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Implant positioning in total hip arthroplasty: influence of horizontal and vertical offset on functionality of prosthetic hip joint

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Abstract

Purpose

To analyze the effect of implant position measured in terms of offset on patient reported outcomes (PRO) following hip arthroplasty (THA).

Methods

A total of 243 patients of the total hip replacement who had a one year follow-up were included in the study. Standard both hips radiograph was used to asses post-surgery implant position in terms of horizontal offset and vertical offset, and correlated with functional outcome which was evaluated as change in PRO. i.e., Harris hip score (HHS) post-op. With center of hip rotation as reference, horizontal offset was calculated as sum of distance, of centre, from proximal femoral shaft axis and a vertical line through ipsilateral teardrop, and vertical offset as limb length discrepancy. Post-op patients were classified into three groups depending on the measurement of horizontal offset of the operated hip. The patients having operated hip horizontal offset within 5 mm of the normal hip were grouped as restored offset (RO); those having shorter or higher offset by more than 5 mm compared to normal hip were labeled as decreased (DO) or increased offset (IO) group respectively. The groups were further subdivided into suboptimal and optimal function groups based on HHS, and among these groups, limb length discrepancy was evaluated.

Results

Post follow-up mean HHS (78.23 ± 9.96) improved significantly in all three groups (p < 0.0001). The difference in post-operative HHS among DO, RO, and IO groups was significant, with their averages being 72.5 ± 4.7, 82.1 ± 6.5, and 75.2 ± 4.8 respectively (p = .01). Limb length discrepancy was significantly more common in patients with suboptimal functional scores in all three groups.

Conclusion

This study concluded that both horizontal offset and vertical offset should be reconstructed in patients operated with unilateral THR due to hip pathology, since both factor demonstrated a comparable additive effect on clinical outcome.

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Data availability

The data that support the findings of this study are available from institutional records but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of IEC.

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Authors and Affiliations

  1. Department of Orthopaedics, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India

    Arun Vaishy, Rahul Aanand, Kamaldeep Singh, Hitesh Kumar Rulaniya, Naveen Kumawat & Ramakishan Choudhary

  2. Department of Orthopaedics, Choudhary Bhupendra Hospital, Bhinmal, Rajasthan, Jalore, India

    Mohd Arif

  3. Department of Dermatology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India

    Paras Choudhary

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  1. Arun Vaishy
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by KS, MA, and AV. The first draft of the manuscript was written by KS and all authors commented on previous versions of the manuscript. NK, RA, and HKR helped in statistical analysis and manuscript review. All authors read and approved the final manuscript. RC supervised all the things.

Corresponding author

Correspondence to Kamaldeep Singh.

Ethics declarations

Ethics approval

Approval was obtained from the ethics committee of DR. S. N. Medical College and associated group of hospitals, Jodhpur (Date-27/04/2018, No.F.1 Acad/MC/Ju/18/6909).

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Informed consent was obtained from all study participants.

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Patients signed informed consent regarding publishing their data and photographs.

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The authors declare no competing interests.

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Vaishy, A., Arif, M., Aanand, R. et al. Implant positioning in total hip arthroplasty: influence of horizontal and vertical offset on functionality of prosthetic hip joint. International Orthopaedics (SICOT) 46, 1501–1506 (2022). https://doi.org/10.1007/s00264-022-05364-7

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  • DOI: https://doi.org/10.1007/s00264-022-05364-7

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