Effect of surgical technique and use of a rigid centralizing device on stem positioning and geometric reconstruction in the sagittal plane during total hip replacement in canine cadavers

Abstract

Objective - To determine the effect of surgical technique and use of a rigid centralizing device on stem positioning and geometric reconstruction in the sagittal plane during total hip replacement in dogs. Sample Population - Bilateral femurs from 8 adult mixed-breed canine cadavers. Procedure - Femurs were prepared for femoral stem implantation, using 4 variations in technique. Proximal femoral reconstruction and femoral stem positioning were evaluated on radiographs. Results - Implants evaluated in this study accurately reconstructed displacement of the femoral head of the intact canine femur in the sagittal plane. Centralization of the distal aspect of the stem was optimized by use of an undersized femoral stem. Ostectomy at the level of the lesser trochanter resulted in the smallest diaphysis-to-implant angle. Anteversion and retroversion of implants significantly decreased the distance between the distal tip of the implant and the adjacent cortex, compared with normoversion. The centralizing device significantly increased the minimum distance between the distal tip of the implant and adjacent cortex but did not improve the odds of actually centralizing the tip of the implant. Conclusions and Clinical Relevance - Malpositioning of implants in the sagittal plane may be minimized through ostectomy at the lesser trochanter and use of an undersized implant positioned in normoversion. Use of a polymethylmethacrylate centralizing device will help eliminate contact between the implant tip and adjacent cortex. Implantation of an undersized femoral component, avoidance of substantial anteversion or retroversion, and use of a rigid centralizing device are recommended when using the prosthesis described-for total hip replacement of dogs.