Journal List > Hip Pelvis > v.25(2) > 1081967

Yun, Yoon, Lee, Yun, and Kim: The Usefulness of Intraoperative Radiography for Prevention of Malalignment of the Cemented Femoral Stem

Abstract

Purpose

The purpose of this study was to evaluate the usefulness of our method, which estimated femoral stem alignment using a c-arm when the broach was inserted, for prevention of femoral stem malalignment.

Materials and Methods

A total of 103 hips were enrolled in this study. All patients underwentprimary hip arthroplasty from October 2011 to February 2013. The study was conductedretrospectively. Intraoperative estimated femoral stem alignments and final femoral stem alignments were classified into three groups. Multinomial logistic regression analysis was performed for analysis of factors (age, sex, diagnosis, body mass index, femoral stem size, osteoporosis, and proximal demur geometry) thatmight affect intraoperatively estimated femoral stem alignment.

Results

The distribution of intraoperative estimated femoral stem alignment was 80(78%) in the neutral group, 18(17%) in the varus group, and 5(5%) in the valgus group. The distribution of final femoral stem alignment was 100(97%) in the neutral group, 2(2%) in the varus group, and 1(1%) in the valgus group. There was no statistically significant factor affecting the intraoperatively estimated femoral stem alignment.

Conclusion

Intraoperative estimated femoral stem alignment using a c-arm is an effective method for prevention of femoral stem malalignment.

Figures and Tables

Fig. 1
(A, B) The radiographs show estimated varus femoral stem malalignment is corrected to neutral femoral stem alignment. (C, D) The radiographs show estimated valgus femoral stem malalignment is corrected to neutral femoral stem alignment.
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Fig. 2
(A, B) The radiographs show thin cement mantle thickness is expected in the lateral area of distal femoral stem and its corrected condition. (C, D) The radiographs show thin cement mantle thickness is expected in the medial area of distal femoral stem and its corrected condition.
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Table 1
The Results of Multinomial Logistic Regression Analysis Associated with Intraoperative Estimated Femoral Stem Malalignment
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Table 2
Established Results for Femoral Stem Alignment
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References

1. Kitada M, Nakamura N, Iwana D, Kakimoto A, Nishii T, Sugano N. Evaluation of the accuracy of computed tomography-based navigation for femoral stem orientation and leg length discrepancy. J Arthroplasty. 2011; 26:674–679.
crossref
2. Herrlin K, Pettersson H, Selvik G, Lidgren L. Femoral anteversion and restricted range of motion in total hip prostheses. Acta Radiol. 1988; 29:551–553.
crossref
3. Müller M, Crucius D, Perka C, Tohtz S. The association between the sagittal femoral stem alignment and the resulting femoral head centre in total hip arthroplasty. Int Orthop. 2011; 35:981–987.
crossref
4. Min BW, Song KS, Bae KC, Cho CH, Kang CH, Kim SY. The effect of stem alignment on results of total hip arthroplasty with a cementless tapered-wedge femoral component. J Arthroplasty. 2008; 23:418–423.
crossref
5. Patel AB, Wagle RR, Usrey MM, Thompson MT, Incavo SJ, Noble PC. Guidelines for implant placement to minimize impingement during activities of daily living after total hip arthroplasty. J Arthroplasty. 2010; 25:1275–1281.
crossref
6. Khalily C, Lester DK. Results of a tapered cementless femoral stem implanted in varus. J Arthroplasty. 2002; 17:463–466.
crossref
7. Vresilovic EJ, Hozack WJ, Rothman RH. Radiographic assessment of cementless femoral components. Correlation with intraoperative mechanical stability. J Arthroplasty. 1994; 9:137–141.
8. Jaffe WL, Hawkins CA. Normalized and proportionalized cemented femoral stem survivorship at 15 years. J Arthroplasty. 1999; 14:708–713.
crossref
09. Munuera L, Garcia-Cimbrelo E. The femoral component in low-friction arthroplasty after ten years. Clin Orthop Relat Res. 1992; 163–175.
crossref
10. Davis ET, Gallie P, Macgroarty K, Waddell JP, Schemitsch E. The accuracy of image-free computer navigation in the placement of the femoral component of the Birmingham Hip Resurfacing: a cadaver study. J Bone Joint Surg Br. 2007; 89:557–560.
11. Hananouchi T, Sugano N, Nakamura N, et al. Preoperative templating of femoral components on plain X-rays. Rotational evaluation with synthetic X-rays on ORTHODOC. Arch Orthop Trauma Surg. 2007; 127:381–385.
crossref
12. Miller RG. Osteoporosis in postmenopausal women. Therapy options across a wide range of risk for fracture. Geriatrics. 2006; 61:24–30.
13. Hauschild O, Ghanem N, Oberst M, et al. Evaluation of Singh index for assessment of osteoporosis using digital radiography. Eur J Radiol. 2009; 71:152–158.
crossref
14. Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone. 1993; 14:231–242.
crossref
15. Reitman RD, Emerson R, Higgins L, Head W. Thirteen year results of total hip arthroplasty using a tapered titanium femoral component inserted without cement in patients with type C bone. J Arthroplasty. 2003; 18:116–121.
crossref
16. Mollan RA, Watters PH, Steele R, McClelland CJ. Failure of the femoral component in the Howse total hip arthroplasty. Clin Orthop Relat Res. 1984; 142–147.
crossref
17. Garcia-Cimbrelo E, Cruz-Pardos A, Madero R, Ortega-Andreu M. Total hip arthroplasty with use of the cementless Zweymüller Alloclassic system. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 2003; 85-A:296–303.
18. Schramm M, Keck F, Hohmann D, Pitto RP. Total hip arthroplasty using an uncemented femoral component with taper design: outcome at 10-year follow-up. Arch Orthop Trauma Surg. 2000; 120:407–412.
crossref
19. Devitt A, O'Sullivan T, Quinlan W. 16- to 25-year follow-up study of cemented arthroplasty of the hip in patients aged 50 years or younger. J Arthroplasty. 1997; 12:479–489.
crossref
20. Munuera L, Garcia-Cimbrelo E. The femoral component in low-friction arthroplasty after ten years. Clin Orthop Relat Res. 1992; 163–175.
crossref
21. Macpherson GJ, Hank C, Schneider M, et al. The posterior approach reduces the risk of thin cement mantles with a straight femoral stem design. Acta Orthop. 2010; 81:292–295.
crossref
22. Ebramzadeh E, Sarmiento A, McKellop HA, Llinas A, Gogan W. The cement mantle in total hip arthroplasty. Analysis of long-term radiographic results. J Bone Joint Surg Am. 1994; 76:77–87.
crossref
23. Joshi RP, Eftekhar NS, McMahon DJ, Nercessian OA. Osteolysis after Charnley primary low-friction arthroplasty. A comparison of two matched paired groups. J Bone Joint Surg Br. 1998; 80:585–590.
24. Smith SW, Estok DM 2nd, Harris WH. Total hip arthroplasty with use of second-generation cementing techniques. An eighteen-year-average follow-up study. J Bone Joint Surg Am. 1998; 80:1632–1640.
crossref
25. Woolson ST, Milbauer JP, Bobyn JD, Yue S, Maloney WJ. Fatigue fracture of a forged cobalt-chromium-molybdenum femoral component inserted with cement. A report of ten cases. J Bone Joint Surg Am. 1997; 79:1842–1848.
crossref
26. Kawate K, Ohmura T, Hiyoshi N, Natsume Y, Teranishi T, Tamai S. Thin cement mantle and osteolysis with a precoated stem. Clin Orthop Relat Res. 1999; 124–129.
crossref
27. Mann KA, Gupta S, Race A, Miller MA, Cleary RJ, Ayers DC. Cement microcracks in thin-mantle regions after in vitro fatigue loading. J Arthroplasty. 2004; 19:605–612.
crossref
28. Ramos A, Simões JA. The influence of cement mantle thickness and stem geometry on fatigue damage in two different cemented hip femoral prostheses. J Biomech. 2009; 42:2602–2610.
crossref
29. Barrack RL, Mulroy RD Jr, Harris WH. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review. J Bone Joint Surg Br. 1992; 74:385–389.
crossref
30. Yi JW, Shon WY, Huh CH, Yun HH, Huh YJ. Follow-up study of the cemented polished femoral stem for more than five years. J Korean Hip Soc. 2011; 23:25–31.
crossref
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