Selection of endoprosthetic components and value of general femoral offset after hip replacement (X-ray study)
Background. To ensure maximum endoprosthesis survival, all components of the “normal” biomechanics of the artificial joint should be balanced optimally. An important stage in planning the surgery is the selection of endoprothetic components, which should restore the so-called global femoral offset (the abductor muscle moment arm), but it is not always possible to restore the correct biomechanics with artificial joint.The purpose of this research was to study the ratio of the abductor moment arm before surgery and the value of global femoral offset after hip replacement, depending on the sex of the patients. Materials and methods. The materials for the study were pelvis X-rays of 42 patients before the operation, X-ray images of the hip performed to select the components of the endoprosthesis, and X-rays of the same hip after arthroplasty, data from the case histories: surgery protocols and nomenclature characteristics of the components of implanted hip endoprosthesis. Measurement of the abductor moment arm before the operation was performed according to survey radiograph of the pelvis. If the change in the index of the abductor moment arm was more than 5 mm, the indicator was considered to be changed. The data were processed statistically. Results. In men after total arthroplasty, a significant (t = 4.076, p = 0.001) decrease in global femoral offset was noted compared with the abductor moment arm before surgery. In women, the change in the mean abductor moment arm before and after arthroplasty was significantly lower and did not reach a statistically significant level (t = –1.739; p = 0.092). Reduction of the abductor moment arm was noted in 17 cases, which amounted to 30.91 % of the total number of measurements, and the vast majority of joints with reduced abductor moment arm belonged to men (13 cases). Conclusions. Reducing the abductor moment arm is an unfavorable biomechanical factor in terms of restoring the abduction mechanism. Such changes were noted in 17 cases, which amounted to 30.91 % of the total number of measurements, and the vast majority of joints with reduced abductor moment arm belonged to men — 13 cases (women — 4 cases). When performing total hip arthroplasty in women, it is more often possible to provide favorable biomechanical conditions for restoring the function of the abduction mechanism in comparison with men.
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