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Uncemented femoral stem orientation and position in total hip arthroplasty: A CT study

Belzunce, MA; Henckel, J; Di Laura, A; Hart, A; (2020) Uncemented femoral stem orientation and position in total hip arthroplasty: A CT study. Journal of Orthopaedic Research , 38 (7) pp. 1486-1496. 10.1002/jor.24627. Green open access

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Abstract

In total hip arthroplasty (THA), accurate positioning of components is important for the functionality and long life of the implant. Femoral component version has been underinvestigated when compared with the acetabular cup. Accurate prediction of the femoral version on the preoperative plan is particularly important because a well-fitting uncemented stem will, by definition, press-fit into a version that is dictated by the anatomy of the proximal femur. A better understanding of this has recently become an unmet need because of the increased use of uncemented stems and of preoperative image-based planning. We present the first, three-dimensional (3D) comparison between the planned and achieved orientation and position of the femoral components in THA. We propose a comparison method that uses the 3D models of a, computed tomography-generated (CT-generated), preoperative plan and a postoperative CT to obtain the discrepancy in the six possible degrees of freedom. We ran a prospective study (level 2 evidence) of 30 patients undergoing uncemented THA to quantify the discrepancy between planned and achieved femoral stem orientation and position. The discrepancy was low for femoral stem vertical position and leg length, and varus-valgus and anterior-posterior orientation. The discrepancy was higher for femoral version with a mean (±SD) of -1.5 ± 7.8 deg. Surgeons should be aware of the variability of the eventual position of uncemented stems in THA and acknowledge the risk of achieving a less-than-optimal femoral version, different from the preoperative 3D CT plan.

Type: Article
Title: Uncemented femoral stem orientation and position in total hip arthroplasty: A CT study
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/jor.24627
Publisher version: https://doi.org/10.1002/jor.24627
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: 3D planning, THA, offset, postoperative CT, uncemented stem, version
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Ortho and MSK Science
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Mechanical Engineering
URI: https://discovery.ucl.ac.uk/id/eprint/10108661
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