Increased Anteversion of Press-fit Femoral Stems Compared with Anatomic Femur

Overview

Journal Clin Orthop Relat Res

Publisher Wolters Kluwer

Specialty Orthopedics

Date 2011 Jul 26

PMID 21786055

Citations 19

Authors

Roger H Emerson Jr

Affiliations

Soon will be listed here.

Abstract

Background: With contemporary canal-filling press-fit stems, there is no adjustability of stem position in the canal and therefore the canal anatomy determines stem version. Stem version will affect head/neck impingement, polyethylene wear from edge loading, and hip stability, but despite this, the postoperative version of a canal-filling press-fit stem is unclear.

Questions/purposes: Is there a difference between the version of the nonoperated femur and the final version of a canal-filling press-fit femoral component? Could a difference create an alignment problem for the hip replacement?

Methods: Sixty-four hips were studied with fluoroscopy and 46 nonarthritic and 41 arthritic hips were studied with MRI. A standardized fluoroscopic technique for determining preoperative and postoperative femoral version was developed with the patient supine on a fracture table undergoing supine total hip arthroplasty. To validate the methods, the results were compared with two selected series of axial MRI views of the hip comparing the version of the head with the version of the canal at the base of the neck.

Results: For the operated hips, the mean anatomic hip version was less than the stem version: 18.9° versus 27.0°. The difference on average was 8.1° of increased anteversion (SD, 7.4°). Both MRI series showed the femoral neck was more anteverted on average than the femoral head, thereby explaining the operative findings.

Conclusion: With a canal-filling press-fit femoral component there is wide variation of postoperative component anteversion with most stems placed in increased anteversion compared with the anatomic head. The surgical technique may need to adjust for this if causing intraoperative impingement or instability.

Citing Articles

Femoral Neck Anteversion: Which Distal Femur Landmark Matters?.

Davis E, LeBrun D, McCarthy T, Westrich G Arthroplast Today. 2024; 26:101318.

PMID: 38440289 PMC: 10910236. DOI: 10.1016/j.artd.2024.101318.

Variety of femoral anteversion and its measurement in cementless total hip arthroplasty: Does robotic technology improve accuracy?.

Shao H, Huang Y, Yang D, Deng W, Wu X, Zhou Y J Orthop Surg Res. 2024; 19(1):47.

PMID: 38195511 PMC: 10775668. DOI: 10.1186/s13018-024-04527-z.

Cemented or uncemented fixation: Which allows a more acceptable prosthetic femoral version in total hip arthroplasty?.

Moralidou M, Di Laura A, Hothi H, Henckel J, Hart A J Orthop Surg Res. 2023; 18(1):948.

PMID: 38071336 PMC: 10710710. DOI: 10.1186/s13018-023-04331-1.

Accuracy of Positioning and Risk Factors for Malpositioning Custom-Made Femoral Stems in Total Hip Arthroplasty-A Retrospective Multicenter Analysis.

Anderson P, Heinz T, Rak D, Arnholdt J, Holzapfel B, Dorsch S J Pers Med. 2023; 13(9).

PMID: 37763052 PMC: 10532930. DOI: 10.3390/jpm13091285.

Total Hip Arthroplasty through Direct Anterior Approach in a Patient with Ipsilateral Knee Arthrodesis: A Case Report.

Follet L, Verhelst L, Ghijselings S, Liekens K J Orthop Case Rep. 2023; 13(1):81-86.

PMID: 37143554 PMC: 10152964. DOI: 10.13107/jocr.2023.v13.i01.3524.

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