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

Öz

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.

Anahtar Kelimeler

• Total hip arthroplasty
• liner orientation
• hip range of motion

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

Öz

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.

Anahtar Kelimeler

• Total hip arthroplasty
• liner orientation
• hip range of motion

Kaynakça

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