Liner Orientation Does Not Determine Postoperative Hip Mobility: The Dominant Roles of Limb Length Discrepancy and Soft-Tissue Management in THA

Year 2026, Volume: 9 Issue: 1 , 163 - 168 , 17.03.2026

Hilmi Alkan , Mehmet Murat Bala , Tural Talıblı , Yasin Erdoğan

https://doi.org/10.36516/jocass.1838403

https://izlik.org/JA85GR69XB

Abstract

Aim: Acetabular liner orientation has been widely studied in the context of instability and impingement after total hip arthroplasty (THA), yet its impact on postoperative hip range of motion (ROM) remains unclear. ROM may be influenced by multiple confounding factors, including limb length discrepancy (LLD), femoral offset, body mass index (BMI), smoking status, and soft-tissue procedures. Methods: This retrospective study included 92 hips that underwent primary THA with either a posterosuperior or posterior liner orientation. Demographic, radiographic, and surgical variables—including LLD, femoral offset, bursal repair, and postoperative drain output—were recorded. Hip ROM (flexion, abduction, internal and external rotation) was measured goniometrically at final follow-up. Correlation analyses and multivariable linear regression models were used to evaluate independent predictors of ROM. Results:Mean ROM did not differ significantly between the posterosuperior (n = 61) and posterior (n = 31) liner groups. LLD was independently associated with reduced flexion and external rotation. Abduction and internal rotation were positively associated with bursal repair and greater drain output, whereas higher BMI showed a trend toward reduced abduction. Smoking demonstrated a statistical association with higher abduction values, although this was likely confounded by patient characteristics. Overall, ROM variation was more strongly related to LLD and soft-tissue–related surgical factors than to liner orientation. Conclusion:Liner orientation (posterosuperior vs. posterior) did not significantly influence postoperative ROM after THA. Postoperative mobility was primarily determined by LLD and soft-tissue management. Surgical planning should prioritize correction of LLD and optimization of soft-tissue balance rather than relying on liner orientation to improve ROM.

Keywords

Total hip arthroplasty , liner orientation , hip range of motion

Ethical Statement

E1-23-3379

Liner Yönelimi Postoperatif Kalça Hareketliliğini Belirlemez: Total Kalça Artroplastisinde Ekstremite Uzunluk Farkı ve Yumuşak Doku Yönetiminin Baskın Rolleri

https://izlik.org/JA85GR69XB

Abstract

Amaç: Asetabular liner yönelimi, total kalça artroplastisi (TKA) sonrası instabilite ve impingement bağlamında geniş ölçüde araştırılmış olsa da, ameliyat sonrası kalça eklem hareket açıklığı (ROM) üzerindeki etkisi net değildir. ROM; ekstremite uzunluk farkı (LLD), femoral offset, vücut kitle indeksi (BMI), sigara kullanımı ve yumuşak doku işlemleri gibi karıştırıcı faktörlerden etkilenebilir. Yöntem: Bu retrospektif çalışma, primer TKA yapılan ve liner’ı posterosuperior veya posterior yerleştirilen 92 kalçayı içermektedir. LLD, femoral offset, bursa onarımı ve postoperatif drenaj miktarı dahil demografik, radyografik ve cerrahi değişkenler kaydedildi. Kalça ROM’u (fleksiyon, abduksiyon, iç ve dış rotasyon) son kontrolde gonyometrik olarak ölçüldü. ROM’un bağımsız belirleyicilerini değerlendirmek için korelasyon analizleri ve çok değişkenli lineer regresyon modelleri kullanıldı. Bulgular: Posterosuperior (n = 61) ve posterior (n = 31) liner grupları arasında ortalama ROM açısından anlamlı fark saptanmadı. LLD, fleksiyon ve dış rotasyonda azalma ile bağımsız olarak ilişkiliydi. Abduksiyon ve iç rotasyon, bursa onarımı ve daha yüksek drenaj miktarı ile pozitif yönde ilişkili bulundu. Yüksek BMI, abduksiyon azalması yönünde eğilim gösterdi. Sigara kullanımının abduksiyonla ilişkisi ise muhtemelen karıştırıcı faktörlere bağlıydı. Genel olarak ROM farklılıklarının liner yöneliminden çok LLD ve yumuşak dokuya ilişkin cerrahi faktörlerle ilişkili olduğu görüldü. Sonuç: Liner yönelimi (posterosuperior vs. posterior) TKA sonrası kalça ROM’unu anlamlı şekilde etkilememektedir. Postoperatif hareket açıklığını belirleyen temel unsurlar LLD ve yumuşak doku yönetimidir. Cerrahi planlamada LLD’nin düzeltilmesi ve yumuşak doku dengesinin korunması önceliklendirilmelidir.

Keywords

Total hip arthroplasty , liner orientation , hip range of motion

Ethical Statement

E1-23-3379

References

• 1. Liu XW, Zi Y, Xiang LB, Wang Y. Total hip arthroplasty: a review of advances, advantages and limitations. Int J Clin Exp Med. 2015;8(1):27-36. [Crossref]
• 2.Tanaka H, Yamada N, Kurishima H, Mori Y, Sakamoto T, Oyama M. The intraoperative hip range of motion in total hip arthroplasty predicts postoperative patient's satisfaction for cutting toenails and putting on sock. J Orthop Sci. 2022;27(5):1060-6. [Crossref]
• 3.Davis KE, Ritter MA, Berend ME, Meding JB. The importance of range of motion after total hip arthroplasty. Clin Orthop Relat Res. 2007;465:180-4. [Crossref]
• 4.Widmer KH, Zurfluh B. Compliant positioning of total hip components for optimal range of motion. J Orthop Res. 2004;22(4):815-21. [Crossref]
• 5.van Arkel RJ, Ng KCG, Muirhead-Allwood SK, Jeffers JRT. Capsular Ligament Function After Total Hip Arthroplasty. J Bone Joint Surg Am. 2018;100(14):e94. [Crossref]
• 6.Tezuka T, Inaba Y, Kobayashi N, Choe H, Higashihira S, Saito T. The influence of patient factors on femoral rotation after total hip arthroplasty. BMC Musculoskelet Disord. 2018;19(1):189. [Crossref]
• 7.Bhaskar D, Rajpura A, Board T. Current Concepts in Acetabular Positioning in Total Hip Arthroplasty. Indian J Orthop. 2017;51(4):386-96. [Crossref]
• 8.Hau R, Hammeschlag J, Law C, Wang KK. Optimal position of lipped acetabular liners to improve stability in total hip arthroplasty-an intraoperative in vivo study. J Orthop Surg Res. 2018;13(1):289. [Crossref]
• 9.Navacchia A, Pagkalos J, Davis ET. Defining the optimal position of the lipped liner in combination with cup orientation and stem version. Bone Joint Res. 2023;12(9):571-9. [Crossref]
• 10.Hu Y, Zhou X, Qiao H, Zhu Z, Li H, Zhang J. Computer simulation of optimal lipped polyethylene liner orientation against prosthetic impingement. J Orthop Surg Res. 2022;17(1):204. [Crossref]
• 11.McGrory BJ, Morrey BF, Cahalan TD, An KN, Cabanela ME. Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg Br. 1995;77(6):865-9. [Crossref]
• 12.Matsushita A, Nakashima Y, Jingushi S, Yamamoto T, Kuraoka A, Iwamoto Y. Effects of the femoral offset and the head size on the safe range of motion in total hip arthroplasty. J Arthroplasty. 2009;24(4):646-51. [Crossref]
• 13.Desai AS, Dramis A, Board TN. Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med. 2013;6(4):336-41. [Crossref]
• 14.Takahashi D, Shimizu T, Miyazaki T, Ogawa T, Iwasaki N. Instability in total hip arthroplasty: A literature review. Journal of Joint Surgery and Research. 2023;1(1):92-6. [Crossref]
• 15.Pryce GM, Sabu B, Al-Hajjar M, et al. Impingement in total hip arthroplasty: A geometric model. Proc Inst Mech Eng H. 2022;236(4):9544119211069472. [Crossref]
• 16.Peker G, Bala MM, Altun İ. Ceramic femoral head in highly cross-linked polyethylene cup. 5 year results of a randomized trial. Annali Italiani di Chirurgia. 2022;93(2):202-9. [Crossref]
• 17.Lecoanet P, Vargas M, Pallaro J, Thelen T, Ribes C, Fabre T. Leg length discrepancy after total hip arthroplasty: Can leg length be satisfactorily controlled via anterior approach without a traction table? Evaluation in 56 patients with EOS 3D. Orthop Traumatol Surg Res. 2018;104(8):1143-8. [Crossref]
• 18.Iversen MD, Chudasama N, Losina E, Katz JN. Influence of self-reported limb length discrepancy on function and satisfaction 6 years after total hip replacement. J Geriatr Phys Ther. 2011;34(3):148-52. [Crossref]
• 19.Gurney B. Leg length discrepancy. Gait Posture. 2002;15(2):195-206. [Crossref]
• 20.Resende RA, Kirkwood RN, Deluzio KJ, Cabral S, Fonseca ST. Biomechanical strategies implemented to compensate for mild leg length discrepancy during gait. Gait Posture. 2016;46:147-53. [Crossref]
• 21.Resende RA, Kirkwood RN, Deluzio KJ, Morton AM, Fonseca ST. Mild leg length discrepancy affects lower limbs, pelvis and trunk biomechanics of individuals with knee osteoarthritis during gait. Clin Biomech (Bristol). 2016;38:1-7. [Crossref]
• 22.Fırat A, Veizi E, Karaman Y, et al. Unrepaired Trochanteric Bursae as a Risk Factor for Deep Gluteal Syndrome After Total Hip Arthroplasty: A Prospective Randomized Controlled Trial. J Arthroplasty. 2024;39(4):1025-30. [Crossref]
• 23.Sun X, Zhu X, Zeng Y, et al. The effect of posterior capsule repair in total hip arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2020;21(1):263. [Crossref]
• 24.Chalidis BE, Sachinis NP, Hawdon G, McMahon S. Lateral trochanteric bursa repair improves early hip function after posterior approach total hip arthroplasty: a prospective randomized control trial. Arthroplasty. 2022;4(1):26. [Crossref]
• 25.Erne F, Wetzel S, Wülker N, Gesicki M, Hofmann UK. Closed Suction Drainage after Primary Total Knee Arthroplasty: A Prospective Randomized Trial. J Knee Surg. 2018;31(8):804-10. [Crossref]
• 26.Walmsley PJ, Kelly MB, Hill RM, Brenkel I. A prospective, randomised, controlled trial of the use of drains in total hip arthroplasty. J Bone Joint Surg Br. 2005;87(10):1397-401. [Crossref]
• 27.Vincent HK, Horodyski M, Gearen P, et al. Obesity and long term functional outcomes following elective total hip replacement. J Orthop Surg Res. 2012;7:16. [Crossref]
• 28.Haverkamp D, Klinkenbijl MN, Somford MP, Albers GH, van der Vis HM. Obesity in total hip arthroplasty--does it really matter? A meta-analysis. Acta Orthop. 2011;82(4):417-22. [Crossref]
• 29.Teng S, Yi C, Krettek C, Jagodzinski M. Smoking and risk of prosthesis-related complications after total hip arthroplasty: a meta-analysis of cohort studies. PLoS One. 2015;10(4):e0125294. [Crossref]
• 30.Bojan B, Perni S, Prokopovich P. Systematic Review and Meta-Analysis of Tobacco Use as a Risk Factor for Prosthetic Joint Infection After Total Hip Replacement. Arthroplast Today. 2020;6(4):959-71. [Crossref]
• 31.Cobb TK, Morrey BF, Ilstrup DM. The elevated-rim acetabular liner in total hip arthroplasty: relationship to postoperative dislocation. J Bone Joint Surg Am. 1996;78(1):80-6. [Crossref]