Error of intraoperative measurement of stem anteversion is decreased by measuring in neutral hip position during total hip arthroplasty

Background: Intraoperative stem anteversion, which is the angle between the lower leg axis and the trial-stem axis with hip flexion and adduction, is generally evaluated by the surgeon's visual estimation during total hip arthroplasty (THA). However, the conventional approach can be influenced by knee osteoarthritis or uncertain surgeon's observation point. Therefore, we developed a new method for measuring the stem anteversion angle in the neutral hip position using an original rod attached to the trial-stem perpendicular to the long axis and parallel to the stem neck. This study aimed to assess the accuracy of our method in comparison with the conventional method of measuring intraoperative stem anteversion angle. Methods: We measured the intraoperative stem anteversion angle in consecutive 106 hips of 106 patients who underwent cementless primary THA with a tapered wedge stem. Absolute error in the stem anteversion angle was expressed as the difference between intraoperative (common vs. neutral hip positions) and postoperative computed tomography measurements, i.e., true stem anteversion. Additionally, we investigated the factors affecting these errors. Results: The absolute error of measurement was significantly smaller in the neutral hip position than in the common position (3.0 degrees +/- 2.5 degrees vs. 8.0 degrees +/- 3.9 degrees; p < 0.0001). The factor associated with the error was advanced knee osteoarthritis in the common position, whereas it was not statistically significant in the neutral hip position. Conclusions: This study suggests that the error in the intraoperative measurement of stem anteversion is decreased by measuring in the neutral hip position during THA. (c) 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.