Coxa valga and antetorta configuration leads to underestimation of the femoral component size: a matched case-control study of patients undergoing cementless total hip arthroplasty
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Coxa valga and antetorta configuration leads to underestimation of the femoral component size: a matched case-control study of patients undergoing cementless total hip arthroplasty. / Schweizer, Conradin; Niggemeyer, Oliver; Jens, Jan-Hauke; Junker, Marius.
in: ARCH ORTHOP TRAUM SU, Jahrgang 144, Nr. 6, 06.2024, S. 2859-2864.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Coxa valga and antetorta configuration leads to underestimation of the femoral component size: a matched case-control study of patients undergoing cementless total hip arthroplasty
AU - Schweizer, Conradin
AU - Niggemeyer, Oliver
AU - Jens, Jan-Hauke
AU - Junker, Marius
N1 - © 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2024/6
Y1 - 2024/6
N2 - BACKGROUND: Total hip arthroplasty (THA) is the gold standard procedure for patients with end-stage osteoarthritis after failed conservative therapy. Digital templating is commonly employed in preoperative preparation for THA and contributes positively to its outcome. However, the impact of coxa valga and antetorta (CVA) configurations on stem size prediction accuracy remains not reported. Previous studies demonstrated that the size of the lesser trochanter (LT) can be used to determine femoral anteversion on pelvis radiographs. This study investigates the accuracy of preoperative digital templating in predicting stem size in patients with CVA undergoing cementless THA.METHODS: Preoperative radiographs of 620 patients undergoing cementless THA were retrospectively investigated. Radiographs were standardized with patients standing and the leg internally rotated by 15°. A CVA group was established including patients with a CCD angle greater than 140° and a lesser trochanter (LT) size of at least 10 mm for men and 8 mm for women. For the control group, radiographs with a CCD angle ranging from 125-135° and LT size 3-10 mm for men and 3-8 mm for women were selected. Preoperative templating was performed using mediCAD. To reduce confounding factors, case-control matching was carried out for BMI and body height.RESULTS: After case-control matching, a total of thirty-one matches were analyzed. Stem size was underestimated in 74% (23/31) in the CVA and 13% (4/31) in the control group (p < 0.001). Moreover, patients with CVA were more likely to be underestimated by two sizes compared to controls (p < 0.004). In contrast, the exact stem size was predicted more frequently in the control group (p < 0.001).CONCLUSION: Stem size in patients with a CVA configuration are at high risk of being underestimated when using digital templating. These findings can be valuable for guiding in intraoperative decisions and lowering the risk of complications associated with an undersized femoral component.
AB - BACKGROUND: Total hip arthroplasty (THA) is the gold standard procedure for patients with end-stage osteoarthritis after failed conservative therapy. Digital templating is commonly employed in preoperative preparation for THA and contributes positively to its outcome. However, the impact of coxa valga and antetorta (CVA) configurations on stem size prediction accuracy remains not reported. Previous studies demonstrated that the size of the lesser trochanter (LT) can be used to determine femoral anteversion on pelvis radiographs. This study investigates the accuracy of preoperative digital templating in predicting stem size in patients with CVA undergoing cementless THA.METHODS: Preoperative radiographs of 620 patients undergoing cementless THA were retrospectively investigated. Radiographs were standardized with patients standing and the leg internally rotated by 15°. A CVA group was established including patients with a CCD angle greater than 140° and a lesser trochanter (LT) size of at least 10 mm for men and 8 mm for women. For the control group, radiographs with a CCD angle ranging from 125-135° and LT size 3-10 mm for men and 3-8 mm for women were selected. Preoperative templating was performed using mediCAD. To reduce confounding factors, case-control matching was carried out for BMI and body height.RESULTS: After case-control matching, a total of thirty-one matches were analyzed. Stem size was underestimated in 74% (23/31) in the CVA and 13% (4/31) in the control group (p < 0.001). Moreover, patients with CVA were more likely to be underestimated by two sizes compared to controls (p < 0.004). In contrast, the exact stem size was predicted more frequently in the control group (p < 0.001).CONCLUSION: Stem size in patients with a CVA configuration are at high risk of being underestimated when using digital templating. These findings can be valuable for guiding in intraoperative decisions and lowering the risk of complications associated with an undersized femoral component.
KW - Humans
KW - Female
KW - Arthroplasty, Replacement, Hip/methods
KW - Male
KW - Case-Control Studies
KW - Aged
KW - Middle Aged
KW - Retrospective Studies
KW - Femur/diagnostic imaging
KW - Hip Prosthesis
KW - Osteoarthritis, Hip/surgery
KW - Radiography
KW - Aged, 80 and over
U2 - 10.1007/s00402-024-05373-8
DO - 10.1007/s00402-024-05373-8
M3 - SCORING: Journal article
C2 - 38743114
VL - 144
SP - 2859
EP - 2864
JO - ARCH ORTHOP TRAUM SU
JF - ARCH ORTHOP TRAUM SU
SN - 0936-8051
IS - 6
ER -
