A Useful Anatomical Reference Guide for Stem Anteversion during Total Hip Arthroplasty in the Dysplastic Hip.

Computed tomography scans of 50 dysplastic hips were obtained and reconstructed using preoperative planning software for total hip arthroplasty. The anteversion of the stem implanted parallel to the line connecting the trochanteric fossa and the middle of the medial cortex of the femoral neck (T line) was measured. The cutting heights of 5mm and 10mm above the lesser trochanter were simulated. The mean difference of the anteversion of the stem using the T line and the native femoral anteversion was 2.7° (95% CI: 1.0°-4.5°) and 3.5° (95% CI: 1.5°-5.5°) at cutting heights of 5mm and 10mm respectively. An anteversion using a T line is compatible with native femoral anteversion even in developmental dysplasia of the hip.

[1]  P. Kingsley,et al.  A study to determine the angle of anteversion of the neck of the femur. , 1948, The Journal of bone and joint surgery. American volume.

[2]  Carsten Perka,et al.  The association between the sagittal femoral stem alignment and the resulting femoral head centre in total hip arthroplasty , 2011, International Orthopaedics.

[3]  Burcin Unlu,et al.  Intraoperative estimation of femoral anteversion in cementless total hip arthroplasty using the lesser trochanter , 2011, Archives of Orthopaedic and Trauma Surgery.

[4]  R. Newell.  The calcar femorale: A tale of historical neglect , 1997, Clinical anatomy.

[5]  Tae Hyun Lee,et al.  The T-line as an intraoperative landmark for reproducing the native femoral anteversion during hip arthroplasty , 2014, Archives of Orthopaedic and Trauma Surgery.

[6]  R. G. Stiles,et al.  The calcar femorale. An anatomic, radiologic, and surgical correlative study. , 1990, Investigative radiology.

[7]  B. Zurfluh,et al.  Compliant positioning of total hip components for optimal range of motion , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[8]  G. Bergmann,et al.  Influence of femoral anteversion on proximal femoral loading: measurement and simulation in four patients. , 2001, Clinical biomechanics.

[9]  Aditya Maheshwari,et al.  Impingement with total hip replacement. , 2007, The Journal of bone and joint surgery. American volume.

[10]  L. Dorr,et al.  A comparison of surgeon estimation and computed tomographic measurement of femoral component anteversion in cementless total hip arthroplasty. , 2009, The Journal of bone and joint surgery. American volume.

[11]  Nobuhiko Sugano,et al.  Three-Dimensional Shape of the Dysplastic Femur: Implications for THR , 2003, Clinical orthopaedics and related research.

[12]  G. Pasquier,et al.  Accuracy of Reconstruction of the Hip Using Computerised Three-dimensional Pre-operative Planning and a Cementless Modular Neck Pre-operative Computerised Three-dimensional Planning Was Carried out in 223 Patients Undergoing Total Hip Replacement with a Cementless Acetabular Component and a Cementle , 2022 .

[13]  Nobuhiko Sugano,et al.  Evaluation of the accuracy of computed tomography-based navigation for femoral stem orientation and leg length discrepancy. , 2011, The Journal of arthroplasty.

[14]  H. Tullos,et al.  The morphology of the femur in developmental dysplasia of the hip , 1998 .

[15]  H. L. Roh,et al.  True femoral anteversion during primary total hip arthroplasty: use of postoperative computed tomography-based sections. , 2006, The Journal of arthroplasty.

[16]  H. Tullos,et al.  Effect of rotation on the radiographic appearance of the femoral canal. , 1994, The Journal of arthroplasty.

[17]  C. Ranawat,et al.  Total hip replacement in congenital dislocation and dysplasia of the hip. , 1979, The Journal of bone and joint surgery. American volume.

[18]  J. B. Griffin.  The calcar femorale redefined. , 1982, Clinical orthopaedics and related research.

[19]  W. Taylor,et al.  THA loading arising from increased femoral anteversion and offset may lead to critical cement stresses , 2003, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[20]  P. Noble,et al.  A comparison of alternative methods of measuring femoral anteversion. , 1998, Journal of computer assisted tomography.

[21]  Fumihiro Yoshimine,et al.  The safe-zones for combined cup and neck anteversions that fulfill the essential range of motion and their optimum combination in total hip replacements. , 2006, Journal of biomechanics.

[22]  I. A. Karnezis.  A technique for accurate reproduction of the femoral anteversion during primary total hip arthroplasty , 2001, Archives of Orthopaedic and Trauma Surgery.

[23]  A Rohlmann,et al.  Is staircase walking a risk for the fixation of hip implants? , 1995, Journal of biomechanics.