Optimising Soft-Tissue Balancing in Hip Hemiarthroplasty Surgery Using a Simple Planning Protocol

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Radiology

Background:

• Intracapsular femur neck fractures are common fragility fractures requiring hemiarthroplasty.
• Restoring horizontal offset and leg length is crucial for optimal hip hemiarthroplasty outcomes.
• Preoperative templating is standard for total hip arthroplasty but not routine for hemiarthroplasty due to lack of scaled radiographs.

Purpose of the Study:

• To introduce and evaluate a simple non-scaled radiograph templating protocol (NSRTP) for hip hemiarthroplasty.
• To assess the NSRTP's efficacy in restoring horizontal offset and leg length.
• To compare outcomes of hemiarthroplasty with and without the NSRTP.

Main Methods:

• A retrospective case-control study comparing 23 patients without templating to 23 patients using the NSRTP.
• NSRTP utilized contralateral hip offset and ipsilateral head diameter on unscaled radiographs, plus intraoperative measurements.
• Leg length restoration involved assessing and restoring the contralateral greater trochanter tip-to-head relationship.

Main Results:

• The NSRTP group achieved restoration of horizontal offset and leg length within 2 mm of the contralateral hip in 22 out of 23 patients (over 96%).
• A statistically significant improvement in offset and leg length restoration was observed with the NSRTP compared to the control group.
• Implants used included C-STEM™ and SPECTRON stems with monopolar heads, available in various offset and neck length options.

Conclusions:

• Accurate restoration of offset and leg length is vital for maximizing hip arthroplasty outcomes.
• The NSRTP provides a reliable method for achieving precise offset and leg length restoration in hip hemiarthroplasty, even without scaled radiographs.
• This protocol offers a practical solution for improving surgical accuracy and patient outcomes in hip hemiarthroplasty.