Chronological Changes in Axial Alignment of the Ipsilateral Hip and Knee After Total Hip Arthroplasty

Internal rotation of the hip and lateral patellar tilt increases after total hip arthroplasty (THA). However, it remains unknown whether these parameters change with time after the index THA.

A total of 91 patients undergoing 2-stage bilateral primary THAs between January 2008 and May 2014 were included to assess the association of chronological changes in internal rotation of the hip or lateral patellar tilt with anthropometric and perioperative parameter and changes in alignment after the index THA. Chronological changes were assessed as changes between postoperative computed tomography on the index surgery and the preoperative computed tomography on the contralateral THA. Internal rotation of the hip was defined as the angle between the posterior intercondylar line and a line passing through the posterior inferior iliac spines. Lateral patellar tilt was defined as the angle between the posterior intercondylar line and a line joining the medial and lateral edges of the patella.

Internal rotation of the hip and lateral patellar tilt changed until 2 years after the index surgery by a mean of -2° (range -17.3° to 17.7°) and -2° (range -18.2° to 5.3°), respectively. Adductor tenotomy was associated with increasing internal rotation of the hip with time (adjusted R² 0.076); leg lengthening and larger preoperative femorotibial angle were associated with decreasing lateral patellar tilt with time (adjusted R² 0.159).

Both internal rotation of the hip at rest and lateral patellar tilt decreased by approximately 2° until 2 years after surgery and there was a large variation in chronological change.