The impact of increasing femoral offset and stem anteversion on postoperative dislocation in bipolar hemiarthroplasty


      • Femoral offset and stem anteversion substantially affects flexion and internal rotation.
      • Increased femoral offset can also increase the range of motion of external rotation.
      • Increased stem anteversion has a negative effect on the range of motion of external rotation.
      • Femoral offset and stem anteversion are not independent but mutually confounding to the ROM (Read-Only Memory).



      Femoral offset and anteversion have been reported to affect the incidence of dislocation following bipolar hemiarthroplasty, although the magnitudes of contributions of the femoral offset and stem anteversion on dislocation, both singly and in combination is not fully understood.


      Using the CT data of 61 patients (61 hips), including 30 male and 31 female who underwent bipolar hemiarthroplasty, three-dimensional dynamic motion analysis was performed using a modular implant that enabled adjustment of femoral offset and stem anteversion independently. The pattern of impingement and relationship between femoral offset/stem anteversion and range of motion were evaluated using the software.


      We found that a higher femoral offset and stem anteversion correlate with a greater range of motion of flexion and internal rotation. Furthermore, an increased femoral offset has a great effect on increasing range of motion of flexion than stem anteversion, and increased both femoral offset and stem anteversion have fewer effect on the flexion, whereas increasing stem anteversion has a great impact on internal rotation than offset, especially in the case with lower femoral anteversion. However, a higher stem anteversion decrease the range of motion of external rotation, whereas a higher femoral offset leads to an increased range of motion of external rotation.


      We demonstrated that both a higher femoral offset and stem anteversion substantially affected the range of motion in flexion, internal rotation and external rotation. However, these are not independent, but rather mutually confounding, the surgeons should consider retaining femoral/anterior offset in bipolar hemiarthroplasty.


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        • Abe T.
        • Kaku N.
        • Tabata T.
        • Tagomori H.
        • Tsumura H.
        Clinical results of hemiarthroplasty using new bipolar cups for stage 3 or lower osteonecrosis of the femoral head: a retrospective study.
        Musculoskelet. Surg. 2018; 102: 241-246
        • Bartz R.L.
        • Nobel P.C.
        • Kadakia N.R.
        • Tullos H.S.
        The effect of femoral component head size on posterior dislocation of the artificial hip joint.
        J. Bone Joint Surg. Am. 2000; 82: 1300-1307
        • Enocson A.
        • Tidermark J.
        • Tornkvist H.
        • Lapidus L.J.
        Dislocation of hemiarthroplasty after femoral neck fracture: better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips.
        Acta Orthop. 2008; 79: 211-217
        • Enocson A.
        • Hedbeck C.J.
        • Törnkvist H.
        • Tidermark J.
        • Lapidus L.J.
        Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures.
        Int. Orthop. 2012; 36: 711-717
        • Fischer M.C.M.
        • Eschweiler J.
        • Schick F.
        • Asseln M.
        • Damm P.
        • Radermacher K.
        Patient-specific musculoskeletal modeling of the hip joint for preoperative planning of total hip arthroplasty: a validation study based on in vivo measurements.
        PLoS One. 2018 Apr 12; 13e0195376
        • Frihagen F.
        • Nordsletten L.
        • Madsen J.E.
        Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial.
        BMJ. 2007; 335: 1251-1254
        • Georgiou G.
        • Siapkara A.
        • Dimitrakopoulou A.
        • Provelengios S.
        • Dounis E.
        Dissociation of bipolar hemiarthroplasty of the hip after dislocation. A report of five different cases and review of literature.
        Injury. 2006; 37: 162-168
        • Gómez L.F.U.
        • Gaitán-Lee H.
        • Duarte M.A.
        • Halley P.D.
        • Jaramillo A.R.
        • García E.L.
        Precision and accuracy of pre-surgical planning of non-cemented total hip replacement with calibrated digital images and acetates.
        J. Orthop. Surg. Res. 2021 Jul 3; 16: 431
        • Haidukewych G.J.
        • Israel T.A.
        • Berry D.J.
        Long-term survivorship of cemented bipolar hemiarthroplasty for fracture of the femoral neck.
        Clin. Orthop. Relat. Res. 2002; 403: 118-126
        • Jameson S.S.
        • Lees D.
        • James P.
        • Johnson A.
        • Nachtsheim C.
        • McVie J.L.
        • Rangan A.
        • Muller S.D.
        • Reed M.R.
        Cemented hemiarthroplasty or hip replacement for intracapsular neck of femur fracture? A comparison of 7732 matched patients using national data.
        Injury. 2013; 44: 1940-1944
        • Kim Y.
        • Kim J.K.
        • Joo I.H.
        • Hwang K.T.
        • Kim Y.H.
        Risk factors associated with dislocation after bipolar hemiarthroplasty in elderly patients with femoral neck fracture.
        Hip Pelvis. 2016; 28: 104-111
        • Kizkapan T.B.
        • Misir A.
        • Uzun E.
        • Oguzkaya S.
        • Ozcamdalli M.
        • Uzunc Erdal
        • Sinan Oguzkaya D.
        Factors affecting dislocation after bipolar hemiarthroplasty in patients with femoral neck fracture.
        Injury. 2020; 51: 663-669
        • Lee B.P.
        • Berry D.J.
        • Harmsen W.S.
        • Sim F.H.
        Total hip arthroplasty for the treatment of an acute fracture of the femoral neck: long-term results.
        J. Bone Joint Surg. Am. 1998; 80: 70-75
        • Li L.
        • Ren J.
        • Liu J.
        • Wang H.
        • Sang Q.
        • Liu Z.
        • Sun T.
        What are the risk factors for dislocation of hip bipolar hemiarthroplasty through the anterolateral approach? A nested case-control study.
        Clin. Orthop. Relat. Res. 2016; 474: 2622-2629
        • Madanat R.
        • Mäkinen T.J.
        • Ovaska M.T.
        • Soiva M.
        • Vahlberg T.
        • Haapala J.
        Dislocation of hip hemiarthroplasty following posterolateral surgical approach: a nested case-control study.
        Int. Orthop. 2012; 36: 935-940
        • Moriya M.
        • Uchiyama K.
        • Takahira N.
        • Fukushima K.
        • Yamamoto T.
        • Hoshi K.
        • Itoman M.
        • Takaso M.
        Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head.
        Int. Orthop. 2012; 36: 2041-2047
        • Pajarinen J.
        • Savolainen V.
        • Tulikoura I.
        • Lindahl J.
        • Hirvensalo E.
        Factors predisposing to dislocation of the Thompson hemiarthroplasty: 22 dislocations in 338 patients.
        Acta Orthop. Scand. 2003; 74: 45-48
        • Parvizi J.
        • Morrey B.F.
        Bipolary hip arthroplasty as a salvage treatment for instability of the hip.
        J. Bone Joint Surg. Am. 2000; 82: 1132-1139
        • Roberts K.C.
        • Brox W.T.
        From evidence to application: AAOS clinical practice guideline on management of hip fractures in the elderly.
        J. Orthop. Trauma. 2015; 29: 119-120
        • Rogmark C.
        • Fenstad A.M.
        • Leonardsson O.
        • Engesæter L.B.
        • Kärrholm J.
        • Furnes O.
        • Garellick G.
        • Gjertsen J.E.
        Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients.
        Acta Orthop. 2014; 85: 18-25
        • Schmid J.
        • Chênes C.
        • Chagué S.
        • Hoffmeyer P.
        • Christofilopoulos P.
        • Bernardoni M.
        • Charbonnier C.
        MyHip: supporting planning and surgical guidance for a better total hip arthroplasty.
        Int. J. Comput. Assist. Radiol. Surg. 2015 Oct, 10; 10: 1547-1556
        • Shoji T.
        • Yasunaga Y.
        • Yamasaki T.
        • Mori R.
        • Hamanishi M.
        • Ochi M.
        Bony impingement depends on the bone morphology of the hip after total hip arthroplasty.
        Int. Orthop. 2013; 37: 1897-1903
        • Shoji T.
        • Yasunaga Y.
        • Yamasaki T.
        • Izumi S.
        • Hachisuka S.
        • Ochi M.
        Low femoral antetorsion as a risk factor for bony impingement after bipolar hemiarthroplasty.
        J. Orthop. Surg. Res. 2015; 10: 105
        • Shoji T.
        • Yamasaki T.
        • Izumi S.
        • Murakami H.
        • Mifuji K.
        • Sawa M.
        • Yasunaga Y.
        • Adachi N.
        • Ochi M.
        Factors affecting the potential for posterior bony impingement after total hip arthroplasty.
        Bone Joint J. 2017; 99–B: 1140-1146
        • Shoji T.
        • Ota Y.
        • Saka H.
        • Murakami H.
        • Takahashi W.
        • Yamasaki T.
        • Yasunaga Y.
        • Iwamori H.
        • Adachi N.
        Factors affecting impingement and dislocation after total hip arthroplasty - computer simulation analysis.
        Clin. Biomech. (Bristol, Avon). 2020; 80105151
        • Sierra R.J.
        • Schleck C.D.
        • Cabanela M.E.
        Dislocation of bipolar hemiarthroplasty: rate, contributing factors, and outcome.
        Clin. Orthop. Relat. Res. 2006; 442: 230-238
        • van der Sijp M.P.L.
        • van Delft D.
        • Krijnen P.
        • Niggebrugge A.H.P.
        • Schipper I.B.
        Surgical approaches and hemiarthroplasty outcomes for femoral neck fractures: a meta-analysis.
        J. Arthroplast. 2018; 33: 1617-1627.e9
        • Sims A.L.
        • Farrier A.J.
        • Reed M.R.
        • Sheldon T.A.
        Thompson hemiarthroplasty versus modular unipolar implants for patients requiring hemiarthroplasty of the hip: a systematic review of the evidence.
        Bone Joint Res. 2017; 6: 506-513
        • Sugano N.
        • Kubo T.
        • Takaoka K.
        • Ohzono K.
        • Hotokebuchi T.
        • Matsumoto T.
        • Igarashi H.
        • Ninomiya S.
        Diagnostic criteria for non-traumatic osteonecrosis of the femoral head: a multicenter study.
        J. Bone Joint Surg. (Br.). 1999; 81: 590-595
        • Sugano N.
        • Atsumi T.
        • Ohzono K.
        • Kubo T.
        • Hotokebuchi T.
        • Takaoka K.
        The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head.
        J. Orthop. Sci. 2002; 7: 601-605
        • Wu G.
        • Siegler S.
        • Allard P.
        • Kirtley C.
        • Leardini A.
        • Rosenbaum D.
        • Whittle M.
        • D’Lima D.D.
        • Cristofolini L.
        • Witte H.
        • Schmid O.
        • Stokes I.
        • Standardization and Terminology Committee of the International Society of Biomechanics
        ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion-part I: ankle, hip, and spine.
        J. Biomech. 2002; 35: 543-548