Useful Method for Neutral Positioning of the Femoral Stem in Cementless Total Hip Arthroplasty

Woo-Jong Kim; Jong-Seok Park; Jae-Wan Soh; Jung-Woo Ji; Jae-Hwi Noh; Sung-Hun Won; Byung-Woong Jang; Chang-Hyun Kim; You-Sung Suh

doi:10.5371/hp.2012.24.4.288

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Kim, Park, Soh, Ji, Noh, Won, Jang, Kim, and Suh: Useful Method for Neutral Positioning of the Femoral Stem in Cementless Total Hip Arthroplasty

Original Article

Hip & Pelvis

Hip & Pelvis 2012; 24(4): 288-294.

Published online: 31 December 2012

DOI: https://doi.org/10.5371/hp.2012.24.4.288

Useful Method for Neutral Positioning of the Femoral Stem in Cementless Total Hip Arthroplasty

Woo-Jong Kim, MD, Jong-Seok Park, MD, Jae-Wan Soh, MD, Jung-Woo Ji, MD^*, Jae-Hwi Noh, MD, Sung-Hun Won, MD^*, Byung-Woong Jang, MD, Chang-Hyun Kim, MD^*, You-Sung Suh, MD^*

Department of Orthopaedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.

^*Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.

Address reprint request to Jong-Seok Park, MD. Department of Orthopaedic Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 330-903, Korea. TEL: +82-41-570-2170, FAX: +82-41-572-7234, jsparksch@schmc.ac.kr

Received 16 July 2012 Revised 5 December 2012 Accepted 7 December 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to evaluate the usefulness of a method for positioning the femoral stem in neutral position refer to the measured value of "lateral distance" in pre-operative templating and the femoral stem position post-operatively.

Materials and Methods

A total of 81 hips in 76 patients underwent cementless total hip arthroplasty between March 2008 and April 2012 using the C2 stem (Lima Corporate S.P.A, Udine, Italy). We measured the perpendicular distance from the lateral outermost part of the greater trochanter to the lateral outermost part of the femoral stem (lateral distance, LD) in pre-operative templating. We aimed to insert the femoral stem in neutral position by comparing LD measured intra-operatively. We evaluated the position of the femoral stem on post-operative plain radiography. We compared the result of post-operative re-measurement of the LD with that of pre-operative measurement.

Results

In all of the 81 cases, the femoral stem was inserted in neutral position, defined as the femoral stem position within 3°valgus or varus. The average angle of the inserted femoral stem was 1.20°(0.003-2.85°). LD measured in preoperative templating was 15.6 mm(10-21.5 mm), and it showed no correlation ratio with LD; LD re-measured post-operatively was 15.9 mm(10.3-23.5 mm) (P=0.781).

Conclusion

Measuring LD pre-operatively and using the value intra-operatively is an effective method for insertion of the femoral stem in neutral position.

Keywords: Preoperative templating, Lateral distance, Neutral position, Cementless total hip arthroplasty

Figures and Tables

Fig. 1

The titanium alloy (titanium, 6% aluminum, 4% vanadium) implant used in this study features a tapered wedge geometry, rectangular in cross-section, with a sand-blasted surface (C2 stem; Lima Corporate S.P.A, Udine, Italy).

Fig. 2

Preoperative "monitor templating" for measuring lateral distance (LD) in 115% magnified radiograph of anteroposterior view of left hip in picture archiving communication system. Lateral distance between lateral side of the implant and outmost lateral side of greater trochanter was measured.

Fig. 3

An image showing the measurement of the operative lateral distance for left hip.

Fig. 4

Postoperative radiograph shows (A) the method used to measure alignment and (B) lateral distance in the coronal plnae. Lines were described parallel to the femoral shaft and to the long axis of the implant, and the angle between was measured.

Table 1

Intra- and Interobserver Reliability of Measurements on Radiography of Stem Alignment, Pre- and Post-Operative Lateral Distance

^*LD: Lateral Distance

^†ICC: Intraclass Correlation Coefficient

^‡CI: Confidence Interval

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