Comparative study of stem anteversion using a cementless tapered wedge stem in dysplastic hips between the posterolateral and anterolateral approaches
Comparative study of stem anteversion using a cementless tapered wedge stem in dysplastic hips between the posterolateral and anterolateral approaches
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DOI：
10.1016/j.otsr.2019.08.006
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发表时间：
2019-11-01
影响因子：
2.3
通讯作者：
Haro, Hirotaka
中科院分区：
文献类型：
--
作者：
Taniguchi, Naofumi;Jinno, Tetsuya;Haro, Hirotaka
背景：在全髋关节置换术（THA）中，联合前倾的概念被认为是假体关节稳定性的最佳指标之一。技术参数可能影响股骨柄和髋臼杯前倾。因此，我们调查了在非骨水泥型THA中使用锥形楔形股骨柄和stem-first technique.Hypothesis的手术入路是否会影响股骨柄前倾角：我们假设入路类型，后外侧入路（PLA）或前外侧入路（ALA），会影响发育不良髋关节患者的股骨柄前倾角。我们问（1）是否干前倾更高的PLA组和（2）如何术后干前倾与术前股骨前倾在每个group.Patients和方法：我们回顾性比较两组髋关节进行THA使用锥形楔形干与后外侧（PLA组; 154髋关节）或前外侧（ALA组; 81髋关节）的方法。使用计算机断层扫描测量股骨颈和股骨柄前倾角。结果：PLA组和ALA组的股骨柄前倾角分别为43.7 ° ± 9.8 °和34.0 ° ± 12.3 °（p < 0.01）。逐步筛选出一个包括股骨颈前倾角和手术入路的模型（p < 0.01）。ALA组的股骨柄前倾角（r = 0.75，p < 0.01）与股骨颈前倾角的相关性好于PLA组（r = 0.52，p < 0.01）。讨论：由于股骨暴露难度的差异，认为经ALA植入股骨柄比经PLA植入股骨柄更受限制。锥形楔形股骨柄相对较薄且扁平，在股骨髓腔内具有较高的自由度。因此，在使用锥形楔形股骨柄的非骨水泥型THA中，手术入路对股骨柄前倾的影响不同。与通过PLA相比，通过ALA的股骨柄前倾在解剖学上更好地恢复到股骨颈前倾。(C)2019 Elsevier Masson SAS。All rights reserved.
Background: In total hip arthroplasty (THA), the concept of combined anteversion is accepted as one of best indicators of prosthetic joint stability. Technical parameters may influence the stem and cup anteversion. We therefore investigated if stem anteversion could be influenced by surgical approaches in cementless THA using a tapered wedge stem with stem-first technique.Hypothesis: We postulated that the type of approach, posterolateral (PLA) or anterolateral approach (ALA), would influence stem anteversion in dysplastic hip patients. We asked (1) whether stem anteversion was higher in the PLA group and (2) how postoperative stem anteversion was correlated to preoperative femoral anteversion in each group.Patients and Methods: We retrospectively compared two groups of hips that underwent THA using a tapered wedge stem with the posterolateral (PLA group; 154 hips) or anterolateral (ALA group; 81 hips) approaches. Computed tomography was utilized to measure femoral neck and stem anteversion. To investigate related factors that affect stem anteversion, a stepwise regression analysis was performed.Results: The stem anteversion in the PLA and ALA groups was 43.7 degrees +/- 9.8 degrees and 34.0 degrees +/- 12.3 degrees, respectively (p < 0.01). The stepwise selection process resulted in a model involving femoral neck anteversion and surgical approach (p < 0.01). The stem anteversion of the ALA group (r = 0.75, p < 0.01) was better correlated to femoral neck anteversion than that of the PLA group (r = 0.52, p < 0.01).Discussion: The stem implantation through the ALA is thought to be more restricted than that through the PLA due to the difference of difficulty in femoral exposure. Tapered wedge stems, which are relatively thin and flat, have a high degree of freedom in the femoral canal. Consequently, in cementless THA using a tapered wedge stem, the surgical approaches affected stem anteversion differently. Stem anteversion was more anatomically restored to femoral neck anteversion through the ALA than through the PLA. (C) 2019 Elsevier Masson SAS. All rights reserved.