Abstract：
BACKGROUND: Total hip arthroplasty (THA) is the gold standard procedure for patients with end-stage osteoarthritis after failed conservative therapy. Digital templating is commonly employed in preoperative preparation for THA and contributes positively to its outcome. However, the impact of coxa valga and antetorta (CVA) configurations on stem size prediction accuracy remains not reported. Previous studies demonstrated that the size of the lesser trochanter (LT) can be used to determine femoral anteversion on pelvis radiographs. This study investigates the accuracy of preoperative digital templating in predicting stem size in patients with CVA undergoing cementless THA.
METHODS: Preoperative radiographs of 620 patients undergoing cementless THA were retrospectively investigated. Radiographs were standardized with patients standing and the leg internally rotated by 15°. A CVA group was established including patients with a CCD angle greater than 140° and a lesser trochanter (LT) size of at least 10 mm for men and 8 mm for women. For the control group, radiographs with a CCD angle ranging from 125-135° and LT size 3-10 mm for men and 3-8 mm for women were selected. Preoperative templating was performed using mediCAD. To reduce confounding factors, case-control matching was carried out for BMI and body height.
RESULTS: After case-control matching, a total of thirty-one matches were analyzed. Stem size was underestimated in 74% (23/31) in the CVA and 13% (4/31) in the control group (p < 0.001). Moreover, patients with CVA were more likely to be underestimated by two sizes compared to controls (p < 0.004). In contrast, the exact stem size was predicted more frequently in the control group (p < 0.001).
CONCLUSIONS: Stem size in patients with a CVA configuration are at high risk of being underestimated when using digital templating. These findings can be valuable for guiding in intraoperative decisions and lowering the risk of complications associated with an undersized femoral component.
METHODS: Preoperative radiographs of 620 patients undergoing cementless THA were retrospectively investigated. Radiographs were standardized with patients standing and the leg internally rotated by 15°. A CVA group was established including patients with a CCD angle greater than 140° and a lesser trochanter (LT) size of at least 10 mm for men and 8 mm for women. For the control group, radiographs with a CCD angle ranging from 125-135° and LT size 3-10 mm for men and 3-8 mm for women were selected. Preoperative templating was performed using mediCAD. To reduce confounding factors, case-control matching was carried out for BMI and body height.
RESULTS: After case-control matching, a total of thirty-one matches were analyzed. Stem size was underestimated in 74% (23/31) in the CVA and 13% (4/31) in the control group (p < 0.001). Moreover, patients with CVA were more likely to be underestimated by two sizes compared to controls (p < 0.004). In contrast, the exact stem size was predicted more frequently in the control group (p < 0.001).
CONCLUSIONS: Stem size in patients with a CVA configuration are at high risk of being underestimated when using digital templating. These findings can be valuable for guiding in intraoperative decisions and lowering the risk of complications associated with an undersized femoral component.
摘要：
背景：全髋关节置换术（THA）是保守治疗失败后终末期骨关节炎患者的金标准。数字模板通常用于THA的术前准备，并对其结果做出积极贡献。然而,Coxavalga和antetorta（CVA）构型对茎大小预测准确性的影响仍未报告。先前的研究表明，小转子（LT）的大小可用于确定骨盆X光片上的股骨前倾。这项研究调查了术前数字模板在预测CVA患者无骨水泥THA中茎大小方面的准确性。
方法：对620例无骨水泥THA患者的术前X线片进行回顾性调查。对患者站立和腿部内部旋转15°的放射线照相进行了标准化。建立了CVA组，其中包括CCD角度大于140°的患者，男性小转子（LT）尺寸至少为10mm，女性为8mm。对于对照组，选择了CCD角度为125-135°的X射线照片，男性的LT尺寸为3-10mm，女性的LT尺寸为3-8mm。术前模板使用mediCAD进行。为了减少混杂因素，对BMI和身高进行病例对照匹配.
结果：病例对照匹配后，共分析了31个匹配项.CVA中74%(23/31)的茎大小被低估,对照组为13%(4/31)(p<0.001)。此外，与对照组相比,CVA患者更有可能被低估两个大小(p<0.004).相比之下,在对照组中，精确的茎大小更频繁地预测（p<0.001）。
结论：CVA配置患者的茎大小在使用数字模板时存在被低估的高风险。这些发现对于指导术中决策和降低与尺寸过小的股骨部件相关的并发症的风险可能是有价值的。
方法：对620例无骨水泥THA患者的术前X线片进行回顾性调查。对患者站立和腿部内部旋转15°的放射线照相进行了标准化。建立了CVA组，其中包括CCD角度大于140°的患者，男性小转子（LT）尺寸至少为10mm，女性为8mm。对于对照组，选择了CCD角度为125-135°的X射线照片，男性的LT尺寸为3-10mm，女性的LT尺寸为3-8mm。术前模板使用mediCAD进行。为了减少混杂因素，对BMI和身高进行病例对照匹配.
结果：病例对照匹配后，共分析了31个匹配项.CVA中74%(23/31)的茎大小被低估,对照组为13%(4/31)(p<0.001)。此外，与对照组相比,CVA患者更有可能被低估两个大小(p<0.004).相比之下,在对照组中，精确的茎大小更频繁地预测（p<0.001）。
结论：CVA配置患者的茎大小在使用数字模板时存在被低估的高风险。这些发现对于指导术中决策和降低与尺寸过小的股骨部件相关的并发症的风险可能是有价值的。
