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Making decisions about things like what college to attend and reuniting with longstanding crush Jesse Foster—all that can wait. II Distance between vertical midline proximal lateral femoral cortex global offset. IV Distance between horizontal line and roof of acetabulum. V Distance between horizontal line and COR.
The distances were automatically calculated in PACS. Measurements were done twice and the mean value used in our data. Image magnification was accounted for by measuring the size of a metal ball with a known diameter. In a previous study we found this method to be applicable with intraclass correlation coefficient above 0. As there are sparse relevant data in the literature and our data are presented descriptively rather than statistically, we did not perform power analyses before the study.
P value equal 0. In 20 of 73 cases there was a medial shift of COR by more than 5. The changes of COR in the vertical direction ranged from 18 mm in proximal direction to 11 mm in distal direction with a mean of 1. In 14 cases COR was moved more than 5. Distribution in horizontal movement of center of rotation COR in patients operated with primary total hip arthroplasty. Distribution in verical movement of center of rotation COR in patients operated with primary total hip arthroplasty.
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- Changes of center of rotation and femoral offset in total hip arthroplasty.
In 10 cases the femoral offset was reduced by more than 5. Distribution in change of femoral offset in patients operated with primary total hip arthroplasty. In 17 cases global offset was reduced by more than 5. Scatter plot of correlations between changes of acetabular and femoral offset in patients operated with primary total hip arthroplasty. Scatter plot of correlations between changes of acetabular and global offset in patients operated with primary total hip arthroplasty.
Scatter plot of correlations between changes of femoral and global offset in patients operated with primary total hip arthroplasty. The postoperative course was uneventful in all patients, and at follow-up at 12 months they all had gluteal stability as evaluated by clinical testing Trendelenburg sign.
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In this study we addressed the controversy how we manage to preserve the COR to the anatomic position with an uncemented total hip prosthesis implanted with free hand technique. In the literature there is agreement that an optimal reconstruction of COR in THA is within 5 mm from the anatomic location 8 , 27 , We found that in 40 of 73 patients hips the COR was preserved within 5 mm from the preoperative anatomy.
In all except one case with acetabular reaming of more than 10 mm in medial or proximal direction, COR was relocated more than 10 mm medially of proximally to the anatomic location. This finding supports the logical conclusion that the degree of acetabular reaming affects relocation of COR. There are limitations to our study: Second, we relied on proper standardization of radiographs and measurement techniques, but radiographic interpretation relies heavily on the clinicians experience with reading radiographs.
To minimize shortcomings, we calibrated with a ball of known size, and in a previous study this method proved to have high reliability and agreement of both within the same observer and between observers Third, frontal X-rays only represent two-dimensional change of distances between the object of interest.
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When measuring the change of femoral offset, the possible change of femoral neck version might be a confounder We did not measure the femoral neck angles, but compared the physiological femoral offset with the patella facing frontally. In our series femoral offset was preserved within 5 mm in 34 cases. The optimal outcome in terms of stress has been observed when COR is medialized, but with an equivalent increase in femoral offset to restore global offset.
This was obtained in 15 of our cases. Medialization of the cup decreases stress on the head-cup interface and on the abductor muscles 10 , On the other hand, any increase of femoral and global offset significantly increases the length and the tension in the anterior bundles of the abductor muscles, and an increased expression of pain has been linked to increased femoral offset The contribution of an offset increase is larger in a patient with little femoral torsion.
Large femoral antetorsion and an increased femoral offset move the insertion of the abductor muscles on the greater trochanter more posteriorly and less laterally compared with a patient with little femoral antetorsion Due to this a shift of femoral offset has been questioned. At least it seems that the effect of cup medialization is of less clinical importance than previously assumed.
A fair correlation was found between the changes of acetabular and global offset, and a better between femoral and global offset. This underlines that the surgeon has a greater influence on the femoral offset than the acetabular offset 8. The use of computer navigation may help to orientate the acetabular component in THA However, the authors did not report how this affected offsets or clinical outcome. While a correlation was found between the changes of femoral and global offset, there was no correlation between the changes of acetabular and femoral offset that would have conserved the global offset.
The variations had no influence on the function of the hip, but our results indicate a potential for better restoring the location of COR and femoral offset when planning and implanting an uncemented THA.
The clinical consequences are, however, unknown. The authors have no conflicts of interest to declare. National Center for Biotechnology Information , U. Journal List Ann Transl Med v. Bjarnason and Olav Reikeras. Author information Article notes Copyright and License information Disclaimer. I Conception and design: All authors; II Administrative support: Offset of Migos - Single by Peewee Longway". Offset - Single by Made Man". Offset - Single by Cousin Stizz". Retrieved July 29, Offset - Single by Juicy J". Retrieved August 4, Retrieved November 2, Retrieved 18 October Archived from the original on December 12, Retrieved January 18, Retrieved March 7, Bubbling Under Hot Singles".
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