Year : 2017  |  Volume : 2  |  Issue : 3  |  Page : 91-96

How well do lower femoral neck shaft angled stems match patients with coxa vara hip deformities?

Texas Center for Joint Replacement, Plano, TX, USA

Correspondence Address:
Omar Alnachoukati
Texas Center for Joint Replacement, Plano, TX
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2542-4157.213686

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Background and objectives: Patients undergoing total hip arthroplasty (THA) may have femoral deformities classified as either coxa vara, coxa valga, or physiologic. Understanding patients' anatomies is of importance for surgeons in an effort to tailor not only surgical approach, but also implant selection, and ultimately ensure optimal outcomes. The goal of the present study is to determine the efficacy of implanting a lower neck shaft angle (NSA) femoral stem in patients with coxa vara deformities and determine short-term clinical outcomes. Design: A retrospective chart review study. Methods: The study took place at The Texas Center for Joint Replacement in Plano, Texas. Two patient groups, clinical outcomes group and EOS group, were used for this study. The clinical outcomes group contained 55 patients who had undergone primary THA surgery from June 2013 to June 2015 by the senior author. The EOS group contained 36 patients who had undergone primary THA, and completed both preoperative and postoperative biplanar X-rays (low dose imaging device EOS) to obtain three-dimensional reconstructions of the skeletal system from October 2015 to November 2016. Operations were performed in all hips through the anterior supine intermuscular approach utilizing a 123° NSA femoral stem, which was lower than the NSA (133°) found in standard femoral stem implants. Outcome measures: Pre- and postoperative Harris hip scores used to assess clinical outcomes following surgery. Pre- and postoperative femoral offset, NSA, and femur length determined by EOS. Results: In the EOS group, mean femoral offset decreased by 3.5 mm, from 41.08 mm preoperatively to 37.6 mm postoperatively. Mean femoral NSAs decreased by 0.02°, from 123.02° preoperatively to 123.00° postoperatively. Mean femur length decreased by 2.4mm, from 404.2 mm preoperatively to 401.8 mm postoperatively. In the clinical outcomes group, mean Harris hip scores rose from 47 preoperatively to 93 postoperatively. Hip flexion range of motion improved from 87.5° preoperatively to 98° postoperatively. Conclusion: The lower NSA femoral stem examined in this study was proven to accurately restore NSA by 0.03°, femoral offset by 3.47 mm, and femur length by 2 mm, all within clinically documented satisfactory ranges without no revisions, suggesting excellent clinical outcomes in patients with coxa vara hip deformities. THA surgeons may consider utilizing femoral stems with a lower NSA in an effort to adequately restore hip function in patients with coxa vara hip deformities. Trial registration: This is a retrospective chart review study, therefore registration was not required.

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