title: Femoral stem tip orientation and surgical approach in total hip arthroplasty.
abstract: BACKGROUND
  A posterior entry point, a neutral tip position and neutral stem alignment are recommended to avoid a thin cement mantle and ensure an optimal outcome in total hip arthroplasty (THA). Our aim was to highlight any influence of surgical approach in obtaining an optimal stem orientation.
  
  
  METHODS
  We examined the post-operative, digitised radiographs of 100 (50 each group) polished, tapered Exeter THA, inserted via the antero-lateral or posterior approaches. Stem tip position was assessed in both coronal and sagittal planes and stem alignment was assessed in the coronal plane.
  
  
  RESULTS
  There was a significant difference between the two approaches in the sagittal stem tip position only (p=0.01).
  
  
  CONCLUSIONS
  Our results illustrate that a neutral stem tip position in THA is significantly more difficult to obtain with an antero-lateral approach, when compared to the posterior approach. A posterior approach to the hip avoids the cuff of glutei that can lever the proximal stem anteriorly causing an anterior entry point and a posterior stem tip position. We also illustrate how the anatomy of the proximal femur in the sagittal plane makes a neutral stem alignment difficult to achieve with either approach.
authors.affiliation: Department of Trauma and Orthopaedics, Heatherwood and Wexham Park NHS Trust, Slough, Berkshire, UK. drphilipvaughan@yahoo.com
authors.forename: P D
authors.initials: PD
authors.lastname: Vaughan
authors.forename: P J
authors.initials: PJ
authors.lastname: Singh
authors.forename: R
authors.initials: R
authors.lastname: Teare
authors.forename: R
authors.initials: R
authors.lastname: Kucheria
authors.forename: G C
authors.initials: GC
authors.lastname: Singer