Is There Safety Outside the “Safe Zone” in Total Hip Replacement? A Retrospective Observational Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Design
- osteoarthritis of the sacroiliac or vertebral joints in the radiological examination—due to their potential influence on hip joint mobility and pain;
- a previous operation in the area of the hip—to exclude the impacts of previous operations on the hip, including potential restrictions and alterations in the range of motion;
- no follow-up visits—due to a lack of data.
2.2. Data Collection
2.3. Surgical Technique
2.4. Statistical Analysis
3. Results
3.1. Distribution of Offset and Anteversion
3.2. Offset Change Regarding Anteversion
3.3. Anteversion and Postoperative Results in HHS
3.4. Anteversion Impact on Pain
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- OECD. “Health Status (Edition 2017)”. OECD Health Statistics (Database). 2017. Available online: https://www.oecd-ilibrary.org/social-issues-migration-health/data/oecd-health-statistics/health-status-edition-2017_268ba6ea-en (accessed on 6 May 2024).
- Moldovan, F.; Gligor, A.; Moldovan, L.; Bataga, T. An Investigation for Future Practice of Elective Hip and Knee Arthroplasties during COVID-19 in Romania. Medicina 2023, 59, 314. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Ferguson, R.J.; Palmer, A.J.; Taylor, A.; Porter, M.L.; Malchau, H.; Glyn-Jones, S. Hip replacement. Lancet 2018, 392, 1662–1671. [Google Scholar] [CrossRef] [PubMed]
- Della Valle, A.G.; Padgett, D.E.; Salvati, E.A. Preoperative planning for primary total hip arthroplasty. J. Am. Acad. Orthop. Surg. 2005, 13, 455–462. [Google Scholar] [CrossRef] [PubMed]
- Banerjee, S.; Pivec, R.; Issa, K.; Kapadia, B.H.; Khanuja, H.S.; Mont, M.A. Large-diameter femoral heads in total hip arthroplasty: An evidence-based review. Am. J. Orthop. 2014, 43, 506–512. [Google Scholar] [PubMed]
- Ochi, H.; Homma, Y.; Baba, T.; Nojiri, H.; Matsumoto, M.; Kaneko, K. Sagittal spinopelvic alignment predicts hip function after total hip arthroplasty. Gait Posture 2017, 52, 293–300. [Google Scholar] [CrossRef] [PubMed]
- Esposito, C.I.; Carroll, K.M.; Sculco, P.K.; Padgett, D.E.; Jerabek, S.A.; Mayman, D.J. Total Hip Arthroplasty Patients with Fixed Spinopelvic Alignment Are at Higher Risk of Hip Dislocation. J. Arthroplast. 2018, 33, 1449–1454. [Google Scholar] [CrossRef] [PubMed]
- Haffer, H.; Wang, Z.; Hu, Z.; Hipfl, C.; Pumberger, M. Acetabular cup position differs in spinopelvic mobility types: A prospective observational study of primary total hip arthroplasty patients. Arch. Orthop. Trauma Surg. 2022, 142, 2979–2989. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Schoof, B.; Jakobs, O.; Schmidl, S.; Lausmann, C.; Fensky, F.; Beckmann, J.; Gehrke, T.; Gebauer, M. Anterior iliopsoas impingement due to a malpositioned acetabular component—Effective relief by surgical cup reorientation. Hip Int. 2017, 27, 128–133. [Google Scholar] [CrossRef] [PubMed]
- Ong, C.B.; Buchan, G.B.J.; Hecht, I.C.J.; Kendoff, D.O.; Homma, Y.; Kamath, A.F. Fluoroscopy-based robotic assistance for total hip arthroplasty improves acetabular cup placement accuracy for obese patients compared to the manual, fluoroscopic- assisted technique. Technol. Health Care, 2023; ahead of print. [Google Scholar] [CrossRef] [PubMed]
- Song, X.; Ni, M.; Li, H.; Li, X.; Li, X.; Fu, J.; Chen, J. Is the cup orientation different in bilateral total hip arthroplasty with right-handed surgeons using posterolateral approach? J. Orthop. Surg. Res. 2018, 13, 123. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Mouri, K.; Madachi, A.; Karita, T. Intraoperative Pelvic Tilt and Axial Rotation During Total Hip Arthroplasty Through the Direct Anterior Approach is Affected by the Acetabular Retractor and Cup Impactor. Arthroplast. Today 2023, 24, 101251. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Scheerlinck, T. Cup positioning in total hip arthroplasty. Acta Orthop. Belg. 2014, 80, 336–347. [Google Scholar] [PubMed]
- Tateuchi, H.; Tsukagoshi, R.; Fukumoto, Y.; Akiyama, H.; So, K.; Kuroda, Y.; Ichihashi, N. Pelvic instability and trunk and hip muscle recruitment patterns in patients with total hip arthroplasty. J. Electromyogr. Kinesiol. 2013, 23, 151–158. [Google Scholar] [CrossRef] [PubMed]
- Lewinnek, G.E.; Lewis, J.L.; Tarr, R.; Compere, C.L.; Zimmerman, J.R. Dislocations after total hip-replacement arthroplasties. J. Bone Joint Surg. Am. 1978, 60, 217–220. [Google Scholar] [CrossRef] [PubMed]
- Tezuka, T.; Heckmann, N.D.; Bodner, R.J.; Dorr, L.D. Functional Safe Zone Is Superior to the Lewinnek Safe Zone for Total Hip Arthroplasty: Why the Lewinnek Safe Zone Is Not Always Predictive of Stability. J. Arthroplast. 2019, 34, 3–8. [Google Scholar] [CrossRef] [PubMed]
- Bahl, J.S.; Nelson, M.J.; Taylor, M.; Solomon, L.B.; Arnold, J.B.; Thewlis, D. Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: A systematic review and meta-analysis. Osteoarthr. Cartil. 2018, 26, 847–863. [Google Scholar] [CrossRef] [PubMed]
- Hussain, S.; Malik, S.S.; Budair, B.; Prakash, D. Anatomic placement of the acetabular implant in cementless total hip arthroplasty does not adversely affect the implant survival and patient satisfaction. J. Clin. Orthop. Trauma 2022, 31, 101927. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Higa, M.; Tanino, H.; Abo, M.; Kakunai, S.; Banks, S.A. Effect of acetabular component anteversion on dislocation mechanisms in total hip arthroplasty. J. Biomech. 2011, 44, 1810–1813. [Google Scholar] [CrossRef] [PubMed]
- Whitehead, A.L.; Julious, S.A.; Cooper, C.L.; Campbell, M.J. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat. Methods Med. Res. 2016, 25, 1057–1073. [Google Scholar] [CrossRef] [PubMed]
- Manjunath, K.S.; Soruban, V.; Gopalakrishna, K.G. Evaluation of radiological methods of assessing cup anteversion in total hip replacement. Eur. J. Orthop. Surg. Traumatol. Orthop. Traumatol. 2015, 25, 1285–1292. [Google Scholar] [CrossRef] [PubMed]
- Lum, Z.C.; Giordani, M.; Meehan, J.P. Total Hip Instability and the Spinopelvic Link. Curr. Rev. Musculoskelet. Med. 2020, 13, 425–434. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Liebs, T.R.; Nasser, L.; Herzberg, W.; Rüther, W.; Hassenpflug, J. The influence of femoral offset on health-related quality of life after total hip replacement. Bone Joint J. 2014, 96-B, 36–42. [Google Scholar] [CrossRef] [PubMed]
- Bjørdal, F.; Bjørgul, K. The role of femoral offset and abductor lever arm in total hip arthroplasty. J. Orthop. Traumatol. 2015, 16, 325–330. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Weber, M.; Merle, C.; Nawabi, D.H.; Dendorfer, S.; Grifka, J.; Renkawitz, T. Inaccurate offset restoration in total hip arthroplasty results in reduced range of motion. Sci. Rep. 2020, 10, 13208. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Vigdorchik, J.M.; Sharma, A.K.; Elbuluk, A.M.; Carroll, K.M.; Mayman, D.J.; Lieberman, J.R. High Offset Stems Are Protective of Dislocation in High-Risk Total Hip Arthroplasty. J. Arthroplast. 2021, 36, 210–216. [Google Scholar] [CrossRef] [PubMed]
- Sariali, E.; Klouche, S.; Mouttet, A.; Pascal-Moussellard, H. The effect of femoral offset modification on gait after total hip arthroplasty. Acta Orthop. 2014, 85, 123–127. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- De Fine, M.; Romagnoli, M.; Toscano, A.; Bondi, A.; Nanni, M.; Zaffagnini, S. Is there a role for femoral offset restoration during total hip arthroplasty? A systematic review. Orthop. Traumatol. Surg. Res. 2017, 103, 349–355. [Google Scholar] [CrossRef] [PubMed]
- Zajc, J.; Fokter, S.K. Bimodular femoral stems in primary total hip arthroplasty. Expert Rev. Med. Devices 2023, 20, 1051–1064. [Google Scholar] [CrossRef] [PubMed]
- Fokter, S.K.; Noč, N.; Levašič, V.; Hanc, M.; Zajc, J. Dual-Modular Versus Single-Modular Stems for Primary Total Hip Arthroplasty: A Long-Term Survival Analysis. Medicina 2023, 59, 290. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Xu, J.; Pierrepont, J.; Madurawe, C.; Shimmin, A.; Bruce, W. The effect of varus stem placement on joint offset during total hip arthroplasty: A virtual study. Hip Int. 2022, 32, 620–626. [Google Scholar] [CrossRef] [PubMed]
- von Roth, P.; Perka, C.; Mayr, H.O.; Preininger, B.; Ziebula, F.; Matziolis, G.; Hube, R. Reproducibility of femoral offset following short stem and straight stem total hip arthroplasty. Orthopedics 2014, 37, e678–e684. [Google Scholar] [CrossRef] [PubMed]
- Fink, B.; Morgan, M.; Schuster, P. Reconstruction of the anatomy of the hip in total hip arthroplasty with two different kinds of stems. BMC Musculoskelet. Disord. 2022, 23, 212. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Neil Wheelton, A.; Myatt, D.; Helm, A.T. Outcomes for cemented dual mobility cup to treat recurrent instability; A UK case series. J. Orthop. 2019, 16, 220–223. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Gardner, A.; Macdonald, H.; Evans, J.T.; Sayers, A.; Whitehouse, M.R. Survivorship of the dual-mobility construct in elective primary total hip replacement: A systematic review and meta-analysis including registry data. Arch. Orthop. Trauma Surg. 2023, 143, 5927–5934. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Rashed, R.A.; Abdalaziz, A.; Veivenn, V.Y.; Tetali, S.R.; Choudry, Q.A.; Sloan, A.G.; Helm, A. Is dual mobility cup total hip replacement associated with increased incidence of heterotopic ossification compared to conventional total hip replacements in fracture neck of femur patients? Injury 2020, 51, 2676–2681. [Google Scholar] [CrossRef] [PubMed]
- French, J.M.R.; Bramley, P.; Scattergood, S.; Sandiford, N.A. Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: A systematic review and meta-analysis. EFORT Open Rev. 2021, 6, 343–353. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Mancino, F.; Cacciola, G.; Di Matteo, V.; Perna, A.; Proietti, L.; Greenberg, A.; Ma, M.; Sculco, P.K.; Maccauro, G.; De Martino, I. Surgical implications of the hip-spine relationship in total hip arthroplasty. Orthop. Rev. 2020, 12 (Suppl. S1), 8656. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Lazennec, J.Y.; Thauront, F.; Robbins, C.B.; Pour, A.E. Acetabular and Femoral Anteversions in Standing Position are Outside the Proposed Safe Zone After Total Hip Arthroplasty. J. Arthroplast. 2017, 32, 3550–3556. [Google Scholar] [CrossRef] [PubMed]
- Zheng, N.; Hu, X.; Dimitriou, D.; Dai, K.; Guo, T.; Tsai, T.Y. Well-Placed Acetabular Component Oriented Outside the Safe Zone During Weight-Bearing Daily Activities. Front. Bioeng. Biotechnol. 2021, 9, 664907. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Ellapparadja, P.; Mahajan, V.; Deakin, A.H.; Deep, K. Reproduction of Hip Offset and Leg Length in Navigated Total Hip Arthroplasty: How Accurate Are We? J. Arthroplast. 2015, 30, 1002–1007. [Google Scholar] [CrossRef] [PubMed]
- Debbi, E.M.; Rajaee, S.S.; Mayeda, B.F.; Penenberg, B.L. Determining and Achieving Target Limb Length and Offset in Total Hip Arthroplasty Using Intraoperative Digital Radiography. J. Arthroplast. 2020, 35, 779–785. [Google Scholar] [CrossRef] [PubMed]
- Lazennec, J.Y.; Brusson, A.; Dominique, F.; Rousseau, M.A.; Pour, A.E. Offset and anteversion reconstruction after cemented and uncemented total hip arthroplasty: An evaluation with the low-dose EOS system comparing two- and three-dimensional imaging. Int. Orthop. 2015, 39, 1259–1267. [Google Scholar] [CrossRef] [PubMed]
Feature | In Lewinnek’s Safe Zone N = 44 | Outside Lewinnek’s Safe Zone N = 10 | p-Value |
---|---|---|---|
Age (years) | 69.6 (±9.82) | 69.9 (±7.88) | 0.91 |
BMI | 28.55 (±3.78) | 28.41 (±2.09) | 0.90 |
Duration of symptoms (years) | 2.37 (±1.43) | 3.13 (±2.37) | 0.19 |
Inclination | 40.33 (±7.02) | 37.35 (±5.35) | 0.22 |
Mean HHS score preoperatively | 34.67 (±10.03) | 39.99 (±13.06) | 0.17 |
Mean HHS score postoperatively | 91.16 (±12.02) | 90.75 (±11.54) | 0.45 |
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Stępiński, P.; Jegierski, D.; Maciąg, G.; Maciąg, B.; Adamska, O.; Stolarczyk, A. Is There Safety Outside the “Safe Zone” in Total Hip Replacement? A Retrospective Observational Study. Medicina 2024, 60, 772. https://doi.org/10.3390/medicina60050772
Stępiński P, Jegierski D, Maciąg G, Maciąg B, Adamska O, Stolarczyk A. Is There Safety Outside the “Safe Zone” in Total Hip Replacement? A Retrospective Observational Study. Medicina. 2024; 60(5):772. https://doi.org/10.3390/medicina60050772
Chicago/Turabian StyleStępiński, Piotr, Dawid Jegierski, Grzegorz Maciąg, Bartosz Maciąg, Olga Adamska, and Artur Stolarczyk. 2024. "Is There Safety Outside the “Safe Zone” in Total Hip Replacement? A Retrospective Observational Study" Medicina 60, no. 5: 772. https://doi.org/10.3390/medicina60050772