Our Summary

This research paper looks at the benefits of restoring the femoral offset, which is the distance from the center of the hip to the femoral shaft, during total hip replacement surgery. The aim of this is to reduce the wear and tear on the artificial joint, the risk of the joint becoming loose, and the risk of dislocation.

One way to customize the femoral offset is with modular neck stems, but these have been linked to issues such as corrosion and sudden failures. The researchers reviewed existing studies to see if there was evidence that adjusting the femoral offset itself had a proven benefit in reducing wear and tear, loosening, and dislocation.

They excluded certain types of studies, including observational studies and case reports, and only included articles in English. They examined data such as offset values, dislocation rates, wear rates, and surgical approaches.

In the end, they found a significant link between restoring the femoral offset and reducing wear on the artificial joint in two out of three papers that looked at the issue. However, they didn’t find any link between the femoral offset and dislocation rates or loosening.

The researchers concluded that although adjusting the femoral offset can help reduce wear on the joint, it doesn’t seem to help with dislocation or loosening. They also suggested that the benefits of reducing wear could be achieved by other means, such as using hard bearing surfaces or a certain type of liner, and using larger femoral heads to improve stability. As a result, they do not recommend routinely using modular neck stems in total hip replacement surgery.

FAQs

  1. What is the femoral offset and how is it relevant to hip replacement surgery?
  2. What are the potential benefits of adjusting the femoral offset during hip replacement surgery?
  3. Why do the researchers not recommend routinely using modular neck stems in total hip replacement surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hip replacement is to follow a personalized rehabilitation plan to ensure a successful recovery. This may include physical therapy exercises to strengthen the hip muscles and improve range of motion, as well as lifestyle modifications to prevent complications such as infection or dislocation. It is important to follow all post-operative instructions provided by the healthcare team and attend follow-up appointments to monitor progress and address any concerns.

Suitable For

Patients who are typically recommended for hip replacement surgery are those who are experiencing severe hip pain that limits their daily activities, have arthritis in the hip joint, have had a hip fracture, have failed other treatments such as physical therapy or medication, and have a decreased quality of life due to hip pain. These patients may also have difficulty walking, climbing stairs, and getting in and out of chairs or the bathtub. Additionally, patients who have tried non-invasive treatments for hip pain without success may also be candidates for hip replacement surgery.

Timeline

Before hip replacement surgery:

  1. Patient experiences chronic hip pain, stiffness, and limited range of motion.
  2. Patient undergoes a series of diagnostic tests such as X-rays, MRI, and physical examinations to determine the extent of damage to the hip joint.
  3. Orthopedic surgeon recommends hip replacement surgery as a treatment option.
  4. Patient undergoes pre-operative evaluations including blood tests, EKG, and consultation with an anesthesiologist.
  5. Patient receives education on the surgery, potential risks and benefits, and post-operative care.

After hip replacement surgery:

  1. Patient undergoes the surgery which involves removing the damaged parts of the hip joint and replacing them with artificial components.
  2. Patient stays in the hospital for a few days for monitoring and rehabilitation.
  3. Patient starts physical therapy to regain strength and range of motion in the hip joint.
  4. Patient may experience temporary pain, swelling, and discomfort post-surgery.
  5. Patient gradually resumes normal activities and may need assistive devices such as crutches or walker.
  6. Patient follows up with the surgeon for routine check-ups and monitoring of the artificial joint.
  7. Patient experiences improved mobility, reduced pain, and better quality of life compared to before the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hip replacement surgery include:

  1. What are the potential risks and complications associated with hip replacement surgery?
  2. How long is the recovery time after hip replacement surgery?
  3. What type of implant will be used in the surgery, and what are the potential risks associated with that specific implant?
  4. Will restoring the femoral offset be a part of the surgery, and what are the potential benefits of doing so?
  5. Are there any alternative surgical approaches or techniques that could be considered for my specific case?
  6. How long can I expect the artificial hip joint to last?
  7. What type of physical therapy or rehabilitation will be necessary after surgery?
  8. How soon after surgery can I expect to return to normal activities?
  9. Are there any specific lifestyle changes or precautions I need to take after hip replacement surgery?
  10. Are there any specific exercises or activities that should be avoided after surgery to prevent complications?

Reference

Authors: De Fine M, Romagnoli M, Toscano A, Bondi A, Nanni M, Zaffagnini S. Journal: Orthop Traumatol Surg Res. 2017 May;103(3):349-355. doi: 10.1016/j.otsr.2016.12.013. Epub 2017 Jan 31. PMID: 28159679