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. 2023 Oct 21;12(20):6662.
doi: 10.3390/jcm12206662.

Stem Design in Total Hip Arthroplasty Influences Ipsilateral Knee Valgus: A Retrospective Comparative Analysis of 2953 Cases

Paul Thöne  1   2 , Michael Stephan Gruber  2 , Harald Kindermann  3 , Walter Gussner  2 , Patrick Sadoghi  4 , Reinhold Ortmaier  2
Affiliations

Stem Design in Total Hip Arthroplasty Influences Ipsilateral Knee Valgus: A Retrospective Comparative Analysis of 2953 Cases

Paul Thöne et al. J Clin Med. .

Abstract

Background: Total hip arthroplasty (THA) affects the biomechanics of the hip and the patient gait. The stem design influences femoral lever ratios and tissue trauma. Biomechanical changes such as these have the potential to induce knee arthritis. A varus or valgus configuration of knee arthritis is formed by asymmetric loadings. The aim of this study was to evaluate the impact of stem design in THA on knee valgus by comparing a standard implant with an implant with a short stem.

Methods: A total of 2953 patients who underwent primary total knee arthroplasty for end-stage osteoarthritis between 2015 and 2021 were included in this retrospective data analysis. Patients were divided into three groups, depending on hip status (straight stem, short stem, and native joint). Leg alignment was distinguished as varus or valgus, and the degree of axial deviation was measured. Descriptive and explorative statistical analyses were performed, with a p value < 0.05 set as significant.

Results: Ipsilateral knee valgus occurred significantly more often in patients with straight stems (57.2%) than in those with short stems (29%) and native joints (25.8%) (p < 0.001). Additionally, mean valgus deviation was significantly increased in patients with straight stems (8.9°) compared to those with short stems (6.4°) or native hip joints (6.7°). Both findings were accentuated in women.

Conclusions: Previous ipsilateral straight-stem THA is associated with knee valgus deformity, especially in women. Short-stem THA seems to be better suited to restoring physiological biomechanics and preventing the development of valgus osteoarthritis of the ipsilateral knee.

Keywords: knee arthritis; short stem; straight stem; total hip arthroplasty; valgus malalignment.

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Conflict of interest statement

The authors declare no conflict of interest.

Clinical Trial Registration: Not applicable in this investigation.

Figures

Figure 1
Figure 1
Inclusion process and investigation process in detail.
Figure 2
Figure 2
(a) Representative HKAA measurements in female subjects with straight stem, (b) short stem, (c) and native hip joint and ipsilateral knee valgus malalignment.
Figure 3
Figure 3
Hip stem design influences the odds ratio for valgus gonarthritis. OR > 1 indicates an increased occurrence of valgus, OR < 1 indicates a decreased occurrence of valgus.
Figure 4
Figure 4
Impact of straight-stem THA on ipsilateral leg alignment and the association with valgus knee arthritis. (a) straight leg axis, (b) valgus malalignment, red lines symbolize muscle vector, HKAA is illustrated by blue dots.
See this image and copyright information in PMC

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