NDLI: Novel radiologic indices for stem type decision in total hip arthroplasty in patients with metaphyseo-diaphyseal mismatched Dorr A proximal femur

Content Provider	Springer Nature : BioMed Central
Author	Lee, Han Jin Kim, Hong Seok Yoo, Jeong Joon
Abstract	Background In metaphyseo-diaphyseal (M-D) mismatched Dorr A femurs, it is difficult to achieve proper fixation with a type 1 stem. Proper interpretation of the geometry of the femur is integral at the preoperative stage in an M-D mismatched femur, but there has been a scarcity of studies on the radiologic indices. Therefore, we analyze the previous radiologic indices and suggest the novel ones for M-D mismatched femurs. Methods Our study was a retrospective review of preoperative radiographs of patients who underwent total hip arthroplasty with the smallest type 1 stem or with type 3 C stem at a single institution from July 2014 to March 2022. A Type 3 C stem was used when the smallest type 1 stem failed to achieve metaphyseal fixation. One hundred twenty-six patients were categorized into two main groups. Canal-flare index, canal-calcar ratio, modified morphological cortical index, and two novel indices (lesser trochanter-to-distal ratio-α and -β [LDR-α and -β]) were assessed on preoperative pelvic radiographs. Results Multivariate and ROC analysis demonstrated that high LDR-β (Exp[B]: 485.51, CI: 36.67-6427.97, p < 0.001) was associated with a more mismatched tendency group and had clinically acceptable discriminatory power (AUC: 0.765, CI: 0.675–0.855, p < 0.001) between the two cohorts. Conclusion Correct assessment of preoperative femoral morphology would be fundamental in the selection of a suitable stem. The ratio based on 3 cm below the lesser trochanter of the femur seemed crucial. We recommend evaluating the newly described radiological index preoperatively in M-D mismatched Dorr A femur for planning precisely and selecting a proper stem.
Related Links	https://bmcmusculoskeletdisord.biomedcentral.com/counter/pdf/10.1186/s12891-024-07223-5.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	14712474
DOI	10.1186/s12891-024-07223-5
Journal	BMC Musculoskeletal Disorders
Issue Number	1
Volume Number	25
Language	English
Publisher	BioMed Central
Publisher Date	2024-02-09
Access Restriction	Open
Subject Keyword	Orthopedics Rehabilitation Rheumatology Sports Medicine Internal Medicine Epidemiology Total hip arthroplasty Dorr A type Stem selection Metaphyseo-diaphyseal mismatch
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Rheumatology
Journal Impact Factor	2.2/2023
5-Year Journal Impact Factor	2.6/2023

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