Accurate Restoration of Femoral Version During Total Hip Arthroplasty With Custom Stems Allows 94% of Professional Ballet Dancers to Return to Dance

INTRODUCTION: For professional dancers undergoing hip arthroplasty, precise restoration of hip anatomy and biomechanics is essential to allow return to professional activity. The purpose was to evaluate differences between planned versus postoperative radiographic measurements and report functional outcomes after hip arthroplasty by muscle-sparing direct anterior approach using custom femoral stems and individualised 3D preoperative planning in a cohort of professional ballet dancers. METHODS: Active professional ballet dancers who underwent primary total hip arthroplasty through muscle-sparing direct anterior approach using custom femoral stems between November 2013 and January 2025 were included. Preoperative and postoperative 3D CT scans were used to evaluate hip morphology, limb length discrepancy, offset restoration, and component orientation. Clinical outcomes were assessed at a minimum follow-up of 12 months including the Oxford Hip Score, Forgotten Joint Score, UCLA Activity Scale, patient satisfaction with surgery on Visual Analogue Scale, and return to dance. RESULTS: . Postoperative CT scans demonstrated accurate restoration of hip anatomy, with mean differences between planned and achieved values for limb length discrepancy of 0.2 ± 2.9 mm, for cup diameter of 0.0 ± 0.0 mm, for acetabular offset of 0.3 ± 1.7 mm, for femoral offset 0.6 ± 1.8 mm, for stem version 0.6° ± 4.1°, for cup version of 5.7° ± 6.3°, and for cup inclination of 1.1° ± 5.8°. Mean Oxford Hip Score was 45.9 ± 4.4, mean Forgotten Joint Score was 89.2 ± 15.6, and mean UCLA Activity Scale was 9.3 ± 1.1. Patient satisfaction was high (4.7 ± 0.8), and 94% of patients returned to dance. CONCLUSION: In professional ballet dancers, hip arthroplasty performed through a muscle-sparing direct anterior approach using custom femoral stems and individualised 3D preoperative planning resulted in accurate anatomical restoration, promising clinical outcomes, and high rates of return to dance. These findings support the use of individualised 3D planning and custom implants in this high-demanding population.