Hip Offset in Total Hip Arthroplasty: Quantitative Measurement with Navigation

Background Offset in THA correlates to abductor muscle function, wear, and impingement. Femoral offset after THA is not independent of the cup center of rotation (COR) so hip offset, a combination of femoral offset and change in hip COR, becomes the important measurement. Questions/purposes We therefore asked whether hip offset in arthritic hips would correlate with cup COR; whether offset could always be balanced within 6 mm of contralateral normal hips; and whether hip length could also be kept within 6 mm. Methods We compared hip offset of arthritic and contralateral normal hips on radiographs in 82 patients (82 hips) who had THA. We used computer navigation in all patients with the aim of reconstructing the hip offset and to compare hip offset change to the quantitative change of the hip COR. Results The preoperative radiographic change to equalize the offset ranged from −12 to +21 mm (mean, 1.5); postoperatively the change was 1.4 ± 6.4 mm and was within ± 6 mm in 78 of 82 hips. As COR displaced superiorly from 3 to 6+ mm the offset had to be substantially increased. Only with COR 0–3 mm superior and 0–5 mm medial was offset always within 5 mm. Conclusions Hip offset reconstruction was directly related to the position of the hip COR, and navigation allowed quantitative control of offset and hip length.