ArticleJournal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology2023
Clinical effects of different center of rotation reconstructions in total hip arthroplasty after femoral neck fractures: a cohort study including a follow-up analysis on patient's mobility and daily living ability.
Article in Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Period-Specific Determinants of Mortality After Geriatric Hip Fracture: Insights into Inflammation, Comorbidity and Surgical Timing.Geriatric orthopaedic surgery & rehabilitation · 2026Article
- Incorrect acetabular cup positioning in a MoM THA: an announced failure with growth of bulky pseudotumour. A case report.International journal of surgery case reports · 2025Article
- Surgical timing and clinical factor predicting in-hospital mortality in older adults with hip fractures: a neuronal network analysis.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2025Observational
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Abstract
backgroundThe aim of this study is a clinical evaluation of the center of rotation (COR) placement towards a patient's recovery with respect to daily living ability and mobility. In past experiments based on three-dimensional (3D) models, medialization of the COR in total hip arthroplasty (THA) showed a negative influence on muscle strength of the abductors and reaction force of the hip joint. This contradicts paradigms, where reduced hip loading forces are claimed to increase functional outcomes.
methodsThe plain X-rays of 110 patients who underwent THA after a femoral neck fracture between January 2019 and January 2021 were retrospectively evaluated. A Barthel Index on discharge was obtained in 69 cases. 47 patients were available for a follow-up interview concerning the Barthel Index, Parker mobility score (PMS), and pain levels (NRS) 6 and 12 months after surgery.
resultsMedialization of the COR had a significantly negative effect on the need for care (Barthel Index) at patient discharge (Spearman correlation 0.357, p = 0.013). The effect on the PMS is still existent at 6 and 12 months (Spearman correlation 0.471, p = 0.009 at 6 months; 0.472, p = 0.008 at 12 months). Mann-Whitney U tests showed that the groups with medialized COR performed significantly worse than the lateralized groups. This was seen for the Barthel Index at discharge and at 6 months after surgery and for the PMS at 6 and 12 months. The accurately reconstructed CORs showed no significant differences from the lateralized rotation centers in need of care and mobility. The superior COR placement group showed significantly reduced mobility at 12 months in contrast to the inferior COR placement group (p = 0.008), and the group of accurately reconstructed rotation centers showed significantly less pain than the inferior COR placement group (p = 0.007 after 6 months, p = 0.026 after 12 months). Especially the combination of both (superomedialization) leads to reduced mobility (Spearman correlation 0.67, p = < 0.001).
conclusionsCOR superior displacement, COR medialization, and the combination of both (superomedialization, Spearman p = < 0.001) lead to reduced mobility while inferior displacement showed increased pain. According to our results, we recommend an exact vertical COR restoration, while horizontal medial displacement needs to be avoided. LEVEL OF EVIDENCE: III.
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