INFLUENCE OF THE ABDUCTOR LEVER ARM ON THE DEVELOPMENT OF TOTAL HIP ARTHROPLASTY DISLOCATION

Abstract

Purpose: Changes in the lever arm of the abductors is not always perfectly controlled during implantation of total hip arthroplasties. Its possible effect on the development of prothesis dislocation is not known. The purpose of this study was to evaluate the influence of the lever arm and its modifications on the development of prosthetic instability.

Material and methods: We analysed prospectively 73 total hip arthroplasties implanted via the posterolateral approach. The study group was composed of a consecutive series of 45 dislocated prostheses and a control group of 28 stable prostheses selected at random. The following measurements were made on the anteroposterior x-ray: 1) lever arm of the abductors, 2) femoral offset. These measures were compared with the healthy contralateral hip and when this hip was diseased or had a prosthesis, with the pre-implantation x-rays.

Results: None of the studied parameters was statistically different between the dislocated and stable prostheses. However, in the dislocated prostheses, the lever arm of the abductors before insertion of the prosthesis was shorter than in the control group (p = 0.04) suggesting the presence of a group of hips “at risk”. There was a correlation between the offset values and the lever arm values for the stable prostheses and for the healthy contralateral hips in both groups. Conversely, this balance was not found in the dislocated hips. The lever arm/offset ratio was calculated to determine if the ideal ratio influenced hip stability. This ratio was not directly related to the development of dislocation, but it was decreased for dislocated hips. This ratio was ideal for 75% of the stable prostheses and for only 53% of the dislocated prostheses.

Conclusions: We concluded that: 1) hips “at risk” of dislocation would have a shorter lever arm, 2) the lever arm or the femoral offset do not have a direct effect on dislocation, and 3) stable hip prostheses have a balance similar to that in healthy hips identified by a correlation between the lever arm and the femoral offset. We thus emphasise the importance of respecting these parameters although they are probably not the only factors influencing prosthesis stability. Allowable variations are small, demanding careful and precise operation planning.