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Scientific Articles   |    
Orientation of the Femoral Component in Surface Arthroplasty of the HipA Biomechanical and Clinical Analysis
Paul E. Beaulé, MD, FRCSC1; Jessica L. Lee, MS2; Michel J. Le Duff, MA1; Harlan C. Amstutz, MD1; Edward Ebramzadeh, PhD3
1 Joint Replacement Institute at Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007. E-mail address for P.E. Beaulé: pbeaule@laoh.ucla.edu
2 Department of Biomedical Engineering, University of Southern California, OHE 500, MC1451, University Park, Los Angeles, CA 90007. E-mail address: jessicll@usc.edu
3 Biomechanics Laboratory, Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007-2697
The Journal of Bone & Joint Surgery.  2004; 86:2015-2021 
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Abstract

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.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Paul E. Beaule, M.D., FRCSC
    Posted on March 21, 2005
    Untitled
    Joint Replacement Institute at Orthopaedic Hospital, Los Angeles, CA 90007

    To The Editor:

    In the paper “Orientation of the Femoral Component in Surface Arthroplasty of the Hip. A Biomechanical and Clinical Analysis” (2004;86:2015-21), by Beaulé et al., information on the clinical outcome presented in the Results section had already been published in the Clinical Orthopaedics and Related Research article “Risk Factors Affecting Outcome of Metal-on-Metal Surface Arthroplasty of the Hip.”(1) However, the CORR article was referenced only in the Materials and Methods section of the JBJS article. Our intent was to provide the reader with the clinical context and the relevant data that motivated us to create the biomechanical model for the analysis of the stresses within the femoral neck that was presented in the second manuscript. In retrospect, we realized that the appropriate way to accomplish this would have been to present a summary of the methods, results, and discussion sections of the CORR article in the introduction section of the JBJS paper rather than in the Materials and Methods and Results sections. Unfortunately, the way that we presented our information in the JBJS article gave the impression that this was the first time that the clinical study had been published. We offer our sincere apologies to the Editors of both journals for this unfortunate mistake as well as for the oversight of not requesting prior copyright permission to reproduce Figure 2 of the CORR article in the JBJS article (Figure 1 in that article). As the two major contributors cited in both articles, we assume complete responsibility for this oversight and would also like to extend our apologies to the readership of both journals.

    We would like to thank Dr. Heckman and Dr. Brand for bringing this to our attention, since maintaining the highest quality in peer-reviewed publication is something we all continue to strive for(2).

    -Paul E. Beaulé, MD, FRCSC Harlan C. Amstutz, MD Corresponding author: Paul E. Beaulé, MD, FRCSC Joint Replacement Institute at Orthopaedic Hospital 2400 South Flower Street Los Angeles, CA 90007

    References

    1. Beaulé PE, Dorey FJ, LeDuff M, Gruen T, Amstutz HC. Risk factors affecting outcome of metal-on-metal surface arthroplasty of the hip. Clin Orthop. 2004;418:87-93.

    2. Brand RA, Heckman JD, Scott J. Changing ethical standards in scientific publication. J Bone Joint Surg Br. 2004;86:937-8.

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