N°014 - November / December 2021
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Prosthetic management of coxa vara hips with increased femoral offset: the value of hip resurfacing
By Julien Girard (a, b, c), Pierre Martinot (a, b), Julien Dartus (a, b), Sophie Putman (a, b), Henri Migaud (a, b) in category UPDATE
(a) Univ Lille Nord de France, F-59000 Lille, France - (b) Service d’orthopédie II, Hôpital Salengro, Place de Verdun, CHU Lille, F-59000 Lille, France - (c) Univ. Lille, Univ. Artois, Univ. Littoral Côte d’Opale, EA 7369 – URePSS – Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France / [email protected]
During hip arthroplasty (THR) implantation, restoration of the femoral lever arm (offset) is a crucial element in order to maintain the stability of the prosthetic joint, improve joint amplitudes and optimize the efficiency and power of the gluteal muscles [1,2]. This last point is essential, especially when the implantation is performed on a population of young subjects who wish to resume their sports activities. Indeed, adequate gluteal tension is essential for resuming activities such as running or sports with impulses on the lower limb. A value of 40 mm is commonly accepted as the upper limit of the mean femoral offset . Hips with a high lever arm are very frequently accompanied by a long femoral neck and are most often found in young men and rarely in women. This is referred to as "long-neck coxa vara".
Prosthetic replacement of these hips with increased femoral offset and long necks is difficult, because it exposes the patient to many risks: instability, lameness, lengthening to tighten the gluteals and unevenness of length, and muscle failure if the offset is not restored . Few non-modular femoral pivots can restore an offset of more than 40 mm. When this is possible with specific stems with a reduced neck-shaft angle, the survival rate of these...
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