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A comprehensive analysis on contributing factors for varus or valgus malposition of femoral stems in uncemented total hip arthroplasty via DAA

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dc.contributor.authorHak Lian Teh
dc.contributor.authorMostafa Abounouh
dc.contributor.authorPhilip Haibock
dc.contributor.authorVeenesh Selvaratnam
dc.contributor.authorShubash Shander Ganapathy
dc.contributor.authorHeiko Graichen
dc.date.accessioned2024-07-10T07:35:36Z
dc.date.available2024-07-10T07:35:36Z
dc.date.issued2024
dc.description.abstractBackground: 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 mea surement, 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.
dc.identifier.doihttps://doi.org/10.1016/j.jor.2023.11.068
dc.identifier.urihttps://repository.nih.gov.my/handle/123456789/463
dc.language.isoen
dc.relation.ispartofJournal of Orthopaedics
dc.relation.issn0972-978X
dc.titleA comprehensive analysis on contributing factors for varus or valgus malposition of femoral stems in uncemented total hip arthroplasty via DAA
dc.typejournal-article
dspace.entity.typePublication
oaire.citation.volume50
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