vara deformity: low CCD, high femoral offset and long thigh neck. An insufficient capsule release makes femur exposure more difficult and might be an additional factor for this finding. We recommend intraoperative X-ray in the learning phase of the DAA to verify correct implant positioning and to adjust offset options.
INTRODUCTION: Inaccurate stem implantation can cause unsatisfactory offset reconstruction and may result in insufficient gluteal muscle function or aseptic loosening. In this study, stem alignment of a collarless straight tapered HA-coated stem was retrospectively analyzed during the learning phase of the direct anterior approach (DAA) for primary total hip arthroplasty (THA). MATERIAL AND METHODS: From Jan 2013 to Jun 2015, a total of 93 cementless THA were implanted in patients with unilateral coxarthrosis via the DAA in a two surgeon setting using the Corail® or Trendhip® stem (DePuy Synthes or Aesculap). Varus(+)/Valgus(-) stem alignment was analyzed in postoperative anteroposterior pelvic radiographs. Effects on femoral offset reconstruction and correlation to patient's individual clinical and radiological parameters were evaluated. RESULTS: 55 stems were implanted in varus (59%), 32 in neutral (34%) and 6 in valgus alignment (7%). Mean stem alignment in varus position was + 2.2° (SD ± 1.4°). Varus alignment was associated with male gender and preoperative coxa vara deformity: low CCD, high femoral offset and long thigh neck (p ≤ 0.001). Alignment was not correlated to femoral offset restoration, BMI or leg length difference. Mean cup inclination was 44° (SD ± 4.7°) and 90% matched the coronal Lewinnek safe zone. CONCLUSION: In the learning curve, the DAA can be associated with a high incidence of varus stem alignment when using a straight tapered stem, especially in men with coxa vara deformity: low CCD, high femoral offset and long thigh neck. An insufficient capsule release makes femur exposure more difficult and might be an additional factor for this finding. We recommend intraoperative X-ray in the learning phase of the DAA to verify correct implant positioning and to adjust offset options.
Authors: Alexander Jahnke; Ann-Kathrin Wiesmair; Carlos Alfonso Fonseca Ulloa; Gafar Adam Ahmed; Markus Rickert; Bernd Alexander Ishaque Journal: Arch Orthop Trauma Surg Date: 2019-11-30 Impact factor: 3.067
Authors: André Busch; Alexander Wegner; Dennis Wassenaar; Daniel Brandenburger; Marcel Haversath; Marcus Jäger Journal: Orthopadie (Heidelb) Date: 2022-10-07
Authors: Sebastian Serong; Moritz Schutzbach; Ivica Zovko; Marcus Jäger; Stefan Landgraeber; Marcel Haversath Journal: Eur J Med Res Date: 2020-12-10 Impact factor: 2.175