Background: Although the orientation of the femoral component has
been shown to influence the outcome of total hip replacement, its effect on
the clinical outcome of surface arthroplasty has not been studied, to our
knowledge. The purpose of this study was to examine the relationship between
femoral component positioning and the outcome of a surface arthroplasty of the
hip.
Methods: We reviewed the results of ninety-four hybrid
metal-on-metal surface arthroplasties in patients who were forty years old or
younger at the time of the operation and were followed for a minimum of two
years or until the prosthesis failed. Measurements of the hip reconstruction
were made on the anteroposterior pelvic radiograph. The correlation between
the orientation of the femoral component and the outcome of the arthroplasty
was evaluated, as were stresses within the resurfaced femoral head as a
function of the orientation of the femoral component.
Results: The mean duration of follow-up was 4.2 years. Thirteen hips
had an adverse outcome, defined as conversion to a total hip replacement,
radiolucency of >1 mm in thickness adjacent to the femoral stem, or
narrowing of the femoral neck of >10%. The mean femoral stem-shaft angle in
the coronal plane was 138°, with the hips that had an adverse outcome
having a significantly lower mean angle than the rest of the cohort (133°
compared with 139°, p = 0.03). Hips with an angle of =130° had an
increase in the relative risk of an adverse outcome by a factor of 6.1 (p <
0.004). In the entire cohort, stresses in the superior aspect of the
resurfaced femoral head were substantially lower during slow walking than they
were during fast walking (7.1 N/mm2 compared with 14.2
N/mm2).
Conclusions: Optimizing the femoral stem-shaft angle toward a valgus
orientation during the preparation of the femoral head is important when a hip
is being reconstructed with a surface arthroplasty because the resurfaced hip
transmits the load through a narrow critical zone in the femoral head-neck
region and the valgus angulation may reduce these stresses.
Level of Evidence: Therapeutic study, Level III-2
(retrospective cohort study). See Instructions to Authors for a complete
description of levels of evidence.