Influence of femoral broach shape on stem alignment using anterior approach for total hip arthroplasty: A radiologic comparative study of 3 different stems

Cécile Batailler, Camdon Fary, Elvire Servien, Sébastien Lustig, Cécile Batailler, Camdon Fary, Elvire Servien, Sébastien Lustig

Abstract

Background: Malalignment of the femoral stem in total hip arthroplasty (THA) can detrimentally affect outcome. Poor preparation of the femur intraoperatively is an important cause of stem malalignment.

Purposes: The objective was to compare coronal alignment of three different stems using three different broaches.

Methods: Retrospective study of three groups of 60 patients following primary THA via direct anterior approach, by the same surgeon, between January 2015 and January 2016. Each group had a similar designed stem (Corail Depuy, Targos Lepine or Meije Tornier). Groups were matched for age, body mass index, gender, side, neck shaft angle and indications. The significant difference between groups was the broach shape. Broaches for the Corail and Meije stems had a prominent shoulder laterally, while the broach of the Targos stem had a rounded less prominent shape laterally. Coronal alignment was determined radiologically at 2 months.

Results: The mean varus was significantly lower for the Targos stems (1.1° +/-0.8) compared to the Corail (2.3° +/-1.5) and Meije stems (1.9° +/-1.2) (p<0.0001). There were significantly less Targos stems with varus greater than 3° (1.7%, n = 1) compared to the Corail (40%, n = 24) and Meije stems (20%, n = 12) (p<0.001).

Conclusion: A femoral broach with a prominent lateral shoulder when performing a THA via direct anterior approach will increase the risk of varus femoral stem alignment compared to a less laterally prominent broach.

Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: CB declares that they have no conflict of interest. CF: Consultant for Amplitude, Institutional research support from Medacta and Stryker. ES: Consultant for Smith & Nephew and Corin. SL: Consultant for Smith & Nephew, Institutional research support from Tornier-Wright and Amplitude. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. The three stems used during…
Fig 1. The three stems used during this study.
a. Corail Depuy; b. Meije Tornier; c. Targos Lepine. The design includes a fully hydroxyapatite coating non-porous forged titanium alloy stem, with a proximal trapezoidal/quadrangular cross-section and a tapered distal stem. All stems had a collar.
Fig 2. The three broach handles used…
Fig 2. The three broach handles used in this study with lateral and superior views.
(a. Corail Depuy; b. Meije Tornier; c. Targos Lepine). All had a double offset with the same curve, allowing a femoral preparation in a satisfying axis, even with difficult exposures.
Fig 3. The three broaches used for…
Fig 3. The three broaches used for the preparation femoral in this study.
(a. Corail Depuy; b. Meije Tornier; c. Targos Lepine). The broach for the Targos stem presents a rounded back, in the continuity of the handle. The broaches for the Corail and Meije stems have a shoulder more or less marked, just before the handle.
Fig 4. Postoperative pelvic AP views of…
Fig 4. Postoperative pelvic AP views of three stems used in this study.
a. Right THA with a Corail stem (varus of 4.3°). b. Right THA with a Meije stem (varus of 4°). c. Right THA with a Targos stem (only Targos stem with a varus positioning of 3.1°).

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