The effect of varus stem placement on joint offset during total hip arthroplasty: a virtual study

With total hip replacement (THR), varus alignment of an uncemented stem will increase offset which can have significant detrimental effects on muscular balance, leg length and overall satisfaction. Thus, we used 3D planning software to determine the change in joint offset with increasing varus stem placement.

Eight patients undergoing THR had routine computed tomography (CT) scans to allow for 3D hip planning. Each set of CTs was templated with a straight stem and an uncemented acetabular cup. Initial templating was performed to reproduce native leg length and offset. The templated stem was then rotated into varus at 1° intervals, up to 6° varus while offset changes for all varus positions were noted. This was repeated for each of 3 neck angles, 125°, 135° and 135° lateral and for each stem sizes 1, 3, 5 and 7.

Overall, there was a mean 1.5 mm increase in offset for every 1° of varus. The stems with a 125° neck angle had the greatest increase in mean offset at 1.6 mm for every 1° of varus. The stem neck angles of 135° lateral offset and 135° standard offset, had a mean increase in offset of 1.5 mm and 1.4 mm respectively for every 1° of varus. A greater mean increase in offset for every 1° of varus was observed with increasing stem size.

We have quantified the relationship between alignment and offset with every 1° of varus placement increasing hip offset for straight stems by 1.5 mm. This can be used as a guide for surgeons during THR so that they have a better quantitative understanding of how varus placement of the stem affects the hip offset.