Final Femoral Rasp Predicts Intraoperative Stem Alignment in Primary Total Hip Arthroplasty Using a Cementless Triple-Tapered Stem.
- 1Musculoskeletal University Center Munich (MUM), Department of Orthopaedics, Trauma Surgery and Rehabilitative Medicine, LMU University Hospital Munich, Munich, Germany.
Abstract
Background
The final femoral rasp (FFR) serves as an intraoperative surrogate for positioning the final femoral implant (FFI) in total hip arthroplasty (THA), yet quantitative data on rasp-implant concordance for modern triple-tapered stems are limited. This study quantified positional differences between the final rasp and implant in primary cementless THA via the direct anterior approach (DAA).Methods
This prospective study included 63 THA procedures using the DAA. Intraoperative fluoroscopic images of FFR and FFI were analyzed in coronal and axial projections, measuring from lateral shoulder to the greater trochanter tip and from osteotomy plane to taper apex in coronal view, as well as angular deviation between rasp/implant axis and proximal femoral shaft axis in both views. Positional differences (Δ = FFR - FFI) were assessed.Results
The implant was positioned more proximally than the rasp (Δ greater trochanter-shoulder = 0.64 ± 2.51 mm, P = .048) and demonstrated valgus alignment relative to the rasp (Δ coronal angle = 0.63° ± 1.38°, P < .001), whereas no differences were observed for the remaining parameters.Conclusions
This intraoperative analysis demonstrated close positional agreement between FFR and FFI in a cementless, triple-tapered stem THA design implanted via the DAA. The FFI was positioned in valgus and at a more proximal level than the FFR. These differences were limited and likely attributable to minor intraoperative adjustment and design-related geometric differences. Overall, the findings support the reliability of the FFR as an intraoperative surrogate for implant positioning in cementless THA.
Related
- Association of Surgical Approach with Intraoperative Femoral Fracture Patterns During Cementless Hemiarthroplasty for Femoral Neck Fracture
- The Effect of Cementless Stem Design on Late Periprosthetic Fractures After Total Hip Arthroplasty. Does the Design of Cementless Stems Affects the Rate of Periprosthetic Femoral Fractures?
- Agreement and Systematic Differences Between Intraoperative ROSA Hip-Knee-Ankle Measurements and Standing Radiographic Alignment After Robotic-Assisted Total Knee Arthroplasty: A Retrospective Agreement Study
- CT-Based Assessment of Femoral Stem Anteversion After Intentional Intraoperative Rotational Adjustment of a Single-Wedge Tapered Stem in Total Hip Arthroplasty
- Fracture Morphology and Extraction-Related Femoral Damages in Short Versus Standard Cementless Stems: Analyses of Vancouver B2 Fractures and Well-Fixed Nonfracture Revisions
BibTeX
@article{ahlheit2026final,
title = {{Final Femoral Rasp Predicts Intraoperative Stem Alignment in Primary Total Hip Arthroplasty Using a Cementless Triple-Tapered Stem.}},
author = {Yannick Alexander Ahlheit and Gautier Beckers and Dominic Simon and Salome Hagelstein and Mattia De Benedictis and Boris Michael Holzapfel and Lennart Marvin Schroeder},
journal = {Arthroplasty today},
year = {2026},
month = oct,
doi = {10.1016/j.artd.2026.102186},
url = {https://europepmc.org/article/MED/42926808},
note = {CC BY},
}
RIS
TY - JOUR
TI - Final Femoral Rasp Predicts Intraoperative Stem Alignment in Primary Total Hip Arthroplasty Using a Cementless Triple-Tapered Stem.
AU - Yannick Alexander Ahlheit
AU - Gautier Beckers
AU - Dominic Simon
AU - Salome Hagelstein
AU - Mattia De Benedictis
AU - Boris Michael Holzapfel
AU - Lennart Marvin Schroeder
PY - 2026
DA - 2026/10/15
JO - Arthroplasty today
DO - 10.1016/j.artd.2026.102186
UR - https://europepmc.org/article/MED/42926808
AB - Background The final femoral rasp (FFR) serves as an intraoperative surrogate for positioning the final femoral implant (FFI) in total hip arthroplasty (THA), yet quantitative data on rasp-implant concordance for modern triple-tapered stems are limited. This study quantified positional differences between the final rasp and implant in primary cementless THA via the direct anterior approach (DAA).Methods This prospective study included 63 THA procedures using the DAA. Intraoperative fluoroscopic images of FFR and FFI were analyzed in coronal and axial projections, measuring from lateral shoulder to the greater trochanter tip and from osteotomy plane to taper apex in coronal view, as well as angular deviation between rasp/implant axis and proximal femoral shaft axis in both views. Positional differences (Δ = FFR - FFI) were assessed.Results The implant was positioned more proximally than the rasp (Δ greater trochanter-shoulder = 0.64 ± 2.51 mm, P = .048) and demonstrated valgus alignment relative to the rasp (Δ coronal angle = 0.63° ± 1.38°, P < .001), whereas no differences were observed for the remaining parameters.Conclusions This intraoperative analysis demonstrated close positional agreement between FFR and FFI in a cementless, triple-tapered stem THA design implanted via the DAA. The FFI was positioned in valgus and at a more proximal level than the FFR. These differences were limited and likely attributable to minor intraoperative adjustment and design-related geometric differences. Overall, the findings support the reliability of the FFR as an intraoperative surrogate for implant positioning in cementless THA.
SN - 2352-3441
ER -