The Hip-Spine Relationship Simplified.

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Abstract

[Indexed for MEDLINE] 3. J Am Acad Orthop Surg. 2024 Oct 15;32(20):921-928. doi: 10.5435/JAAOS-D-23-00931. Epub 2024 Jun 28. Offset Considerations in Total Hip Arthroplasty. Driesman AS(1), Jennings JM, Yang CC, Dennis DA. Author information: (1)From the Colorado Joint Replacement, Denver, CO (Driesman, Jennings, Yang, and Dennis), Department of Mechanical and Materials Engineering, University of Denver, Denver, CO (Jennings and Dennis), the Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO (Dennis), and the Department of Biomedical Engineering, University of Tennessee, Knoxville, TN (Dennis). To perform total hip arthroplasty (THA) successfully, a surgeon must be able to place the implants in a position that will restore and duplicate the patient's baseline anatomy and soft-tissue tension. One of the critical factors is the restoration of femoral offset. It is the goal of this review to precisely define measurement of offset in THA, describe its role in hip joint biomechanics, outline alterations that can be performed intraoperatively, and explain how it can create potential pathologic states. If there is a lack of offset restoration, it can result in a host of complications, including bony impingement with pain, edge loading or prosthetic joint instability, and alterations in the muscle length-tension relationship leading to reduced motor performance. Excessive femoral offset can increase hip abductor muscle and iliotibial band tension resulting in greater trochanteric pain regardless of the surgical approach. The purpose of this review was to analyze intraoperative surgical factors, choice of prosthetic implant type and position that are required to maximize stability, and dynamic motor performance after THA. Copyright © 2024 by the American Academy of Orthopaedic Surgeons. DOI: 10.5435/JAAOS-D-23-00931