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Validity of the intra-operative measurement of stem anteversion and factors for the erroneous estimation in cementless total hip arthroplasty using postero-lateral approach - 24/04/18

Doi : 10.1016/j.otsr.2017.11.023 
Y.K. Lee a, 1, J.W. Kim a, 1, T.Y. Kim b, c, , Y.C. Ha d, K.H. Koo a
a Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, 166 Gumi-ro, Bundang-gu, Seongnam 463-707 South Korea 
b Hallym University Sacred Heart Hospital, Department of Orthopaedic Surgery, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, South Korea 
c Konkuk University Medical Center, Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul 05030, South Korea 
d Chung-Ang University, College of Medicine, Department of Orthopaedic Surgery, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, South Korea 

Corresponding author at: Konkuk University Medical Center, Department of Orthopaedic Surgery, School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea.Konkuk University Medical Center, Department of Orthopaedic Surgery, School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea.

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Abstract

Background

Intra-operative estimation of stem anteversion in total hip arthroplasty (THA) using postero-lateral approach is made by the surgeon's visual assessment, using the tibia as a guide, with the assumption that tibial axis is vertical to the trans-epicondylar axis. However, the accuracy of the intra-operative estimation has rarely been verified with postoperative CT-scans, with controversies regarding these measurements particularly in case of knee osteoarthritis. Therefore we performed a prospective study to: (1) determine the accuracy of the intra-operative measurement and (2) investigate factors affecting the discrepancy between the surgeon's estimation and the real stem anteversion.

Hypothesis

Intra-operative estimation of stem anteversion correlated with the real stem anteversion on CT-scan.

Patients and methods

Sixty-seven THAs using cementless straight stems (65 patients) without ipsilateral total knee arthroplasty were prospectively evaluated to compare the intra-operative measurement of stem anteversion with the real stem anteversion on computed tomography (CT) scans. There were 33 men and 34 women with a mean age of 59.7years (range, 27–84years) at the time of surgery. Age, tibia plateau angle, native femoral anteversion, femoro-tibial angle, body mass index, operative site, gender, coronal and sagittal tilt of the stem, stem type, ipsilateral knee osteoarthritis, and preoperative diagnosis were analyzed to evaluate the factors affecting the discrepancy between the intra-operative and CT measurements.

Results

The intra-operative estimation (mean, 21.5°±8.5°; range, 5.0°–39.0°) was greater than the CT measurement (mean, 19.5°±8.7°; range, 4.5°–38.5°) by 2.0°. The mean absolute value of discrepancy was 4.5°. The correlation coefficient between intra-operative and CT measurements was 0.837. The femoro-tibial angle was associated with the discrepancy between the two measurements. In the presence of genu varum deformity, the intra-operative measurement underestimated the stem anteversion.

Discussion

Although intra-operative estimation of stem anteversion was slightly greater than the real stem anteversion, there was an excellent correlation between the two. The femoro-tibial angle should be considered to optimize the stem anteversion during cementless THA using postero-lateral approach.

Level of evidence

Level III, prospective case control study.

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Keywords : Intra-operative estimation, Anteversion, Femoro-tibial angle, Cementless stem, Total hip arthroplasty, Postero-lateral approach


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Vol 104 - N° 3

P. 341-346 - mai 2018 Retour au numéro
Article précédent Article précédent
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