Development and application of calibrated femoral canal file and corresponding femoral stem prosthesis based on the digital anatomy of the hip joint to reduce the leg length discrepancy after total hip arthroplasty
Duan Xudong1,2, Wang Kunzheng3, Li Shufeng2, Sun Huaqiang2, Shi Zhiwei1, Gu Yange1, Yin Luxu2, Zhang Yeyong2, Yang Pei3, Zhou Jiansheng4, Yan Xinfeng2
1 Surgery Speciality Grade 2018, Cheeloo College of Medicine, Shandong University, Jinan 250014, China; 2 Department of Orthopedic Surgery, the First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Shandong Key Laboratory of Rheumatic Disease and Translational medicine,Jinan 250014, China; 3 Department of Orthopedics, the Second Affiliated Hospital of Xi'an Jiao Tong University Xi'an 710001, China; 4 Department of Orthopedics, the First Affiliated Hospital of the Bengbu Medical College, Bengbu 233004, China
Abstract：Objective According to the digital anatomical characteristics of the hip joint, a calibrated femoral canal file, and corresponding femoral stem prosthesis and its measuring method are developed. To explore the effect of this technique on controlling the leg length in total hip arthroplasty (THA) and analyze the causes for the results obtained by this method. Methods Retrospective cohort study. A total of 300 patients who underwent the first unilateral THA in Qianfoshan Hospital of Shandong Province from June 2017 to July 2020 were selected. Among them, there were 154 males and 146 females, aged 27-86 (59.5±11.3) years old. Patients were divided into groups according to the methods used of controlling their leg length discrepancy (LLD) during the operation: 134 patients with calibrated femoral canal files to control leg length were included in the observation group, meanwhile, 166 patients with unarmed methods were included in the control group. Observation indicators: (1) the baseline data of equal sex, height, preoperative LLD, and operation side were compared between the two groups. (2) the differences between LLD and the distribution of LLD were measured and compared between the two groups. (3) to compare the proportion of patients with LLD >10 mm in the two groups, and to analyze the causes of postoperative LLD >10 mm. Results All patients completed their primary wound healing. (1) There was no significant difference found in gender, height, preoperative LLD, and operation side between the two groups (all P values >0.05). (2) The postoperative LLD of the observation group was 4.76 (2.98,7.18) mm, and that of the control group was 5.85 (3.78,8.38) mm, the difference was statistically significant (Z=-2.84, P=0.004), and the distribution of the LLD of the observation group was better than that of the control group, and the difference was statistically significant (Z=3.078, P=0.002). (3) In the observation group, 8 cases (5.97%, 8/134) had postoperative LLD >10 mm, and in 24 cases in the control group (14.46%, 24/166), the difference was statistically significant (χ2=5.61, P=0.018). Cause analysis: It was related to the mismatch between the prosthesis and the patients (3 cases in the observation group and 4 cases in the control group; it was related to the lower orientation of Kirschner wire caused by obvious hyperplasia of osteophytes in the lower edge of the acetabulum (5 cases in the observation group and 3 cases in the control group). Conclusion The use of calibrated femoral canal file in the THA can control postoperative LLD more effectively than the unarmed method, the mismatch of the prosthesis, and the lower orientation of Kirschner wire caused by hyperplasia of osteophytes in the lower edge of the acetabulum affect the control of LLD by this method.
段续东, 王坤正, 李树锋, 孙华强, 石志伟, 顾言阁, 殷鲁旭, 张业勇, 杨佩, 周建生, 闫新峰. 基于髋关节数字解剖降低THA术后下肢不等长带刻度股骨髓腔锉和相应股骨柄假体及技术的研发与应用[J]. 中华解剖与临床杂志, 2022, 27(7): 468-474.
Duan Xudong, Wang Kunzheng, Li Shufeng, Sun Huaqiang, Shi Zhiwei, Gu Yange, Yin Luxu, Zhang Yeyong, Yang Pei, Zhou Jiansheng, Yan Xinfeng. Development and application of calibrated femoral canal file and corresponding femoral stem prosthesis based on the digital anatomy of the hip joint to reduce the leg length discrepancy after total hip arthroplasty. Chinese Journal of Anatomy and Clinics, 2022, 27(7): 468-474.
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2022, Vol. 27 
