title: Biomechanical reconstruction of the hip: comparison between modular short-stem hip arthroplasty and conventional total hip arthroplasty.
abstract: OBJECTIVE
  Short-stem hip arthroplasty preserves femoral bone stock which includes the femoral neck. This implies that the stem has to follow the anatomy of the femoral neck. Therefore, it has been questioned whether biomechanical reconstruction of the hip can be safely achieved with SHA.
  
  
  METHODS
  Biomechanical reconstruction of the hip was analysed for 50 modular short-stem hip arthroplasties (SHA) and compared to 50 conventional total hip arthroplasties (THA). Biomechanical parameters were analysed on pre- and postoperative pelvic overviews and compared to those of the contralateral side.
  
  
  RESULTS
  The position of the acetabular cup (vertical and horizontal hip centre of rotation) changed slightly and was comparable for both groups. Horizontal femoral offset increased more in SHA (6.2 mm) than in THA (2.0 mm). Compared to the contralateral side it was significantly greater after SHA (+3.6 mm) but almost balanced after THA (-0.2 mm). Limb length increased with both procedures (8.0 mm SHA, 9.1 mm THA), but showed a significantly greater discrepancy after SHA (3.3 mm) as compared to THA (1.3 mm). According to the different implant designs, the stem-shaft axis showed a wider varus-valgus range for SHA (6.2° varus to 8.8° valgus) than for THA (2.6° varus to 3.3° valgus).
  
  
  CONCLUSIONS
  Horizontal femoral offset increased more with modular SHA than with conventional THA, but was within a beneficial range. Restoration of limb length appears more difficult in SHA and has a tendency to prolong limb length, which is probably related to the higher femoral resection level. This should be taken into consideration when considering SHA for a patient as well as during implantation.
authors.affiliation: Department of Orthopaedic Surgery, University Hospital of Munich (LMU), and Department of Trauma Surgery, Technical University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany. florian.schmidutz@med.uni-muenchen.de
authors.forename: Florian
authors.initials: F
authors.lastname: Schmidutz
authors.forename: Marc
authors.initials: M
authors.lastname: Beirer
authors.forename: Patrick
authors.initials: P
authors.lastname: Weber
authors.forename: Farhad
authors.initials: F
authors.lastname: Mazoochian
authors.forename: Andreas
authors.initials: A
authors.lastname: Fottner
authors.forename: Volkmar
authors.initials: V
authors.lastname: Jansson
mesh_terms: D000077:Acetabulum / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000601:surgery; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D001696:Biomechanical Phenomena; D017760:Bone Malalignment; D019544:Equipment Failure Analysis; D005260:Female; D005269:Femur / Q000473:pathology / Q000601:surgery; D005271:Femur Head Necrosis / Q000601:surgery; D006618:Hip Dislocation, Congenital / Q000601:surgery; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D007870:Leg Length Inequality / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult