Does the thigh circumference affect the positioning of the acetabular component when using the direct anterior approach in total hip arthroplasty?

C. A. Jacobs, E. T. Kusema, B. J. Keeney, W. E. Moschetti

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Aims The hypothesis of this study was that thigh circumference, distinct from body mass index (BMI), may be associated with the positioning of components when undertaking total hip arthroplasty (THA) using the direct anterior approach (DAA), and that an increased circumference might increase the technical difficulty. Patients and Methods We performed a retrospective review of prospectively collected data involving 155 consecutive THAs among 148 patients undertaken using the DAA at an academic medical centre by a single fellowship-trained surgeon. Preoperatively, thigh circumference was measured at 10 cm, 20 cm, and 30 cm distal to the anterior superior iliac spine, in quartiles. Two blinded reviewers assessed the inclination and anteversion of the acetabular component, radiological leg-length discrepancy, and femoral offset. The radiological outcomes were considered as continuous and binary outcome variables based on Lewinnek’s ‘safe zone’. Results Similar trends were seen in all three thigh circumference groups. In multivariable analyses, patients in the largest 20 cm thigh circumference quartile (59 cm to 78 cm) had inclination angles that were a mean of 5.96° larger (95% confidence interval (CI) 2.99° to 8.93°; p < 0.001) and anteversion angles that were a mean of 2.92° larger (95% CI 0.47° to 5.37°; p = 0.020) than the smallest quartile. No significant differences were noted in leg-length discrepancy or offset. Conclusion There was an associated increase in inclination and anteversion as thigh circumference increased, with no change in the risk of malpositioning the components. THA can be performed using the DAA in patients with large thigh circumference without the risk of malpositioning the acetabular component.

Original languageEnglish
Pages (from-to)529-535
Number of pages7
JournalBone and Joint Journal
Volume101 B
Issue number5
DOIs
StatePublished - 2019

Bibliographical note

Publisher Copyright:
©2019 The British Editorial Society of Bone & Joint Surgery.

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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