Extended Offset Stems Are Infrequently Required in Anterior Approach Total Hip Arthroplasty and Low Usage Does Not Compromise Stability

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2024 Mar 21

PMID 38512461

Authors

Edward Weldon

Keinan Agonias

James DeJesus

Rosana Hernandez Weldon

Donna Lyn M T Au

Cass K Nakasone

Affiliations

Soon will be listed here.

Abstract

Introduction: Extended offset (EO) stems are commonly used in posterior approach (PA) total hip arthroplasty (THA), but usage rates and complications are not well studied with anterior approach (AA) THA. This study evaluated usage rates, radiographic outcomes and complications following AA THA between patients receiving EO stems and a matched cohort receiving standard offset (SO) stems.

Materials And Methods: This retrospective review evaluated 1515 consecutive AA THA performed between 2014 and 2021. The recent 100 EO were included in radiographic and complication analysis and were matched to 100 SO stems based on stem size, procedure (unilateral/bilateral), sex, body mass index (BMI), and age. Data collection included patient demographics; pre- and postoperative radiographic measurements of leg length difference (LLD) and global hip offset difference (GHOD); and complications within 1 year. Independent t-tests and Chi-squared analyses compared EO and SO groups.

Results: EO was utilized in 8% of all AA THA. Despite matching procedures, the distribution of racial groups was different between EO and SO groups, respectively: Caucasian (75% vs. 43%), Asian (12% vs. 35%), Native Hawaiian/Pacific Islander (NHPI) (9% vs. 13%), and other (4% vs. 9%) (p < 0.001). No fractures, dislocations, or revisions occurred within 1 year after surgery in either group. One deep infection was noted in the SO group. The proportions of patients following surgery who had a GHOD < 6 mm (76% vs. 82%; p = 0.193) and LLD < 6 mm (81% vs. 86%; p = 0.223) were not significantly different between EO and SO groups, respectively.

Conclusions: Prioritizing hip symmetry over stability results in a high proportion of patients achieving hip symmetry without high usage of EO stems in AA THA. Furthermore, low use of EO stems did not result in increased dislocations. Due to racial anatomical differences, Caucasian patients required EO stems to achieve hip symmetry more frequently than Asian and NHPI patients.

Citing Articles

No differences in clinical and radiographic outcomes between standard versus high offset collared stems for primary total hip arthroplasty at five years follow-up.

Jacquot L, Machenaud A, Grew B, Ramos-Pascual S, Dubreuil S, Saffarini M Int Orthop. 2024; 48(10):2525-2533.

PMID: 39112838 DOI: 10.1007/s00264-024-06264-8.

References

Ferguson R, Palmer A, Taylor A, Porter M, Malchau H, Glyn-Jones S . Hip replacement. Lancet. 2018; 392(10158):1662-1671. DOI: 10.1016/S0140-6736(18)31777-X. View

Mei X, Gong Y, Safir O, Gross A, Kuzyk P . Long-term outcomes of total hip arthroplasty in patients younger than 55 years: a systematic review of the contemporary literature. Can J Surg. 2019; 62(4):249-258. PMC: 6660275. DOI: 10.1503/cjs.013118. View

Lecerf G, Fessy M, Philippot R, Massin P, Giraud F, Flecher X . Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res. 2009; 95(3):210-9. DOI: 10.1016/j.otsr.2009.03.010. View

Desai A, Dramis A, Board T . Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med. 2013; 6(4):336-41. PMC: 4094096. DOI: 10.1007/s12178-013-9180-0. View

Debbi E, Rajaee S, Mayeda B, Penenberg B . Determining and Achieving Target Limb Length and Offset in Total Hip Arthroplasty Using Intraoperative Digital Radiography. J Arthroplasty. 2019; 35(3):779-785. DOI: 10.1016/j.arth.2019.10.003. View

Clement N, S Patrick-Patel R, MacDonald D, Breusch S . Total hip replacement: increasing femoral offset improves functional outcome. Arch Orthop Trauma Surg. 2016; 136(9):1317-1323. PMC: 4990628. DOI: 10.1007/s00402-016-2527-4. View

Vigdorchik J, Sharma A, Elbuluk A, Carroll K, Mayman D, Lieberman J . High Offset Stems Are Protective of Dislocation in High-Risk Total Hip Arthroplasty. J Arthroplasty. 2020; 36(1):210-216. DOI: 10.1016/j.arth.2020.07.016. View

Zahar A, Rastogi A, Kendoff D . Dislocation after total hip arthroplasty. Curr Rev Musculoskelet Med. 2013; 6(4):350-6. PMC: 4094102. DOI: 10.1007/s12178-013-9187-6. View

Dargel J, Oppermann J, Bruggemann G, Eysel P . Dislocation following total hip replacement. Dtsch Arztebl Int. 2015; 111(51-52):884-90. PMC: 4298240. DOI: 10.3238/arztebl.2014.0884. View

10.

Burzynski S, Sabik A, Witkowski W, Luczkiewicz P . Influence of the femoral offset on the muscles passive resistance in total hip arthroplasty. PLoS One. 2021; 16(5):e0250397. PMC: 8096111. DOI: 10.1371/journal.pone.0250397. View

11.

Jinno T, Koga D, Asou Y, Morita S, Okawa A, Muneta T . Intraoperative evaluation of the effects of femoral component offset and head size on joint stability in total hip arthroplasty. J Orthop Surg (Hong Kong). 2017; 25(1):2309499016684298. DOI: 10.1177/2309499016684298. View

12.

Weber M, Merle C, Nawabi D, Dendorfer S, Grifka J, Renkawitz T . Inaccurate offset restoration in total hip arthroplasty results in reduced range of motion. Sci Rep. 2020; 10(1):13208. PMC: 7413373. DOI: 10.1038/s41598-020-70059-1. View

13.

Matta J, Shahrdar C, Ferguson T . Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res. 2005; 441:115-24. DOI: 10.1097/01.blo.0000194309.70518.cb. View

14.

Luu K, Nishioka S, Lawton D, Unebasami E, Andrews S, Nakasone C . Influence of obesity and intra-operative imaging guidance technology on acetabular cup positioning in total hip arthroplasty. Arch Orthop Trauma Surg. 2023; 143(11):6857-6863. DOI: 10.1007/s00402-023-04922-x. View

15.

Thorne T, Nishioka S, Andrews S, Mathews K, Nakasone C . Component placement accuracy of two digital intraoperative fluoroscopy supplementation systems in direct anterior total hip arthroplasty. Arch Orthop Trauma Surg. 2021; 142(6):1283-1288. DOI: 10.1007/s00402-021-04008-6. View

16.

Thorne T, Nishioka S, Andrews S, Mathews K, Nakasone C . Comparison of Component Placement Accuracy Using Two Intraoperative Fluoroscopic Grid Technologies During Direct Anterior Total Hip Arthroplasty. J Arthroplasty. 2020; 35(12):3601-3606. DOI: 10.1016/j.arth.2020.06.053. View

17.

Amirouche F, Solitro G, Chandrasekaran S, Domb B, Gonzalez M . Validating a Modified Circle Theorem Method for the Measurement of Acetabular Cup Anteversion on Plain Radiography with Intra-Operative Data from Robotic Assisted Total Hip Arthroplasty. J Arthroplasty. 2015; 31(1):323-9. DOI: 10.1016/j.arth.2015.07.042. View

18.

Hayashi S, Nishiyama T, Fujishiro T, Hashimoto S, Kanzaki N, Nishida K . Excessive femoral offset does not affect the range of motion after total hip arthroplasty. Int Orthop. 2013; 37(7):1233-7. PMC: 3685658. DOI: 10.1007/s00264-013-1881-x. View

19.

Elkins J, Daniel M, Pedersen D, Singh B, Yack H, Callaghan J . Morbid obesity may increase dislocation in total hip patients: a biomechanical analysis. Clin Orthop Relat Res. 2012; 471(3):971-80. PMC: 3563777. DOI: 10.1007/s11999-012-2512-3. View

20.

Haynes J, Hopper Jr R, Ho H, McDonald 3rd J, Parks N, Hamilton W . Direct Anterior Approach for Primary Total Hip Arthroplasty Lowers the Risk of Dislocation Compared to the Posterior Approach: A Single Institution Experience. J Arthroplasty. 2021; 37(3):495-500. DOI: 10.1016/j.arth.2021.11.011. View