Department of Orthopaedic Surgery, Asklepios Klinikum Bad Abbach, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany.
Department of Orthopaedic and Trauma Surgery, Heidelberg University Medical Center, Heidelberg, Germany.
Sci Rep. 2020 Aug 6;10(1):13208. doi: 10.1038/s41598-020-70059-1.
Offset restoration in total hip arthroplasty (THA) is associated with postoperative range of motion (ROM) and gait kinematics. We aimed to research into the impact of high offset (HO) and standard stems on postoperative ROM. 121 patients received cementless THA through a minimally-invasive anterolateral approach. A 360° hip ROM analysis software calculated impingement-free hip movement based on postoperative 3D-CTs compared to ROM values necessary for activities of daily living (ADL). The same model was then run a second time after changing the stem geometry between standard and HO configuration with the implants in the same position. HO stems showed higher ROM for all directions between 4.6 and 8.9° (p < 0.001) compared with standard stems but with high interindividual variability. In the subgroup with HO stems for intraoperative offset restoration, the increase in ROM was even higher for all ROM directions with values between 6.1 and 14.4° (p < 0.001) compared to offset underrestoration with standard stems. Avoiding offset underrestoration resulted in a higher amount of patients of over 20% for each ROM direction that fulfilled the criteria for ADL (p < 0.001). In contrast, in patients with standard stems for offset restoration ROM did increase but not clinically relevant by offset overcorrection for all directions between 3.1 and 6.1° (p < 0.001). Offset overcorrection by replacing standard with HO stems improved ROM for ADL in a low number of patients below 10% (p > 0.03). Patient-individual restoration of offset is crucial for free ROM in THA. Both over and underrestoration of offset should be avoided.
全髋关节置换术 (THA) 中的偏心距恢复与术后活动范围 (ROM) 和步态运动学有关。我们旨在研究高偏心距 (HO) 和标准柄对术后 ROM 的影响。121 名患者接受微创前外侧入路的非骨水泥 THA。360°髋关节 ROM 分析软件根据术后 3D-CT 计算出无撞击髋关节运动，与日常生活活动 (ADL) 所需的 ROM 值进行比较。然后，在将标准和 HO 配置的柄几何形状之间进行更改，并将植入物保持在相同位置后，使用相同的模型再次运行。与标准柄相比，HO 柄在所有方向上的 ROM 均增加了 4.6 至 8.9°（p<0.001），但个体间差异较大。在 HO 柄用于术中偏心距恢复的亚组中，所有 ROM 方向的 ROM 增加更高，值在 6.1 至 14.4°之间（p<0.001），与标准柄的偏心距欠恢复相比。避免偏心距欠恢复导致每个 ROM 方向满足 ADL 标准的患者比例增加超过 20%（p<0.001）。相比之下，在偏心距恢复使用标准柄的患者中，所有方向的 ROM 都有所增加，但由于偏心距过校正，增加幅度不大，在 3.1 至 6.1°之间（p<0.001）。用 HO 柄替代标准柄进行偏心距过校正，仅能使少数低于 10%的患者（p>0.03）的 ADL ROM 得到改善。患者个体的偏心距恢复对 THA 的自由 ROM 至关重要。应避免偏心距过和欠恢复。
