Validity of the intra-operative measurement of stem anteversion and factors for the erroneous estimation in cementless total hip arthroplasty using postero-lateral approach

Young Kyun Lee, J. W. Kim, T. Y. Kim, Y. C. Ha, Kyunghoi Koo

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Intra-operative estimation of stem anteversion in total hip arthroplasty (THA) using postero-lateral approach is made by the surgeon's visual assessment, using the tibia as a guide, with the assumption that tibial axis is vertical to the trans-epicondylar axis. However, the accuracy of the intra-operative estimation has rarely been verified with postoperative CT-scans, with controversies regarding these measurements particularly in case of knee osteoarthritis. Therefore we performed a prospective study to: (1) determine the accuracy of the intra-operative measurement and (2) investigate factors affecting the discrepancy between the surgeon's estimation and the real stem anteversion. Hypothesis: Intra-operative estimation of stem anteversion correlated with the real stem anteversion on CT-scan. Patients and methods: Sixty-seven THAs using cementless straight stems (65 patients) without ipsilateral total knee arthroplasty were prospectively evaluated to compare the intra-operative measurement of stem anteversion with the real stem anteversion on computed tomography (CT) scans. There were 33 men and 34 women with a mean age of 59.7 years (range, 27–84 years) at the time of surgery. Age, tibia plateau angle, native femoral anteversion, femoro-tibial angle, body mass index, operative site, gender, coronal and sagittal tilt of the stem, stem type, ipsilateral knee osteoarthritis, and preoperative diagnosis were analyzed to evaluate the factors affecting the discrepancy between the intra-operative and CT measurements. Results: The intra-operative estimation (mean, 21.5° ± 8.5°; range, 5.0°–39.0°) was greater than the CT measurement (mean, 19.5° ± 8.7°; range, 4.5°–38.5°) by 2.0°. The mean absolute value of discrepancy was 4.5°. The correlation coefficient between intra-operative and CT measurements was 0.837. The femoro-tibial angle was associated with the discrepancy between the two measurements. In the presence of genu varum deformity, the intra-operative measurement underestimated the stem anteversion. Discussion: Although intra-operative estimation of stem anteversion was slightly greater than the real stem anteversion, there was an excellent correlation between the two. The femoro-tibial angle should be considered to optimize the stem anteversion during cementless THA using postero-lateral approach. Level of evidence: Level III, prospective case control study.

Original languageEnglish
Pages (from-to)341-346
Number of pages6
JournalOrthopaedics and Traumatology: Surgery and Research
Volume104
Issue number3
DOIs
StatePublished - 1 May 2018

Fingerprint

Arthroplasty
Hip
Tomography
Knee Osteoarthritis
Tibia
Genu Varum
Tacrine
Knee Replacement Arthroplasties
Thigh
Case-Control Studies
Body Mass Index
Prospective Studies
Surgeons

Keywords

  • Anteversion
  • Cementless stem
  • Femoro-tibial angle
  • Intra-operative estimation
  • Postero-lateral approach
  • Total hip arthroplasty

Cite this

@article{5497c199f86142e3a4452b8a75653b99,
title = "Validity of the intra-operative measurement of stem anteversion and factors for the erroneous estimation in cementless total hip arthroplasty using postero-lateral approach",
abstract = "Background: Intra-operative estimation of stem anteversion in total hip arthroplasty (THA) using postero-lateral approach is made by the surgeon's visual assessment, using the tibia as a guide, with the assumption that tibial axis is vertical to the trans-epicondylar axis. However, the accuracy of the intra-operative estimation has rarely been verified with postoperative CT-scans, with controversies regarding these measurements particularly in case of knee osteoarthritis. Therefore we performed a prospective study to: (1) determine the accuracy of the intra-operative measurement and (2) investigate factors affecting the discrepancy between the surgeon's estimation and the real stem anteversion. Hypothesis: Intra-operative estimation of stem anteversion correlated with the real stem anteversion on CT-scan. Patients and methods: Sixty-seven THAs using cementless straight stems (65 patients) without ipsilateral total knee arthroplasty were prospectively evaluated to compare the intra-operative measurement of stem anteversion with the real stem anteversion on computed tomography (CT) scans. There were 33 men and 34 women with a mean age of 59.7 years (range, 27–84 years) at the time of surgery. Age, tibia plateau angle, native femoral anteversion, femoro-tibial angle, body mass index, operative site, gender, coronal and sagittal tilt of the stem, stem type, ipsilateral knee osteoarthritis, and preoperative diagnosis were analyzed to evaluate the factors affecting the discrepancy between the intra-operative and CT measurements. Results: The intra-operative estimation (mean, 21.5° ± 8.5°; range, 5.0°–39.0°) was greater than the CT measurement (mean, 19.5° ± 8.7°; range, 4.5°–38.5°) by 2.0°. The mean absolute value of discrepancy was 4.5°. The correlation coefficient between intra-operative and CT measurements was 0.837. The femoro-tibial angle was associated with the discrepancy between the two measurements. In the presence of genu varum deformity, the intra-operative measurement underestimated the stem anteversion. Discussion: Although intra-operative estimation of stem anteversion was slightly greater than the real stem anteversion, there was an excellent correlation between the two. The femoro-tibial angle should be considered to optimize the stem anteversion during cementless THA using postero-lateral approach. Level of evidence: Level III, prospective case control study.",
keywords = "Anteversion, Cementless stem, Femoro-tibial angle, Intra-operative estimation, Postero-lateral approach, Total hip arthroplasty",
author = "Lee, {Young Kyun} and Kim, {J. W.} and Kim, {T. Y.} and Ha, {Y. C.} and Kyunghoi Koo",
year = "2018",
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doi = "10.1016/j.otsr.2017.11.023",
language = "English",
volume = "104",
pages = "341--346",
journal = "Orthopaedics and Traumatology: Surgery and Research",
issn = "1877-0568",
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}

TY - JOUR

T1 - Validity of the intra-operative measurement of stem anteversion and factors for the erroneous estimation in cementless total hip arthroplasty using postero-lateral approach

AU - Lee, Young Kyun

AU - Kim, J. W.

AU - Kim, T. Y.

AU - Ha, Y. C.

AU - Koo, Kyunghoi

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: Intra-operative estimation of stem anteversion in total hip arthroplasty (THA) using postero-lateral approach is made by the surgeon's visual assessment, using the tibia as a guide, with the assumption that tibial axis is vertical to the trans-epicondylar axis. However, the accuracy of the intra-operative estimation has rarely been verified with postoperative CT-scans, with controversies regarding these measurements particularly in case of knee osteoarthritis. Therefore we performed a prospective study to: (1) determine the accuracy of the intra-operative measurement and (2) investigate factors affecting the discrepancy between the surgeon's estimation and the real stem anteversion. Hypothesis: Intra-operative estimation of stem anteversion correlated with the real stem anteversion on CT-scan. Patients and methods: Sixty-seven THAs using cementless straight stems (65 patients) without ipsilateral total knee arthroplasty were prospectively evaluated to compare the intra-operative measurement of stem anteversion with the real stem anteversion on computed tomography (CT) scans. There were 33 men and 34 women with a mean age of 59.7 years (range, 27–84 years) at the time of surgery. Age, tibia plateau angle, native femoral anteversion, femoro-tibial angle, body mass index, operative site, gender, coronal and sagittal tilt of the stem, stem type, ipsilateral knee osteoarthritis, and preoperative diagnosis were analyzed to evaluate the factors affecting the discrepancy between the intra-operative and CT measurements. Results: The intra-operative estimation (mean, 21.5° ± 8.5°; range, 5.0°–39.0°) was greater than the CT measurement (mean, 19.5° ± 8.7°; range, 4.5°–38.5°) by 2.0°. The mean absolute value of discrepancy was 4.5°. The correlation coefficient between intra-operative and CT measurements was 0.837. The femoro-tibial angle was associated with the discrepancy between the two measurements. In the presence of genu varum deformity, the intra-operative measurement underestimated the stem anteversion. Discussion: Although intra-operative estimation of stem anteversion was slightly greater than the real stem anteversion, there was an excellent correlation between the two. The femoro-tibial angle should be considered to optimize the stem anteversion during cementless THA using postero-lateral approach. Level of evidence: Level III, prospective case control study.

AB - Background: Intra-operative estimation of stem anteversion in total hip arthroplasty (THA) using postero-lateral approach is made by the surgeon's visual assessment, using the tibia as a guide, with the assumption that tibial axis is vertical to the trans-epicondylar axis. However, the accuracy of the intra-operative estimation has rarely been verified with postoperative CT-scans, with controversies regarding these measurements particularly in case of knee osteoarthritis. Therefore we performed a prospective study to: (1) determine the accuracy of the intra-operative measurement and (2) investigate factors affecting the discrepancy between the surgeon's estimation and the real stem anteversion. Hypothesis: Intra-operative estimation of stem anteversion correlated with the real stem anteversion on CT-scan. Patients and methods: Sixty-seven THAs using cementless straight stems (65 patients) without ipsilateral total knee arthroplasty were prospectively evaluated to compare the intra-operative measurement of stem anteversion with the real stem anteversion on computed tomography (CT) scans. There were 33 men and 34 women with a mean age of 59.7 years (range, 27–84 years) at the time of surgery. Age, tibia plateau angle, native femoral anteversion, femoro-tibial angle, body mass index, operative site, gender, coronal and sagittal tilt of the stem, stem type, ipsilateral knee osteoarthritis, and preoperative diagnosis were analyzed to evaluate the factors affecting the discrepancy between the intra-operative and CT measurements. Results: The intra-operative estimation (mean, 21.5° ± 8.5°; range, 5.0°–39.0°) was greater than the CT measurement (mean, 19.5° ± 8.7°; range, 4.5°–38.5°) by 2.0°. The mean absolute value of discrepancy was 4.5°. The correlation coefficient between intra-operative and CT measurements was 0.837. The femoro-tibial angle was associated with the discrepancy between the two measurements. In the presence of genu varum deformity, the intra-operative measurement underestimated the stem anteversion. Discussion: Although intra-operative estimation of stem anteversion was slightly greater than the real stem anteversion, there was an excellent correlation between the two. The femoro-tibial angle should be considered to optimize the stem anteversion during cementless THA using postero-lateral approach. Level of evidence: Level III, prospective case control study.

KW - Anteversion

KW - Cementless stem

KW - Femoro-tibial angle

KW - Intra-operative estimation

KW - Postero-lateral approach

KW - Total hip arthroplasty

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U2 - 10.1016/j.otsr.2017.11.023

DO - 10.1016/j.otsr.2017.11.023

M3 - Article

C2 - 29458202

AN - SCOPUS:85042913902

VL - 104

SP - 341

EP - 346

JO - Orthopaedics and Traumatology: Surgery and Research

JF - Orthopaedics and Traumatology: Surgery and Research

SN - 1877-0568

IS - 3

ER -