Ueno Shuhei, Iwakiri Kentaro, Ohta Yoichi, Minoda Yukihide, Kobayashi Akio, Nakamura Hiroaki
Department of Orthopaedic Surgery, Shiraniwa Hospital Joint, Arthroplasty Center. 6-10-1 Shiraniwadai Ikoma-city, Nara, 630-0136, Japan.
Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka-city, Osaka, 545-8585, Japan.
Arch Orthop Trauma Surg. 2024 Dec 12;145(1):24. doi: 10.1007/s00402-024-05656-0.
The combined anteversion theory is used for implant placement in total hip arthroplasty (THA). While majority of the research emphasizes the precise placement of the acetabular cup, there's less focus on stem alignment. This study aimed to investigate the impact of the discrepancy between the preoperatively planned femoral neck osteotomy level and the actual osteotomy level during surgery on stem alignment.
The study involved 232 patients (258 joints) who had a total hip arthroplasty (THA) between April 2018 and December 2022 at our hospital. They were implanted with either the ACTIS stem (Depuy Synthes) or Taperloc Complete XR 123° (Zimmer Biomet)-147 joints with ACTIS stem and 111 with Taperloc stem. Three-dimensional templating software was used to evaluate preoperative planning and postoperative stem placement angles. The difference between the actual and preoperatively planned osteotomy levels was also measured. The impact of this difference in femoral neck osteotomy level on stem alignment was evaluated.
In the ACTIS stem group, the femoral neck osteotomy level was - 0.3 ± 3.7 mm. The stem alignment had a varus of 1.8 ± 1.9°, extension of 0.1 ± 1.5°, and anteversion of 2.4 ± 5.9°, compared to preoperative plans. A positive correlation was identified between osteotomy level and varus/valgus alignment (r = 0.607, p < 0.01), with a weak correlation for anteversion (r = 0.236, p < 0.01). No correlation existed with flexion/extension. In the Taperloc stem group, osteotomy level was 2.2 ± 3.1 mm. The postoperative stem showed a varus of 1.6 ± 1.5°, extension of 0.5 ± 1.7°, and anteversion of 4.9 ± 6.5°. A correlation was observed between osteotomy level and varus/valgus alignment (r = 0.476, p < 0.01), but not with flexion/extension or anteversion.
The study examined how differences in planned vs. actual femoral neck osteotomy affect stem alignment in THA using ACTIS stem and Taperloc stem. We found that osteotomy level influenced varus/valgus alignment; mildly affected flexion/extension; and had no effect on anteversion.
联合前倾理论用于全髋关节置换术（THA）中的植入物放置。虽然大多数研究强调髋臼杯的精确放置，但对股骨柄对线的关注较少。本研究旨在调查手术中术前计划的股骨颈截骨水平与实际截骨水平之间的差异对股骨柄对线的影响。
本研究纳入了2018年4月至2022年12月在我院接受全髋关节置换术（THA）的232例患者（258个关节）。他们被植入ACTIS股骨柄（Depuy Synthes）或Taperloc Complete XR 123°（Zimmer Biomet）——147个关节植入ACTIS股骨柄，111个关节植入Taperloc股骨柄。使用三维模板软件评估术前计划和术后股骨柄放置角度。还测量了实际截骨水平与术前计划截骨水平之间的差异。评估了股骨颈截骨水平差异对股骨柄对线的影响。
在ACTIS股骨柄组中股骨颈截骨水平为-0.3±3.7毫米。与术前计划相比，股骨柄对线内翻1.8±1.9°，伸展0.1±1.5°，前倾2.4±5.9°。截骨水平与内翻/外翻对线之间存在正相关（r = 0.607，p < 0.01），与前倾呈弱相关（r = 0.236，p < 0.01）。与屈伸无相关性。在Taperloc股骨柄组中，截骨水平为2.2±3.1毫米。术后股骨柄内翻1.6±1.5°，伸展0.5±1.7°，前倾4.9±6.5°。观察到截骨水平与内翻/外翻对线之间存在相关性（r = 0.476，p < 0.01），但与屈伸或前倾无相关性。
本研究探讨了使用ACTIS股骨柄和Taperloc股骨柄时，计划与实际股骨颈截骨差异如何影响全髋关节置换术中股骨柄对线。我们发现截骨水平影响内翻/外翻对线；对屈伸有轻微影响；对前倾无影响。
