Author/Authors :
Katchky, Adam M. Department of Orthopedics and Rehabilitation - University of Vermont - Burlington - VT, USA , Smith, Mitchell L. Melbourne Orthopaedic Group - Windsor - VIC, Australia , Shimmin, Andrew J. Department of Surgery - Monash University - Melbourne - VIC, Australia , McMahon, Stephen J. Department of Surgery - Monash University - Melbourne - VIC, Australia , Baré, Jonathan V. Department of Surgery - Monash University - Melbourne - VIC, Australia , Latham, Jeremy Spire Southampton Hospital - Southampton, UK
Abstract :
Despite strongly positive results of total hip arthroplasty (THA), patients remain at risk for complications including dislocation.Spinopelvic motion and the hip-spine relationship have been recognized as important factors in surgical planning and implantpositioning in THA. Periarticular osteophytes are one of the hallmark pathoanatomic features of osteoarthritis and may influenceimplant positioning and joint stability; residual osteophytes at the anterior femoral neck may cause anterior impingement andposterior instability. No studies have been identified which establish the prevalence of anterior femoral neck osteophyte forincorporation into THA planning. 413 consecutive patients scheduled for THA underwent preoperative planning taking intoaccount spinopelvic motion to establish optimal component position. Each surgical plan was reviewed retrospectively by fourindependent raterswho were blinded to other imaging and intraoperativefindings. Anteriorfemoral neck osteophytes were rated asbeing absent, minor, or extensive for each case. A single outlying rater was excluded. Inter-rater reliability was calculated manually.The patient group comprised 197 male and 216 female hips, with a mean age of 63 years (range 32–91). The presence of anteriorfemoral neck osteophytes was identified in a mean of 82% of cases (range 78–86%). A significant number of patients were foundto have large or extensive osteophytes present in this location (mean 27%; range 23–31%). Inter-rater reliability was 70%. A largemajority of our THA patients were found to have anterior femoral neck osteophytes. These must be considered during preoperativeplanning with respect to the spinopelvic relationship. Failure to identify and address osteophytes intraoperatively may increasethe risk of impingement in flexion and/or internal rotation, leading to decreased range of motion, joint instability, and possiblydislocation. Planned future directions include incorporation of an impingement and instability model into preoperative planningfor THA
Keywords :
Prevalence , Anterior Femoral Neck Osteophyte , Total Hip Arthroplasty Population , Analysis of Preoperative Surgical Plans
