Background Stem choice in total hip arthroplasty (THA) for hip dysplasia is still controversial. The aims of the study were to evaluate (1) which stem design provided the highest percentage of adequate reconstructions in THA for dysplasia and (2) any correlation between the reconstructions provided by the stems and the native femoral morphology. Materials and methods 150 CT scans including 200 adult dysplastic hips were randomly selected. Using the 3D CT-based software Hip-Op for surgical planning, the native hip anatomy was studied. Then, a single wedge tapered stem, an anatomical stem and a conical tapered stem were simulated in every hip. An adequate reconstruction of hip biomechanics was obtained when combined anteversion, offset restoration, coronal and sagittal tilt, canal filling and leg lengthening were inside the normal ranges. Results Conical stems achieved the highest percentage of adequate reconstructions (87%, p < 0.0001). The anatomical stem was the worst performer. Single wedge and anatomical stem acceptability was mainly influenced by the combined anteversion. Stem anteversion was correlated with the femoral anteversion (fair correlation), the calcar femorale (fair) and the mediolateral femoral diameter at isthmus (poor). When the femoral anteversion was >= 25 degrees, combined anteversion was very acceptable for the conical stem (99.2%), whereas the rate of acceptable combined anteversion for the single wedge tapered stem was 71.4%, and that for the anatomical stem was 51.6% (p < 0.0001). Conclusions Stem choice in developmental hip dysplasia is mainly driven by appropriate combined anteversion, which is dependent on the coronal and axial femoral morphologies. As a rule of thumb, tapered stems are adequate when femoral anteversion is < 25 degrees; conical stems should be adopted for higher anteversions.

Which stem in total hip arthroplasty for developmental hip dysplasia? A comparative study using a 3D CT-based software for pre-operative surgical planning / Castagnini, Francesco; Lucchini, Stefano; Bordini, Barbara; Cosentino, Monica; Pardo, Francesco; Traina, Francesco. - In: JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY. - ISSN 1590-9999. - ELETTRONICO. - 23:1(2022), pp. 1-10. [10.1186/s10195-022-00650-x]

Which stem in total hip arthroplasty for developmental hip dysplasia? A comparative study using a 3D CT-based software for pre-operative surgical planning

Castagnini, Francesco;Lucchini, Stefano;Cosentino, Monica;Pardo, Francesco;Traina, Francesco
2022

Abstract

Background Stem choice in total hip arthroplasty (THA) for hip dysplasia is still controversial. The aims of the study were to evaluate (1) which stem design provided the highest percentage of adequate reconstructions in THA for dysplasia and (2) any correlation between the reconstructions provided by the stems and the native femoral morphology. Materials and methods 150 CT scans including 200 adult dysplastic hips were randomly selected. Using the 3D CT-based software Hip-Op for surgical planning, the native hip anatomy was studied. Then, a single wedge tapered stem, an anatomical stem and a conical tapered stem were simulated in every hip. An adequate reconstruction of hip biomechanics was obtained when combined anteversion, offset restoration, coronal and sagittal tilt, canal filling and leg lengthening were inside the normal ranges. Results Conical stems achieved the highest percentage of adequate reconstructions (87%, p < 0.0001). The anatomical stem was the worst performer. Single wedge and anatomical stem acceptability was mainly influenced by the combined anteversion. Stem anteversion was correlated with the femoral anteversion (fair correlation), the calcar femorale (fair) and the mediolateral femoral diameter at isthmus (poor). When the femoral anteversion was >= 25 degrees, combined anteversion was very acceptable for the conical stem (99.2%), whereas the rate of acceptable combined anteversion for the single wedge tapered stem was 71.4%, and that for the anatomical stem was 51.6% (p < 0.0001). Conclusions Stem choice in developmental hip dysplasia is mainly driven by appropriate combined anteversion, which is dependent on the coronal and axial femoral morphologies. As a rule of thumb, tapered stems are adequate when femoral anteversion is < 25 degrees; conical stems should be adopted for higher anteversions.
2022
Which stem in total hip arthroplasty for developmental hip dysplasia? A comparative study using a 3D CT-based software for pre-operative surgical planning / Castagnini, Francesco; Lucchini, Stefano; Bordini, Barbara; Cosentino, Monica; Pardo, Francesco; Traina, Francesco. - In: JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY. - ISSN 1590-9999. - ELETTRONICO. - 23:1(2022), pp. 1-10. [10.1186/s10195-022-00650-x]
Castagnini, Francesco; Lucchini, Stefano; Bordini, Barbara; Cosentino, Monica; Pardo, Francesco; Traina, Francesco
File in questo prodotto:
File Dimensione Formato  
10195_2022_Article_650.pdf

accesso aperto

Tipo: Versione (PDF) editoriale
Licenza: Licenza per Accesso Aperto. Creative Commons Attribuzione (CCBY)
Dimensione 1.32 MB
Formato Adobe PDF
1.32 MB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/905733
Citazioni
  • ???jsp.display-item.citation.pmc??? 2
  • Scopus 5
  • ???jsp.display-item.citation.isi??? 5
social impact