4.6 Article

Cement Mantle Quality and Stem Alignment in Cemented Collarless Polished Tapered Stems Implanted via the Direct Anterior and Direct Lateral Approaches: A Single Institution Experience

Journal

JOURNAL OF ARTHROPLASTY
Volume 37, Issue 11, Pages 2208-2213

Publisher

CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
DOI: 10.1016/j.arth.2022.05.019

Keywords

direct anterior approach; direct lateral approach; cemented stem; total hip arthroplasty; hybrid total hip arthroplasty

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A comparative study was conducted to compare the stem alignment and cement mantle quality of collarless polished tapered cemented stems inserted through the direct anterior approach (DAA) and the direct lateral approach (DLA) for total hip arthroplasty. The results showed a higher incidence of coronal plane stem malalignment in the DAA group compared to the DLA group, while there was no difference in lateral stem alignment or cement mantle quality.
Background: The aim of this study was to compare the stem alignment and the quality of cement mantle of collarless polished tapered cemented stems inserted through the direct anterior approach (DAA) and the direct lateral approach (DLA).Methods: A comparative retrospective study of 232 hybrid total hip arthroplasties using a cemented collarless polished tapered stem through either the DAA (n = 147) or DLA (n = 85) was performed. Radiographic evaluation included stem alignment, cement mantle quality, and cement mantle thickness.Results: On anteroposterior radiographs, stems implanted through the DLA were more likely to be in neutral alignment, than those implanted through the DAA (83.5%[n = 71] versus 71.4% [n = 105]; P = <.001). No difference between approaches was noted for stem alignment on lateral radiographs or cement mantle quality. Multivariate analysis revealed factors associated with suboptimal cement mantle and included Dorr type B or C femur as well as male gender. A mean cement mantle thickness >= 2mm was achieved in all Gruen zones for both approaches.Conclusion: In our series, the DAA was associated with a higher incidence of coronal plane stem malalignment compared to the DLA when using cemented tapered polished femoral components for total hip arthroplasty. No difference in lateral stem alignment or cement mantle quality was found. (c) 2022 Elsevier Inc. All rights reserved.

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