Skip to main content
SpringerLink
Log in

Anatomic stem inserted according to native anteversion could reproduce the native anterior distance of the femoral head and decrease bony impingement in total hip arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

To investigate whether anatomic and straight stems could reproduce the anteroposterior distance (AD) of the native femoral head and evaluate the effect of AD of the femoral head on range of motion (ROM) and bony impingement.

Methods

This retrospective simulation study included 64 patients who had undergone primary total hip arthroplasty between 2012 and 2014. Using computed tomography (CT)–based templating software, anatomic and straight stems were inserted with same alignment. AD of the head centre was compared between the two stems and native anatomy. Furthermore, post-operative ROM was calculated, and correlation between AD and ROM was assessed.

Results

There was a strong positive correlation between native anteversion (mean 21.9°) and anatomic stem anteversion (mean 22.5°) (R = 0.975, P < 0.001). There was no significant difference in AD between the native and anatomic stems (mean 37.7 and 38.8 mm, respectively), but AD of the straight stem was significantly lower than that of the native and anatomic stems. The straight stem showed a significantly lower ROM in flexion and internal rotation angles with 90° flexion (IR) than the anatomic stem (P < 0.05 and P < 0.001, respectively). AD showed a stronger correlation with ROM of IR than with stem anteversion.

Conclusions

The anatomic stem could reproduce AD of the native femoral head centre, but the head centre of the straight stem in the same anteversion with anatomic stem translated significantly posterior, significantly decreasing the ROM of flexion and IR and increasing bony impingement of IR. To avoid bony impingement and acquire sufficient ROM, reproducing AD was important.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Gwam CU, Mistry JB, Mohamed NS et al (2017) Current epidemiology of revision total hip arthroplasty in the United States: national inpatient sample 2009 to 2013. J Arthroplast 32:2088–2092

    Article  Google Scholar 

  2. Falez F, Papalia M, Favetti F, Panegrossi G, Casella F, Mazzotta G (2017) Total hip arthroplasty instability in Italy. Int Orthop 41:635–644

    Article  Google Scholar 

  3. Widmer KH, Zurfluh B (2004) Compliant positioning of total hip components for optimal range of motion. J Orthop Res 22:815–821

    Article  Google Scholar 

  4. Weber M, Woerner M, Craiovan B et al (2016) Current standard rules of combined anteversion prevent prosthetic impingement but ignore osseous contact in total hip arthroplasty. Int Orthop 40:2495–2504

    Article  Google Scholar 

  5. Shoji T, Yasunaga Y, Yamasaki T, Mori R, Hamanishi M, Ochi M (2013) Bony impingement depends on the bone morphology of the hip after total hip arthroplasty. Int Orthop 37:1897–1903

    Article  Google Scholar 

  6. Hetsroni I, Poultsides L, Bedi A, Larson CM, Kelly BT (2013) Anterior inferior iliac spine morphology correlates with hip range of motion: a classification system and dynamic model. Clin Orthop Relat Res 471:2497–2503

    Article  Google Scholar 

  7. Hirata M, Nakashima Y (2015) Optimal anterior femoral offset for functional range of motion in total hip arthroplasty — a computer simulation study. Int Orthop 39:645–651

    Article  Google Scholar 

  8. Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS (1988) The anatomic basis of femoral component design. Clin Orthop Relat Res 235:148–165

    Google Scholar 

  9. Shoji T, Yamasaki T, Izumi S et al (2017) Factors affecting the potential for posterior bony impingement after total hip arthroplasty. Bone Joint J 99B:1140–1146

    Article  Google Scholar 

  10. Ohmori T, Kabata T, Kajino Y et al (2018) Differences in range of motion with the same combined anteversion after total hip arthroplasty. Int Orthop 42:1021–1028

    Article  Google Scholar 

  11. Miki H, Kyo T, Sugano N (2012) Anatomical hip range of motion after implantation during total hip arthroplasty with a large change in pelvic inclination. J Arthroplast 27:1641–1650.e1

    Article  Google Scholar 

  12. Kingsley PC, Olmsted KL (1948) A study to determine the angle of anteversion of the neck of the femur. J Bone Joint Surg Am 30A:745–751

    Article  CAS  Google Scholar 

  13. Sugano N, Noble PC, Kamaric E, Salama JK, Ochi T, Tullos HS (1998) The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br 80:711–719

    Article  CAS  Google Scholar 

  14. Khanuja BHS, Vakil JJ, Goddard MS, Mont MA (2011) Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am 93:500–509

    Article  Google Scholar 

  15. Yoshitani J, Kabata T, Kajino Y, Takagi T, Ohmori T, Ueno T (2018) The effect of flexion alignment in total hip arthroplasty with a cementless tapered wedge femoral stem. Eur J Orthop Surg Traumatol 28:1625–1632

    Article  Google Scholar 

  16. Worlicek M, Weber M, Craiovan B et al (2016) Native femoral anteversion should not be used as reference in cementless total hip arthroplasty with a straight, tapered stem: a retrospective clinical study. BMC Musculoskelet Disord 17:1–8

    Article  Google Scholar 

  17. Müller M, Crucius D, Perka C, Tohtz S (2011) The association between the sagittal femoral stem alignment and the resulting femoral head centre in total hip arthroplasty. Int Orthop 35:981–987

    Article  Google Scholar 

  18. Miki H, Sugano N (2011) Modular neck for prevention of prosthetic impingement in cases with excessively anteverted femur. Clin Biomech (Bristol, Avon) 26:944–949

    Article  Google Scholar 

  19. Taniguchi N, Jinno T, Koga D et al (2017) Cementless hip stem anteversion in the dysplastic hip: a comparison of tapered wedge vs metaphyseal filling. J Arthroplast 32:1547–1552

    Article  Google Scholar 

  20. Yoshitani J, Nakamura T, Maruhashi Y, Sasagawa T, Ueshima K, Funaki K (2019) Modular stem fracture at stem-sleeve junction after primary total hip arthroplasty. J Orthop Sci 24:170–173

    Article  Google Scholar 

  21. Tsukeoka T, Tsuneizumi Y, Lee TH (2015) A useful anatomical reference guide for stem anteversion during total hip arthroplasty in the dysplastic hip. J Arthroplast 30:1393–1396

    Article  Google Scholar 

  22. Woerner M, Weber M, Sendtner E, Springorum R, Worlicek M, Craiovan B et al (2017) Soft tissue restricts impingement-free mobility in total hip arthroplasty. Int Orthop 41:277–282

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan

    Junya Yoshitani, Tamon Kabata, Yoshitomo Kajino, Takuro Ueno, Ken Ueoka, Yuki Yamamuro & Hiroyuki Tsuchiya

Authors
  1. Junya Yoshitani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tamon Kabata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshitomo Kajino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takuro Ueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ken Ueoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuki Yamamuro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroyuki Tsuchiya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tamon Kabata.

Ethics declarations

Ethical approval

This investigational protocol was conducted with the approval of the institution’s ethics committee.

Informed consent

All patients gave their consent for the use of their data prior to surgery.

Ethical review committee statement

This investigational protocol was conducted with the approval of the Kanazawa University Graduate School of Medical Science Ethics Committee.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshitani, J., Kabata, T., Kajino, Y. et al. Anatomic stem inserted according to native anteversion could reproduce the native anterior distance of the femoral head and decrease bony impingement in total hip arthroplasty. International Orthopaedics (SICOT) 44, 245–251 (2020). https://doi.org/10.1007/s00264-019-04394-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-019-04394-y

Keywords

Search

Navigation