Comparison of clinical and functional outcomes in patients operated with standard offset stem versus high offset stem in total hip replacement: a retrospective study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20241521Keywords:
High offset stem, Standard offset, Total hip replacement, Biomechanics of hip, Harris hip scoreAbstract
Background: Femoral offset restoration in total hip replacement is crucial for normal anatomy and reduced joint forces, with potential implications for implant longevity and complications. This study compares standard and high offset stem total hip replacement outcomes for better restoration of native offset, also to improve understanding of clinical and functional outcomes particularly regarding implant selection in total hip replacements.
Methods: The study will include 40 patients who underwent THR, divided into standard offset and high offset stem groups. Preoperative data, including history and clinical examination, was collected. Post-operative recovery, satisfaction, and pain levels will be assessed through serial follow-ups at 6, 12, and 18 weeks, along with clinical improvement measured by Harris hip score. Analysis at 18 weeks will evaluate the outcomes of standard vs. high offset stem surgeries.
Results: Group A exhibited significantly higher proportions of patients with a Harris hip score >90 (excellent) compared to Group B (70% vs. 25%) and significantly lower proportions with scores indicating poor, fair, and good outcomes (<70: 0% vs. 10%, 70-79: 5% vs. 15%, 80-89: 25% vs. 50%, respectively; p=0.02).
Conclusions: This study confirms that increasing femoral offset with high-offset stems improves functional outcomes and biomechanics in total hip arthroplasty, emphasizing the need for patient-specific anatomical consideration.
References
Ng KG, Jeffers JR, Beaulé PE. Hip joint capsular anatomy, mechanics, and surgical management. J Bone Joint Surg. 2019;101(23):2141.
Mittal G, Kulshrestha V, Kumar S, Datta B. Epidemiology of revision total hip arthroplasty: an Indian experience. Indian J Orthopaed. 2020;54(5): 608-15.
Mendiolagoitia L, Rodríguez MÁ, Crespo I, Del Valle M, Olmedillas H. Kinematic Gait Analysis After Primary Total Hip Replacement: A Systematic Review. Indian J Orthopaed. 2020;54(6):767-75.
Vaidya SV, Jogani AD, Pachore JA, Armstrong R, Vaidya CS. India joining the world of hip and knee registries: present status a leap forward. Indian J Orthopaed. 2021;55(1):46-55.
Malviya A, Abdul N, Khanduja V. Outcomes following total hip arthroplasty: A review of the registry data. Indian J Orthopaed. 2017;51(4):405-13.
Agarwala S, Vijayvargiya M, Chaudhari S. Restoring natural hip movements with large head (ceramic on ceramic) total hip replacement: experience of our 150 patients over 6 years. J Orthoped. 2017;7(12):414-27.
Lum ZC, Dorr LD. Restoration of center of rotation and balance of THR. J Orthoped. 2018;15(4):992-6.
Kumar G, Jisam M, Varghese J, Kandathil JC, Theruvil B. A study of femoral offset in the South Indian population and its clinical implications in hip arthroplasty. J Clin Orthopaed Trauma. 2021;23: 101614.
Tezuka T, Inaba Y, Kobayashi N, Ike H, Kubota S, Kawamura M, et al. Effects of hip joint center location and femoral offset on abductor muscle strength after total hip arthroplasty. Modern Rheumatol. 2015;25(4): 630-6.
Sato H, Maezawa K, Gomi M, Kajihara H, Hayashi A, Maruyama Y, Nozawa M, Kaneko K. Effect of femoral offset and limb length discrepancy on hip joint muscle strength and gait trajectory after total hip arthroplasty. Gait Posture. 2020;77:276-82.
Asayama I, Chamnongkich S, Simpson KJ, Kinsey TL, Mahoney OM. Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty. J Arthroplast. 2005;20(4):414-20.
Vaishy A, Arif M, Aanand R, Singh K, Rulaniya HK, Kumawat N, et al. Implant positioning in total hip arthroplasty: influence of horizontal and vertical offset on functionality of prosthetic hip joint. Int Orthopaed. 2022;15:1-6.
Matsushita A, Nakashima Y, Jingushi S, Yamamoto T, Kuraoka A, Iwamoto Y. Effects of the femoral offset and the head size on the safe range of motion in total hip arthroplasty. J Arthroplast. 2009;24(4):646-51.
Jerosch J, Funken S. Change of offset after implantation of hip alloarthroplasties. Der Unfall Chirurg. 2004;107(6):475-82.
Dolhain P, Tsigaras H, Bourne RB, Rorabeck CH, Mac Donald S, Mc Calden R. The effectiveness of dual offset stems in restoring offset during total hip replacement. Acta Orthopaed Belg. 2002;68(5):490-9.
Ali Khan MA, Brakenbury PH, Reynolds IS. Dislocation following total hip replacement. J Bone Joint Surg. 1981;63(2):214-8.
Kiyama T, Naito M, Shinoda T, Maeyama A. Hip abductor strengths afer total hip arthroplasty via the lateral and posterolateral approaches. J Arthroplast. 2009;25:76-80.
Renkawitz T. Leg length and ofset diferences above 5mm afer total hip arthroplasty are associated with altered gait kinematics. Gait Post. 2010;49:196-201.
Charnley J. Low friction arthroplasty of the hip. New York: Springer-Verlag; 1979: 336-344.
Dolhain P, Tsigaras H, Bourne RB, Rorabeck CH, Mac Donald S, Mc Calden R. The effectiveness of dual offset stems in restoring offset during total hip replacement. Acta Orthopaed Belg. 2002;68(5):490-9.
Terrier A, Levrero FF, Rudiger HA. Benefit of cup medialization in total hip arthroplasty is associated with femoral anatomy. Clin Orthop Relat Res. 2014;472:3159-65.
Little NJ, Busch CA, Gallagher JA, Rorabeck CH, Bourne RB. Acetabular polyethylene wear and acetabular inclination and femoral offset. Clin Orthop Relat Res. 2009;467:2895-900.
Liebs TR, Nasser L, Herzberg W, Ruther W, Hassenpflug J. The influence of femoral offset on health-related quality of life after total hip replacement. Bone Jt J. 2014;96:36-42.
Peng L, Ma J, Zeng Y, Wu Y, Si H, Shen B. Clinical and radiological results of high offset tri-lock bone preservation stem in unilateral primary total hip arthroplasty at a minimum follow-up of 3 years. J Orthopaed Surg Res. 2021;16(1):1-9.
Incavo SJ, Beynnon BD, Coughlin KM. Total hip arthroplasty with the secur-fit and secur-fit plus femoral stem design: a brief follow-up report at 5 to 10 years. J Arthroplast. 2008;23(5):670-6.
Panichkul P, McCalden RW, MacDonald SJ, Somerville LE, Naudie DN. Minimum 15-year results of a dual-offset uncemented femoral stem in total hip. J Arthroplast. 2009;34(12):2992-8.
Malhotra R, Kumar V. Mid-term outcome of total hip arthroplasty using a short stem. J Orthopaed Surg. 2016;24(3):323-7.
Incavo SJ, Havener T, Benson E, McGrory BJ, Coughlin KM, Beynnon BD. Efforts to improve cementless femoral stems in THR: 2-to 5-year follow-up of a high-offset femoral stem with distal stem modification. J Arthroplast. 2004;19(1):61-7.
von Roth P, Perka C, Mayr HO, Preininger B, Ziebula F, Matziolis G, et al. Reproducibility of femoral offset following short stem and straight stem total hip arthroplasty. Orthopedics. 2014;37(7):e678-84.