Femoral stem alignment and post-operative patient satisfaction: a retrospective analysis of total hip arthroplasty...

Using computer-assisted equipment (CAE) in total hip arthroplasty (THA) has facilitated improved accuracy of acetabular cup placement, but the impact of aligning the femoral stem on post-operative patient satisfaction remains unclear. In this study, we evaluated the post-operative patient-reported outcome measures (PROMs) and identified factors related to femoral stem alignment associated with post-operative PROMs after THA.

This retrospective study included 200 patients (205 hips; mean age, 67.3 ± 9.8 years) undergoing THA using CAE for acetabular cup placement at our hospital. Alignment parameters of the femoral stem, including stem anteversion, change in stem anteversion, femoral offset, and coronal and sagittal stem angles, were evaluated using computed tomography scans and radiographs. Patients were categorised into the normal and Low&High alignment groups based on predefined, clinically acceptable ranges and deviation from native femoral anatomy. Patient satisfaction was assessed using a visual analogue scale and clinical outcomes were evaluated using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) at one year post-operatively.

Patients in the normal alignment group demonstrated significantly higher JHEQ total and movement scores than those in the Low&High group. Through multivariate logistic regression analysis, we identified change in stem anteversion as an independent factor associated with high post-operative patient satisfaction.

Accurate femoral stem alignment, particularly minimizing deviations in stem anteversion from the native femoral anteversion, was significantly associated with improved post-operative PROMs after computer-assisted THA. These results highlight the importance of achieving accurate femoral stem alignment, even when acetabular cup placement is optimised using CAE.