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. 2023 Jan;143(1):519-527.
doi: 10.1007/s00402-021-04331-y. Epub 2022 Jan 7.

More than a feeling?-Overruling the preoperatively templated offset option leads to a minor offset increase in short stem total hip arthroplasty

Matthias Luger  1   2 , Christian Stadler  3   4 , Rainer Hochgatterer  3   4 , Jakob Allerstorfer  3   4 , Tobias Gotterbarm  3   4 , Antonio Klasan  3   4
Affiliations

More than a feeling?-Overruling the preoperatively templated offset option leads to a minor offset increase in short stem total hip arthroplasty

Matthias Luger et al. Arch Orthop Trauma Surg. 2023 Jan.

Abstract

Purpose: Short stems are increasingly used in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Digital templating is essential in determining the correct offset option and stem size in THA. However, the preoperative template sizes might be intraoperatively overruled.

Patients and methods: We evaluated the effect of intraoperative overruling of the preoperatively templated offset option of a short curved stem on hip offset, leg length, implant positioning, and femoral canal fill index. The overruling was performed in case of intraoperative instability, telescoping, or both. A series of 1052 consecutive THAs with a cementless short curved stem and press-fit cup was retrospectively screened. One hundred patients with unilateral THA and a contralateral native and morphologically healthy hip as a reference met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior-posterior postoperative radiographs. Patients were divided according to the overruling by offset option or stem size.

Results: Hip offset was increased in all groups, but only with significant increase if an offset option + 1 was used intraoperatively (p = 0.025). LLD was restored without significance in all groups (p = 0.323; p = 0.157).

Conclusion: Intraoperative overruling of the preoperative digital template in cementless short stem total hip arthroplasty results in an increase of hip offset compared to a contralateral healthy hip. However, the increase is marginal and clearly under 5 mm compared to the contralateral healthy hip.

Keywords: Digital templating; Femoral offset; Hip offset; Leg length; Short stem; Total hip arthroplasty.

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Conflict of interest statement

One co-author (R.H) has received consultant honoraria of ZimmerBiomet, Europe, outside the submitted work. The authors report personal fees paid to one co-author (T.G.) during the conduct of the study from Zimmer Biomet, Europe and from Depuy Synthes Orthopädie Gmbh, Peter Brehm GmbH, and ImplanTec GmbH outside the submitted work. The authors report research grants paid to our institution during the conduct of the study from Zimmer Biomet, Europe, Mathys AG Switzerland, and Anika Therapeutics outside the submitted work.

Figures

Fig. 1
Fig. 1
Preoperative digital template on an anterior–posterior radiograph of the pelvis
Fig. 2
Fig. 2
Preoperative measurements: Both sides: FO femoral offset, AO acetabular offset, CCD angle vertical position of the center of rotation (COR), Leg length difference (LLD); Affected hip: Centrum-Collum-Diaphyseal Angle, CI cortical index, Canal Flare Index Canal to Calcar ratio
Fig. 3
Fig. 3
Both sides: FO femoral offset, AO acetabular offset, COR vertical position of the center of rotation, LLD Leg length difference
See this image and copyright information in PMC

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