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Using High Resolution Computed Tomography to Visualize the Three Dimensional Structure and Function of Plant Vasculature
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A modified Gruen classification for comparing short and conventional Zweymüller-type stems: A three-dimensional

Takashi Yoneya1, Junichi Nakamura1, Shigeo Hagiwara1

  • 1Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-0856, Japan.

Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association
|June 4, 2026
PubMed
Summary

A modified Gruen classification improves anatomical accuracy when comparing short and conventional femoral stems in total hip arthroplasty. This method offers better interpretation of stem-cortex contact, potentially reducing thigh pain with short stems.

Keywords:
Computed tomographyFemoral stemModified Gruen classificationStem–cortex contactTotal hip arthroplasty

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Published on: October 9, 2018

Area of Science:

  • Orthopedic surgery
  • Biomedical engineering
  • Radiology

Background:

  • The original Gruen classification is standard for assessing femoral stems in total hip arthroplasty (THA).
  • Comparing stems of varying lengths with the original classification can lead to inaccurate interpretations of regional fixation.
  • A modified classification is needed for precise comparison of different stem lengths.

Purpose of the Study:

  • To propose and evaluate a modified Gruen classification for comparing short and conventional Zweymüller-type stems.
  • To assess the utility of the modified classification using 3D CT scans.
  • To compare stem-cortex contact, bone reactions, and thigh pain between short and conventional stems.

Main Methods:

  • Retrospective review of 519 primary THAs using the direct anterior approach.
  • Propensity score matching to compare 91 MIRFY short stems and 91 Profemur Z conventional stems.
  • Assessment of stem-cortex contact using original and modified Gruen classifications on 3D CT, alongside evaluation of bone reactions and thigh pain at 2 years.

Main Results:

  • The modified classification reallocated distal contacts to more proximal regions, correcting potential misinterpretations from the original classification.
  • The MIRFY short stem demonstrated a more proximal contact distribution compared to the conventional stem under the modified classification.
  • No significant difference in radiographic bone reactions was observed, but the MIRFY group reported less thigh pain.

Conclusions:

  • The modified Gruen classification provides a complementary and more anatomically accurate framework for comparing femoral stems of different lengths.
  • This approach enhances the interpretation of regional stem-cortex contact in total hip arthroplasty.
  • The modified classification aids in understanding fixation patterns and clinical outcomes like thigh pain.