ArticleJournal of orthopaedics2024
A comprehensive analysis on contributing factors for varus or valgus malposition of femoral stems in uncemented total hip arthroplasty via DAA.
Article in Journal of orthopaedics, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Canal fill and radiographic comparison analysis of novel fully hydroxyapatite coated, variable triple-tapered geometry stems: one-year follow-up after direct anterior approach total hip arthroplasty.Archives of orthopaedic and trauma surgery · 2025Article
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Authors and funding
6 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Background: Varus or valgus malposition of uncemented femoral stems have been described to have detrimental effects for long term implant survival. Various pre- and intra-OP factors have been suggested to be relevant, one of them being the approach to the hip. The aim was to investigate several pre- and intra-OP factors associated with femoral stem malpositioning in a large series of DAA hips. Methods: A series of 400 consecutive patients (416 hips) who underwent navigated (Brainlab) cementless Total Hip Arthroplasty (THA) in 2022 (Corail or Actis stem DePuy Synthes) via a direct anterior approach (DAA) was analyzed. Preoperative data were collected based on patients' demographics, radiographic information [critical trochanteric angle (CTA), centrum collum diaphyseal (CCD) angle, greater trochanter overhang, femoral neck resection angle, femoral neck resection height and Door classification], and these were correlated with the postoperative stem position. Univariable and multivariable linear regression were carried out to determine significant factors that contribute to varus and valgus stem malalignment. Results: With the DAA approach, 56.5 % of stems were placed in an optimal neutral position, 38.4 % were in acceptable position of 0.1°-2° varus/valgus and only 5 % had a deviation larger than 2° varus/valgus. The critical trochanteric angle (CTA) was statistically significant in determining varus stem placement whereas centrum collum diaphyseal angle (CCD) was found to affect valgus stem malpositioning. All other factors have shown no relevant effect on stem placement using stepwise regression method. Conclusion: In DAA, 95 % of stems were found in a varus/valgus position of 2° or less. In pre-operative measurement, only femoral morphology (e.g. CTA & CCD) were found to be relevant, affecting varus/valgus stem malposition. All other tested modifiable and non-modifiable factors had no significant effect. Therefore, pre-OP templating including measurement of CTA and CCD, intra-operative assessment as well as proper operative techniques are paramount to prevent excessive varus/valgus mal-position of femoral stem in DAA.
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