ArticleJournal of orthopaedic surgery and research2019
The 'critical trochanter angle': a predictor for stem alignment in total hip arthroplasty.
Article in Journal of orthopaedic surgery and research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed.
- Femoral stem alignment and post-operative patient satisfaction: a retrospective analysis of total hip arthroplasty using computer-assisted equipment for placing cups.International orthopaedics · 2026Article
- Is direct anterior approach associated with a compromise of femoral stem survival after total hip arthroplasty? A regional registry-based analysis.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
- Impact of anatomical adaptation in cemented femoral stems on mechanical properties and alignment.Scientific reports · 2025Article
- Preoperative Predictors of Soft Tissue Releases Required for Femoral Exposure in Direct Anterior Total Hip Arthroplasty.Arthroplasty today · 2025Article
- Does Mal-alignment of the CLS Spotorno Femoral Stem Correlate with Functional Outcome of Patients Undergoing Total Hip Arthroplasty? An Evaluation at Mid-term Follow Up.Indian journal of orthopaedics · 2024Article
- A comprehensive analysis on contributing factors for varus or valgus malposition of femoral stems in uncemented total hip arthroplasty via DAA.Journal of orthopaedics · 2024Article
- Accuracy of Positioning and Risk Factors for Malpositioning Custom-Made Femoral Stems in Total Hip Arthroplasty-A Retrospective Multicenter Analysis.Journal of personalized medicine · 2023Article
- Which patient-specific parameters correlate with operation time for total hip arthroplasty? - A retrospective analysis of the direct anterior approach.International orthopaedics · 2023Article
- The 'critical trochanter angle' does not show superiority over the CCD angle in predicting varus stem alignment in cementless short-stem total hip arthroplasty.Archives of orthopaedic and trauma surgery · 2023Article
- SuperPath® vs. direct anterior approach : A retrospective comparison between two minimally invasive approaches in total hip arthroplasty.Orthopadie (Heidelberg, Germany) · 2022Article
- High varus stem alignment in short-stem total hip arthroplasty: a risk for reconstruction of femoro-acetabular offset, leg length discrepancy and stem undersizing?Archives of orthopaedic and trauma surgery · 2022Article
- Article
- Treatment of Osteoarthritis Secondary to Severe Coxa Vara with Modular Total Hip Arthroplasty.Therapeutics and clinical risk management · 2021Article
- Evaluation of intra- and interobserver reliability in the assessment of the 'critical trochanter angle'.European journal of medical research · 2020Article
- Supercapsular percutaneously assisted total hip arthroplasty versus conventional posterior approach: Comparison of early functional results.Acta orthopaedica et traumatologica turcica · 2020Article
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Authors and funding
6 authors.
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No grant is acknowledged in the PubMed record.
Abstract
introductionStem malalignment can affect offset reconstruction and may result in gluteal muscle insufficiency. In this retrospective study, a novel geometric angle named 'critical trochanter angle' (CTA) is described and investigated towards the risk of malposition of a collarless straight tapered hydroxyapatite-coated stem in primary total hip arthroplasty (THA). MATERIAL AND
methodsA total of 100 cementless THA were implanted in patients with unilateral coxarthrosis via the direct anterior (n = 50) or direct lateral Hardinge approach (n = 50) in a two surgeon setting using the Corail® or Trendhip® stem (DePuy Synthes or Aesculap). Stem alignment was analysed in postoperative AP pelvic radiographs and correlated to the CTA: the angle crest was defined by the intersection of the femoral shaft and neck axis and the angle was measured between the shaft axis and a leg intersecting the vertex between the lateral and superoposterior facet of the trochanter.
resultsForty-seven stems were implanted in varus (≥ + 1°), 42 in neutral (< + 1°/> - 1°) and 11 in valgus position (≤ - 1°). The mean critical trochanter angle was 25.0° (SD ± 7.5°), and there was a negative and statistically significant correlation to stem alignment (r = - 0.52; p ≤ 0.001) independent from the surgical approach. For stem malposition of 2° and above (n = 23), mean CTA was 17.2° for varus (n = 20) and 31.6° for valgus (n = 3). A CTA lesser or equal to 22.75° had a sensitivity of 90% and specificity of 80% for varus stem position of 2° or greater. Specificity raised to 100% with a cutoff CTA of 12.5° or lesser.
conclusionVarus stem alignment in THA is associated with coxa vara deformity and a radiological low CTA. In preoperative planning, the critical trochanter angle can help to evaluate the risk for intraoperative stem malpositioning. If navigation or robotic assistance is not available when using this stem design, we recommend an intraoperative x-ray to verify correct implant positioning in patients with a CTA under 20° or above 30°.
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