A new measurement method of offset in total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QU Wanming ,  ZHOU Hongbin , TIAN Peng , QIN Xiaorong , ZHANG You , SHEN Wenbin

Department of Orthopedics, Yiling Hospital of Yichang, Yichang Hubei, 443100, P. R. China;

Corresponding?author：

ZHOU Hongbin, Email: 723700839@qq.com

Keywords：

Total hip arthroplasty; global offset; greater trochanter offset

DOI：

10.7507/1002-1892.202109064

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Objective To report a new offset parameter for total hip arthroplasty (THA)—greater trochanter offset (GTO), and analyze the effectiveness and feasibility of this parameter based on clinical data. Methods The 47 patients who met the selection criteria and admitted between January 2016 and May 2020 were selected as the research object. The global offset (GO) was used as the offset parameter in preoperative design. Firstly, the test-retest reliability and inter-rater reliability of GTO were analyzed based on pelvic X-ray films. The GTO reconstruction was defined as the difference between the operative side and the healthy side within ±5 mm, and 47 patients were divided into the reconstruction group and the non-reconstruction group. General data (age, gender, type and side of fracture, the interval between injury and operation), visual analogue scale (VAS) score, Harris score, gait score, and leg length discrepancy (LLD) were recorded and compared between two groups. Then, the GTO was used as the offset parameter in preoperative design of 21 patients (GTO group) admitted between June 2020 and December 2020. The pre- and post-operative clinical data were compared between GTO group and GO group to explore the feasibility of GTO for THA.Results Statistical analysis showed that GTO had good test-retest reliability (P<0.001) and inter-rater reliability (P<0.001). There was no significant difference in gender, age, type and side of fracture, the interval between injury and operation, preoperative VAS score, and LLD at 1 year after operation between the GTO reconstruction group and the non-reconstruction group, as well as between the GO and GTO groups (P>0.05). The Harris score and gait score at 1 year after operation, and difference of VAS score between pre- and post- operation in the reconstruction group and GTO group were significantly better than those in the non-reconstruction group and GO group, respectively (P<0.05). There were 23 cases (48.9%) in the GO group and 19 cases (90.5%) in the GTO group with GTO reconstruction, and the difference was significant (χ²=10.606, P=0.001). There were 25 cases (53.2%) in the GO group and 13 cases (61.9%) in the GTO group with GO reconstruction, and the difference was not significant (χ²=0.447, P=0.504). There were 34 cases (72.3%) in the GO group and 19 cases (90.5%) in the GTO group with LLD reconstruction, and the difference was not significant (χ²=2.777, P=0.096). Conclusion GTO has reliable test-retest reliability and inter-rater reliability. GTO as a parameter of preoperative offset reconstruction plan of THA can obtain good reconstruction of offset and limb length, and obtain a good effectiveness.

Citation： QU Wanming, ZHOU Hongbin, TIAN Peng, QIN Xiaorong, ZHANG You, SHEN Wenbin. A new measurement method of offset in total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(4): 425-430. doi: 10.7507/1002-1892.202109064 Copy

1.	Worlicek M, Messmer B, Grifka J, et al. Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty. Sci Rep, 2020, 10(1): 7107. doi: 10.1038/s41598-020-62531-9.
2.	Loughead JM, Chesney D, Holland JP, et al. Comparison of offset in Birmingham hip resurfacing and hybrid total hip arthroplasty. J Bone Joint Surg (Br), 2005, 87(2): 163-166.
3.	Lecerf G, Fessy MH, Philippot R, et al. Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res, 2009, 95(3): 210-219.
4.	Robinson M, Bornstein L, Mennear B, et al. Effect of restoration of combined offset on stability of large head THA. Hip Int, 2012, 22(3): 248-253.
5.	Kjellberg M, Al-Amiry B, Englund E, et al. Measurement of leg length discrepancy after total hip arthroplasty. The reliability of a plain radiographic method compared to CT-scanogram. Skeletal Radiol, 2012, 41(2): 187-191.
6.	Nossa JM, Mu?oz JM, Riveros EA, et al. Leg length discrepancy after total hip arthroplasty: comparison of 3 intraoperative measurement methods. Hip Int, 2018, 28(3): 254-258.
7.	胡勇, 周龐虎, 邱波. 全髖關節置換術后雙下肢不等長的評估. 中華關節外科雜志 (電子版), 2020, 14(2): 201-205.
8.	袁偉. 運動力學對線的人工膝關節有限元建模和生物力學研究. 上海: 第二軍醫大學, 2017.
9.	Kjellberg M, Englund E, Sayed-Noor AS. A new radiographic method of measuring femoral offset. The Sundsvall method. Hip Int, 2009, 19(4): 377-381.
10.	Weber M, Woerner M, Springorum R, et al. Fluoroscopy and imageless navigation enable an equivalent reconstruction of leg length and global and femoral offset in THA. Clin Orthop Relat Res, 2014, 472(10): 3150-3158.
11.	Enke O, Levy YD, Bruce WJ. Accuracy of leg length and femoral offset restoration after total hip arthroplasty with the utilisation of an intraoperative calibration gauge. Hip Int, 2020, 30(3): 296-302.
12.	Renkawitz T, Weber T, Dullien S, et al. Leg length and offset differences above 5mm after total hip arthroplasty are associated with altered gait kinematics. Gait Posture, 2016, 49: 196-201.
13.	Debbi EM, Rajaee SS, Mayeda BF, et al. Determining and achieving target limb length and offset in total hip arthroplasty using intraoperative digital radiography. J Arthroplasty, 2020, 35(3): 779-785.
14.	Sato H, Maezawa K, Gomi M, et al. Effect of femoral offset and limb length discrepancy on hip joint muscle strength and gait trajectory after total hip arthroplasty. Gait Posture, 2020, 77: 276-282.
15.	Biggi S, Banci L, Tedino R, et al. Restoring global offset and lower limb length with a 3 offset option double-tapered stem. BMC Musculoskelet Disord, 2020, 21(1): 646. doi: 10.1186/s12891-020-03674-8.
16.	Snijders TE, van Erp JHJ, de Gast A. Restoring femoral offset and leg length; the potential of a short curved stem in total hip arthroplasty. J Orthop, 2019, 16(5): 396-399.
17.	Tipton SC, Sutherland JK, Schwarzkopf R. The assessment of limb length discrepancy before total hip arthroplasty. J Arthroplasty, 2016, 31(4): 888-892.
18.	Bicanic G, Delimar D, Delimar M, et al. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop, 2009, 33(2): 397-402.

1. Worlicek M, Messmer B, Grifka J, et al. Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty. Sci Rep, 2020, 10(1): 7107. doi: 10.1038/s41598-020-62531-9.
2. Loughead JM, Chesney D, Holland JP, et al. Comparison of offset in Birmingham hip resurfacing and hybrid total hip arthroplasty. J Bone Joint Surg (Br), 2005, 87(2): 163-166.
3. Lecerf G, Fessy MH, Philippot R, et al. Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res, 2009, 95(3): 210-219.
4. Robinson M, Bornstein L, Mennear B, et al. Effect of restoration of combined offset on stability of large head THA. Hip Int, 2012, 22(3): 248-253.
5. Kjellberg M, Al-Amiry B, Englund E, et al. Measurement of leg length discrepancy after total hip arthroplasty. The reliability of a plain radiographic method compared to CT-scanogram. Skeletal Radiol, 2012, 41(2): 187-191.
6. Nossa JM, Mu?oz JM, Riveros EA, et al. Leg length discrepancy after total hip arthroplasty: comparison of 3 intraoperative measurement methods. Hip Int, 2018, 28(3): 254-258.
7. 胡勇, 周龐虎, 邱波. 全髖關節置換術后雙下肢不等長的評估. 中華關節外科雜志 (電子版), 2020, 14(2): 201-205.
8. 袁偉. 運動力學對線的人工膝關節有限元建模和生物力學研究. 上海: 第二軍醫大學, 2017.
9. Kjellberg M, Englund E, Sayed-Noor AS. A new radiographic method of measuring femoral offset. The Sundsvall method. Hip Int, 2009, 19(4): 377-381.
10. Weber M, Woerner M, Springorum R, et al. Fluoroscopy and imageless navigation enable an equivalent reconstruction of leg length and global and femoral offset in THA. Clin Orthop Relat Res, 2014, 472(10): 3150-3158.
11. Enke O, Levy YD, Bruce WJ. Accuracy of leg length and femoral offset restoration after total hip arthroplasty with the utilisation of an intraoperative calibration gauge. Hip Int, 2020, 30(3): 296-302.
12. Renkawitz T, Weber T, Dullien S, et al. Leg length and offset differences above 5mm after total hip arthroplasty are associated with altered gait kinematics. Gait Posture, 2016, 49: 196-201.
13. Debbi EM, Rajaee SS, Mayeda BF, et al. Determining and achieving target limb length and offset in total hip arthroplasty using intraoperative digital radiography. J Arthroplasty, 2020, 35(3): 779-785.
14. Sato H, Maezawa K, Gomi M, et al. Effect of femoral offset and limb length discrepancy on hip joint muscle strength and gait trajectory after total hip arthroplasty. Gait Posture, 2020, 77: 276-282.
15. Biggi S, Banci L, Tedino R, et al. Restoring global offset and lower limb length with a 3 offset option double-tapered stem. BMC Musculoskelet Disord, 2020, 21(1): 646. doi: 10.1186/s12891-020-03674-8.
16. Snijders TE, van Erp JHJ, de Gast A. Restoring femoral offset and leg length; the potential of a short curved stem in total hip arthroplasty. J Orthop, 2019, 16(5): 396-399.
17. Tipton SC, Sutherland JK, Schwarzkopf R. The assessment of limb length discrepancy before total hip arthroplasty. J Arthroplasty, 2016, 31(4): 888-892.
18. Bicanic G, Delimar D, Delimar M, et al. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop, 2009, 33(2): 397-402.

Chinese Journal of Reparative and Reconstructive Surgery

A new measurement method of offset in total hip arthroplasty

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