ArticleArchives of orthopaedic and trauma surgery2021
The direct anterior approach provokes varus stem alignment when using a collarless straight tapered stem.
Article in Archives of orthopaedic and trauma surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 20 citations in OpenAlex.
- Biomechanical effects of varus stem alignment on a cementless metadiaphyseal anchoring hip stem: a biomechanical investigation.Arthroplasty (London, England) · 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
- Outcomes of total hip arthroplasty using collared versus collarless uncemented HA-coated stems: a meta-analysis.EFORT open reviews · 2024Article
- Accuracy of Preoperative 3D vs 2D Digital Templating for Cementless Total Hip Arthroplasty Using a Direct Anterior Approach.Arthroplasty today · 2023Article
- Is the Direct Anterior Approach for Total Hip Arthroplasty Effective in Obese Patients? Early Clinical and Radiographic Results from a Retrospective Comparative Study.Medicina (Kaunas, Lithuania) · 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
- Anterior hip replacement: lower dislocation rates despite less restrictions?Archives of orthopaedic and trauma surgery · 2022Article
- A single-surgeon experience in reconstruction of femoro-acetabular offset and implant positioning in direct anterior approach and anterolateral MIS approach with a curved short stem.Archives of orthopaedic and trauma surgery · 2022Article
- Aseptic Loosening of Smaller Corail Stems in Heavy, Active Males: A Report of Three Cases.Cureus · 2021Article
- Evaluation of intra- and interobserver reliability in the assessment of the 'critical trochanter angle'.European journal of medical research · 2020Article
- The etiology of revision total hip arthroplasty: current trends in a retrospective survey of 3450 cases.Archives of orthopaedic and trauma surgery · 2020Article
- Restoring hip biomechanics during the learning curve of a novice surgeon: Direct anterior approach vs posterior approach.Journal of orthopaedicsArticle
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionInaccurate stem implantation can cause unsatisfactory offset reconstruction and may result in insufficient gluteal muscle function or aseptic loosening. In this study, stem alignment of a collarless straight tapered HA-coated stem was retrospectively analyzed during the learning phase of the direct anterior approach (DAA) for primary total hip arthroplasty (THA). MATERIAL AND
methodsFrom Jan 2013 to Jun 2015, a total of 93 cementless THA were implanted in patients with unilateral coxarthrosis via the DAA in a two surgeon setting using the Corail
results55 stems were implanted in varus (59%), 32 in neutral (34%) and 6 in valgus alignment (7%). Mean stem alignment in varus position was + 2.2° (SD ± 1.4°). Varus alignment was associated with male gender and preoperative coxa vara deformity: low CCD, high femoral offset and long thigh neck (p ≤ 0.001). Alignment was not correlated to femoral offset restoration, BMI or leg length difference. Mean cup inclination was 44° (SD ± 4.7°) and 90% matched the coronal Lewinnek safe zone.
conclusionIn the learning curve, the DAA can be associated with a high incidence of varus stem alignment when using a straight tapered stem, especially in men with coxa vara deformity: low CCD, high femoral offset and long thigh neck. An insufficient capsule release makes femur exposure more difficult and might be an additional factor for this finding. We recommend intraoperative X-ray in the learning phase of the DAA to verify correct implant positioning and to adjust offset options.
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