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Kim HS, Lee YK, Ha JH, Park SJ, Park JW, Koo KH. Distribution and outliers of anteversion of short-length cementless stem. INTERNATIONAL ORTHOPAEDICS 2021; 46:725-732. [PMID: 34799778 DOI: 10.1007/s00264-021-05265-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Inadequate stem version might lead to impingement and instability after cementless total hip arthroplasty (THA). We evaluated (1) the distribution of short-stem anteversion, (2) the proportion of stems with an anteversion less than 5° or larger than 25°, (3) combined cup and stem anteversion, and (4) dislocation rate. MATERIALS AND METHODS We evaluated the native femoral anteversion and stem anteversion in 340 patients (340 THAs): 144 men and 196 women. Their mean age was 56.2 (22-87) years and mean body mass index was 25.1 (15.2-40.7) kg/m2. The femoral neck anteversion was measured on pre-operative CT scan and the stem anteversion was obtained during the operation. The safe zone of the stem anteversion was defined as 5 to 25°. RESULTS The femoral neck anteversion ranged from -15 to 61° (mean, 15.0°; SD, ±10.6°). The stem anteversion ranged -7 to 50° (mean, 15.7°; SD, ±9.5°). It was optimal (5-25°) in 71.2% (242/340), insufficient (<5°) in 13.3% (45/340), and excessive (>25°) in 15.6% (53/340). The stem anteversion had a medium correlation with the femoral neck anteversion (correlation coefficient = 0.449). The combined anteversion was 42.0° (range, 35.2-52.3°; SD, ±2.8°). During two to four year follow-up, no hip dislocated. CONCLUSIONS Short-length stem had a great variability in the anteversion and considerable portion (28.9%, 98/340) of stems had an anteversion outside the safe zone. Surgeons should be aware of this variability of stem anteversion to compensate for abnormal stem anteversion, which might lead to impingement and instability after THA.
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Affiliation(s)
- Hong-Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Joo-Hyung Ha
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea
| | - Se Jin Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea.
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Downsizing in total hip arthroplasty. A short stem as a revision implant. DER ORTHOPADE 2021; 51:230-238. [PMID: 34581833 PMCID: PMC8894309 DOI: 10.1007/s00132-021-04168-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/09/2022]
Abstract
Background Short stems have constantly gained popularity in primary total hip arthroplasty (THA) over the last decade. Although cementless short stems are not primarily designed to be used as revision implants, there may be certain indications for which downsizing the femoral component in failed conventional THA is potentially advantageous. Methods In this single center retrospective case series, six patients who underwent revision using a calcar-guided short stem after failed THA are presented. The mean follow-up was 3.32 years (SD 0.63 years). The health status was evaluated by the EQ-5D-5L score. Patient reported outcome measurements (PROM) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain and satisfaction were assessed using a visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignment and signs of aseptic loosening. Complications were documented. Results At last follow-up the mean EQ-5D-5L index was 0.851 (SD 0.098). Clinical outcome was excellent (HHS ≥ 90) in 4 patients and moderate (HHS 71 and 79) in 2 patients. The mean WOMAC score was 9.20% (SD 12.61%). Pain and satisfaction on VAS were 1.00 (SD 1.15) and 9.17 (SD 0.37), respectively. No major complications occurred. To date, no further revision surgery was needed. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fractures were obvious. Conclusion The present case series indicates that in failed conventional THA downsizing may be considered a treatment option, using short stem THA in selected cases.
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Freitag T, Bieger R, Kiefer H, Dornacher D, Reichel H, Ignatius A, Dürselen L. Biomechanics of a calcar loading and a shortened tapered femoral stem: Comparative in-vitro testing of primary stability and strain distribution. J Exp Orthop 2021; 8:74. [PMID: 34491456 PMCID: PMC8423873 DOI: 10.1186/s40634-021-00388-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The most common femoral short stems available on the market can, in principle, be divided with regard to their anchoring concepts into a calcar loading and a shortened tapered design. The purpose of this study was to compare the primary stability and stress-shielding of two short stems, which correspond to these two different anchoring concepts. Methods Using seven paired fresh frozen human cadaver femurs, primary axial and rotational stabilities under dynamic load (100–1600 N) were evaluated by miniature displacement transducers after 100,000 load cycles. Changes in cortical strains were measured before and after implantation of both stem types to detect implant-specific load transmission and possible stress-shielding effects. Results Reversible and irreversible micromotions under dynamic load displayed no significant differences between the two implants. Implantation of either stem types resulted in a reduction of cortical strains in the proximal femur, which was less pronounced for the calcar loading implant. Conclusions Both short stems displayed comparable micromotions far below the critical threshold above which osseointegration may disturbed. Neither short stem could avoid proximal stress-shielding. This effect was less pronounced for the calcar loading short stem, which corresponds to a more physiological load transmission.
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Affiliation(s)
- Tobias Freitag
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Ralf Bieger
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Hartmuth Kiefer
- Department of Trauma and Orthopaedic Surgery, Lukas Hospital, Buende, Germany
| | - Daniel Dornacher
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University Medical Centre, Helmholtzstr. 14, 89081, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University Medical Centre, Helmholtzstr. 14, 89081, Ulm, Germany
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Kutzner KP. Calcar-guided short-stem total hip arthroplasty: Will it be the future standard? Review and perspectives. World J Orthop 2021; 12:534-547. [PMID: 34485100 PMCID: PMC8384612 DOI: 10.5312/wjo.v12.i8.534] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/10/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
Short stems in total hip arthroplasty (THA) are becoming increasingly popular. In Germany, already 10.4% of all primary THAs are performed using a cementless short stem. The concept of modern, calcar-guided, short stems aims for an individualized reconstruction of the hip anatomy by following the calcar of the femoral neck, a bone- and soft-tissue-sparing implantation technique, and physiological loading. The stem design uses either metaphyseal fixation alone or additional diaphyseal anchoring, depending on the stem alignment and indication. These individualized anchorage types increase the potential indications for the safe use of a short stem. The design features may account for potential advantages of current short stem implants compared with earlier short-stem designs, particularly in cases of reduced bone quality or osteonecrosis of the femoral head and femoral neck fractures. The implantation technique, however, requires distinct knowledge regarding the characteristics of varus and valgus positioning, with the potential for clinical consequences. A learning curve for surgeons new to this technique must be taken into account. Cortical contact with the distal lateral cortex appears to be crucial to provide sufficient primary stability, and the use of intraoperative imaging to identify “undersizing” is highly recommended. Current results of several national registries indicate that calcar-guided short stems are among the most successful implants in terms of mid-term survivorship. However, long-term data remain scarce. This review introduces the characteristics of calcar-guided short-stem THA and summarizes the current evidence.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedic Surgery, St Josefs Hospital Wiesbaden, Germany, Wiesbaden 65189, Germany
- Department of Hip Surgery, Gelenkzentrum Rhein-Main, Wiesbaden 65183, Germany
- Center of Orthopedics and Traumatology, Johannes Gutenberg-University of Mainz, Mainz 55131, Germany
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Tatani I, Solou K, Panagopoulos A, Lakoumentas J, Kouzelis A, Megas P. Short-term clinical and radiological results of two different design metaphyseal fitting femoral stems in total hip arthroplasty: a prospective, randomized trial. J Orthop Surg Res 2021; 16:316. [PMID: 34001204 PMCID: PMC8127309 DOI: 10.1186/s13018-021-02465-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 11/12/2022] Open
Abstract
Background There is great design variability on short femoral stems available on the market. This study aims to evaluate the short-term clinical and radiological results of two different design short femoral stems, both classified as shortened tapered stems. Methods From March 2016 to March 2018, a prospective, randomized, parallel-group design study was conducted to compare functional and radiological outcomes of 45 patients underwent THA using the Tri-Lock Bone Preservation Stem and 45 patients underwent THA with the Minima S stem at a minimum 2 years of follow-up. Patients were assessed clinically and radiographically prior to surgery as well as at 3, 6, 12, and 24 months postoperatively. Primary outcomes were the change in health-related quality of life assessed with Western Ontario and McMaster Universities Osteoarthritis Index and 36-Item Short Form Health Survey and also the incidence of all hip-related complications. Secondary aims included hip function evaluated with the Harris hip score, rates of patient satisfaction, and the outcomes of a detailed radiological analysis. Results There were no significant differences between the 2 study groups in terms of patient-reported outcomes measurements, satisfaction scores, and complication rates at any of the measurement times. In both groups, stable fixation and radiographic osseointegration were achieved. However, analysis of the calcar region showed that 57.8% and 28.9% of patients had grade 1 or 2 stress shielding, in Tri-Lock and Minima S implantation group, respectively (p=0.015). Regarding coronal alignment, stems were placed in slight varus, valgus, and neutral position in 51.1%, 13.3%, and 35.6% of patients, respectively, in Tri-Lock BPS group. The Minima S stem was implanted at slight varus and valgus in 60% and 40% of patients, respectively, and neither stem in the exact neutral position. Conclusions Both different design short femoral stems demonstrated excellent clinical performance at short-term follow up. Nevertheless, concerns were raised regarding the incidence of stress shielding phenomenon and mild discrepancies in coronal stem alignment during implantation. The clinical impact of these observations should be further evaluated through larger cohorts and longer follow-up. Trial registration ISRCTN registry, ISRCTN10096716. Registered on May 8, 2018—Retrospectively registered
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Affiliation(s)
- I Tatani
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece.
| | - K Solou
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece
| | - A Panagopoulos
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece
| | - J Lakoumentas
- Laboratory Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - A Kouzelis
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece
| | - P Megas
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece
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Kim YH, Jang YS, Kim EJ. A Prospective, Randomized Comparison of the Long-Term Clinical and Radiographic Results of an Ultra-Short vs a Conventional Length Cementless Anatomic Femoral Stem. J Arthroplasty 2021; 36:1707-1713. [PMID: 33423878 DOI: 10.1016/j.arth.2020.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to compare the long-term clinical and radiographic results, survival rates, and complication rates of an ultra-short vs a conventional length cementless anatomic femoral stem. METHODS We reviewed 759 patients (858 hips) (mean age, 56.3 ± 12.9 y) who had an ultra-short cementless anatomic stem and 759 patients (858 hips) (mean age, 54.8 ± 12.3 y) who had a conventional length cementless anatomic stem. The mean follow-up was 16.5 years (range 14-17) in the ultra-short stem group and 17.5 years (range 17-20) in the conventional stem group. RESULTS At the latest follow-up, there were no significant differences between the 2 groups in terms of the Harris Hip Scores (92 ± 6 vs 91 ± 7 points, P = .173), Western Ontario and McMaster Universities Osteoarthritis scores (12 ± 8 vs 13 ± 7 points, P = .972), University of California Los Angeles activity scores (7.6 vs 7.8 points, P = .841), patient satisfaction scores (7.7 ± 2.3 vs 7.5 ± 2.5 points, P = .981), and survival rates (97.6% vs 96.6%). However, incidence of thigh pain (P = .031) and stress shielding (P = .001) was significantly higher in the conventional length stem group than in the ultra-short anatomic stem group. Complication rates were similar (1.8% vs 2.7%) between the 2 groups. CONCLUSION Although an ultra-short cementless anatomic femoral stem confers equivalent clinical and radiographic outcomes, survival rates, and complication rates to conventional length cementless anatomic stem, the incidence of thigh pain and stress shielding was significantly lower in the ultra-short cementless anatomic stem. LEVEL OF EVIDENCE Therapeutic Level I.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center of Seoul Metropolitan Seonam Hospital, Seoul, Republic of Korea
| | - Young-Soo Jang
- The Joint Replacement Center of Seoul Metropolitan Seonam Hospital, Seoul, Republic of Korea
| | - Eun-Jung Kim
- The Joint Replacement Center of Seoul Metropolitan Seonam Hospital, Seoul, Republic of Korea
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Munakata Y, Kuramitsu Y, Usui Y, Okazaki K. Comparison of radiographic changes in rectangular curved short stem with thin versus thick porous coating for cementless total hip arthroplasty: a retrospective study with a propensity score matching. J Orthop Surg Res 2021; 16:247. [PMID: 33849591 PMCID: PMC8042942 DOI: 10.1186/s13018-021-02397-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/05/2021] [Indexed: 11/12/2022] Open
Abstract
Background Radiographic changes that appear relatively quickly after fixation of cementless stem in total hip arthroplasty (THA) vary depending on the stem design and fixation style. The present study compared radiographic changes between two types of rectangular curved short stems of similar shape. Methods This retrospective study included 118 hips that underwent primary cementless THA with an anterolateral supine approach using a rectangular, curved, short stem performed by the same surgeon between June 2015 and June 2019. Among the examined hips, 39 had a thicker porous coating stem (thicker group) and 66 had a thinner porous coating and reduced tip stem (thinner group) and at least 12-month follow-up. Radiographs taken during the final course observation were assessed. Propensity score matching was performed based on demographic data and comparisons were made using pairs of 25 hips each. Statistical analysis was performed using chi-square test and p values ≤ 0.05 indicated statistical significance. Results The pattern of the radiolucent lines showed a significant difference after matching (p = 0.0044). A “proximal and distal” pattern was most common in the thicker group and a “distal only” pattern was most common in the thinner group. There was notable and significant difference in cortical hypertrophy in the thicker group after matching (p = 0.024). Conclusions Although the two short stems were similar shapes, the short-term radiographic changes were different. The thinner group showed fewer radiographic changes than the thicker group, making it a more “silent” stem.
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Affiliation(s)
- Yutaro Munakata
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yujiro Kuramitsu
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yutaka Usui
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Alsousou J, Oragui E, Martin A, Strickland L, Newman S, Kendrick B, Taylor A, Glyn-Jones S. Primary stability of a proximally coated and tapered stem. Bone Joint J 2021; 103-B:644-649. [PMID: 33789489 DOI: 10.1302/0301-620x.103b4.bjj-2020-1648.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this prospective cohort study was to evaluate the early migration of the TriFit cementless proximally coated tapered femoral stem using radiostereometric analysis (RSA). METHODS A total of 21 patients (eight men and 13 women) undergoing primary total hip arthroplasty (THA) for osteoarthritis of the hip were recruited in this study and followed up for two years. Two patients were lost to follow-up. All patients received a TriFit stem and Trinity Cup with a vitamin E-infused highly cross-linked ultra-high molecular weight polyethylene liner. Radiographs for RSA were taken postoperatively and then at three, 12, and 24 months. Oxford Hip Score (OHS), EuroQol five-dimension questionnaire (EQ-5D), and adverse events were reported. RESULTS At two years, the mean subsidence of the head and tip for the TriFit stem was 0.38 mm (SD 0.32) and 0.52 mm (SD 0.36), respectively. The total migration of the head and tip was 0.55 mm (SD 0.32) and 0.71 mm (SD 0.38), respectively. There were no statistically significant differences between the three to 12 months' migration (p = 0.105) and 12 to 24 months' migration (p = 0.694). The OHS and EQ-5D showed significant improvements at two years. CONCLUSION The results of this study suggest that the TriFit femoral stem achieves initial stability and is likely to be stable in the mid and long term. A long-term outcome study is required to assess late mechanisms of failure and the effects of bone mineral density (BMD) related changes. Cite this article: Bone Joint J 2021;103-B(4):644-649.
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Affiliation(s)
- Joseph Alsousou
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Emeka Oragui
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alexander Martin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Louise Strickland
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Simon Newman
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ben Kendrick
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Adrian Taylor
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Siôn Glyn-Jones
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
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Mid-term results of short versus conventional cementless femoral stems in patients with bilateral osteonecrosis of the femoral head. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:47-53. [PMID: 33710403 DOI: 10.1007/s00590-021-02924-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study aimed to compare the clinical and radiographic mid-term results between short and conventional stems. METHODS Patients with bilateral osteonecrosis of the femoral head (ONFH) who had undergone bilateral staged THAs using short stem in one hip and conventional stem in the contralateral hip were included. The Harris Hip Score (HHS), thigh pain, patient's joint perception (PJP) and patients' preferred hip were recorded. Using x-ray, osseointegration and stress shielding were analyzed and compared between stems. RESULTS There were 35 cases (70 hips) with the mean age of 46.3 years (25-63), and the mean follow-up was 75.1 months (60-108). HHS was significantly improved in both short and conventional groups (p < 0.001). There was mild thigh pain in 2 cases (5.7%) of the short stem group and 6 cases (17.1%) of the conventional group. With regard to the PJP, we found slightly more natural joint feeling in the short stem group. Of the patients' preferred hip, 11 cases (31.4%) preferred short stem hip and 6 cases (17.1%) preferred conventional stem hip. The short stem group showed osseointegration mainly in the proximal part. The conventional stem group showed osseointegration mainly in the distal part. We found stress shielding grade 1 in 31 cases (88.6%) and grade 2 in 3 cases (8.6%) in the conventional stem group, whereas only grade 1 in 34 cases (97.1%) in the short stem group. CONCLUSIONS The clinical results were promising in both short and conventional stems; however, short stem showed less thigh pain, slightly more natural joint feeling (PJP) and more patients' preferred hip. The short stem provided more favorable results for proximal load transfer and slightly less stress shielding.
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Short versus conventional stem in cementless total hip arthroplasty : An evidence-based approach with registry data of mid-term survival. DER ORTHOPADE 2021; 50:296-305. [PMID: 33666673 PMCID: PMC7990843 DOI: 10.1007/s00132-021-04083-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/20/2022]
Abstract
Background Short-stemmed total hip arthroplasty (THA) is well established and gaining popularity in Germany. The perception that short stems may predispose to primary instability in the femur has resulted in a more thorough follow-up of younger patient cohorts than the typical uncemented THA population. To address this issue, an evidence-based approach is presented for a retrospective mid-term survival analysis of a large registry-based cohort in primary cementless THA comparing short stems with a matched group of conventional stems. Material and methods Propensity score matching (PSM, see Infobox 1) was used on 131,580 primary cementless THAs fulfilling the inclusion criteria performed between November 2012 and September 2019 and the cumulative probability of revision (CPR) of short and conventional stems for any reason, for reasons excluding prosthetic joint infection (PJI), and due to PJI were compared. Results After PSM at 1:1 balanced groups of 17,526 short stems and of 17,526 conventional stems were achieved demonstrating no significant difference for CPR for any reason and for reasons excluding PJI. Matched CPR for any reason was 2.9% (95% confidence interval, CI, 2.4–3.5%) 5 years after primary THA in the short stem and 3.1% (95% CI 2.7–3.4%) in the conventional stem group. The CPR excluding PJI was 2.2% (95% CI 1.7–2.7%) vs. 2.1% (95% CI 1.8–2.4%). In contrast, the incidence of PJI was statistically significant lower for short stems. Conclusion For the considered period, there was no statistically significant survival difference in uncemented THA between comparison groups but a lower incidence for PJI in short-stem THA. Further analyses of registry data are required to rule out range of indications and late mechanical failure of short stems.
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Hauer G, Smolle M, Zaussinger S, Friesenbichler J, Leithner A, Maurer-Ertl W. Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design. Sci Rep 2021; 11:4968. [PMID: 33654124 PMCID: PMC7925530 DOI: 10.1038/s41598-021-82805-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 01/25/2021] [Indexed: 11/09/2022] Open
Abstract
Return to work (RTW) has been specifically identified as a high priority in patients undergoing total hip arthroplasty (THA). This investigation sought to assess the effect of the stem design on patients' RTW. Secondly, the study aimed to identify risk factors that lead to a delayed RTW. Questionnaires inquiring about RTW, employment history, educational level, type of work, physical demands and joint awareness were administered by post. Further data were collected from patients' hospital records. 176 patients who underwent THA using a short-stem and 97 patients using a straight-stem design were compared. The median return to work time was 10 weeks [IQR 7-14 weeks], with no significant difference between the two groups (short stems vs. straight stems; 10 [IQR 7-14] vs. 11 [7.5-13.5] weeks; p = 0.693). In the multivariate linear regression analysis, self-employment vs. employee (p = 0.001), dimension of preoperative workload (p = 0.001), preoperative sick leave (p < 0.001), and hospital length of stay (LOS) (p < 0.001) independently affected the period until work was resumed. The Forgotten-Joint-Score-12 showed no significant difference between the two groups. The data show that the majority of THA patients can expect to resume work and stem design has no impact on RTW. Employees with preoperative sick leave, prolonged hospital LOS and low workload are at higher risk for a delayed RTW.
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Affiliation(s)
- Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Maria Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Sabrina Zaussinger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Joerg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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Coutandin M, Afghanyar Y, Drees P, Dargel J, Rehbein P, Kutzner KP. Can hip resurfacing be safely revised with short-stem total hip arthroplasty? A case series of six patients. J Orthop 2021; 24:274-279. [PMID: 33897129 PMCID: PMC8050111 DOI: 10.1016/j.jor.2021.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/21/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The usage of short stems in primary total hip arthroplasty (THA) has constantly gained popularity over the last decade, however, to date, short stems are not eligible to be used as revision implants. The aim of this study was to retrospectively evaluate the outcome of revision surgery of failed hip resurfacing arthroplasty (HRA) using short-stem THA. METHODS In a single center, retrospective analysis, 6 consecutive patients who were treated with a calcar-guided short stem after failure of HRA were evaluated. The mean follow-up was 3.25 years (SD 0.45). Patient reported outcome measurements (PROMs) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The health status was evaluated by the EQ-5D-5L score. Pain and satisfaction were obtained using the visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignement and signs of aseptic loosening. Complications were documented. RESULTS At last follow-up, clinical outcome was excellent (HHS ≥ 90) in 5 patients and good (HHS = 87) in 1 patient. The mean WOMAC score was 5.73% (SD 3.66%). The mean EQ-5D-5L index was 0.914 (SD 0.07). Pain and satisfaction on VAS was 1.83 (SD 5.18) and 8.67 (SD 0.94), respectively. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fracture were obvious. No major complications occurred. To date, no further revision surgery was needed. CONCLUSIONS The outcomes of the present case series propose that HRA can be safely revised using short-stem THA in a selected patient group. Clinical and radiological results are encouraging. Based on the present data, short stems may be considered as a revision implant for failed HRA for experienced surgeons.
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Affiliation(s)
- Marcel Coutandin
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Yama Afghanyar
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jens Dargel
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Garavaglia G, Gonzalez A, Barea C, Peter R, Hoffmeyer P, Lübbeke A, Hannouche D. Short stem total hip arthroplasty with the direct anterior approach demonstrates suboptimal fixation. INTERNATIONAL ORTHOPAEDICS 2021; 45:575-583. [PMID: 33427897 PMCID: PMC7892742 DOI: 10.1007/s00264-020-04910-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/11/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Short stems use has increased substantially despite variable results reported in the literature. The purpose of this study was to report the rate of complications using a short stem implanted through the direct anterior approach (DAA), and to evaluate mid-term clinical and radiological results focusing on femoral stem fixation. METHODS Between April 2009 and November 2014, 698 elective total hip arthroplasties (THAs) were performed using a fully hydroxyapatite-coated short stem (AMIStem-H®). The mean age was 65.7 years (SD 12.6). Patients were invited for clinical and radiological evaluation, and to complete patient-reported outcomes questionnaires at two and five years after surgery. The mean follow-up was 6.2 years (range 2-9.73 years). RESULTS During the study period, 59 (8.5%) patients died and 24 (3.4%) were lost to follow-up. There were six (0.9%) dislocations and 12 (1.7%) fractures, seven occurred intra-operatively. Twenty-nine (4.2%) THAs required revision surgery. Eleven THAs were revised for aseptic loosening of the stem at a mean 4.9 years (1.2-7.3 years). Five years after surgery, radiographs of 324 THAs (324/425 eligible = 76.2%) were available. Stem subsidence ≥ 2 mm was present in 42 cases (12.9%), proximal radiolucencies in 101 hips (31.5%), cortical thickening in 52 (16.0%), and a pedestal in 219 (67.6%). An Engh score between - 10 and 0 was associated with lower HHS pain subscore (p = 0.005), a higher risk of stem revision for aseptic loosening (18.8% vs. 2.7%; p = 0.008), and was more frequent in younger patients with ASA score 1. CONCLUSION Patients presenting radiological alterations at five years had an increased risk of revision for aseptic stem loosening and also inferior clinical results. Our study warrants further continued scrutiny of mid- and long-term survivorship of the AMIStem-H®, with radiological results at five years indicating suboptimal fixation of the stem in younger and active patients.
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Affiliation(s)
- Guido Garavaglia
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland.
| | - Amanda Gonzalez
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Barea
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Peter
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Hoffmeyer
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Lübbeke
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Didier Hannouche
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
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Shoji T, Saka H, Inoue T, Kato Y, Fujiwara Y, Yamasaki T, Yasunaga Y, Adachi N. Three-dimensional analysis of the cortical contact state of short and conventional stems in different stem positions in total hip arthroplasty. Clin Biomech (Bristol, Avon) 2021; 83:105297. [PMID: 33640706 DOI: 10.1016/j.clinbiomech.2021.105297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the increasing use of short cementless stems in total hip arthroplasty, their potential benefits have yet to be confirmed. We evaluated the cortical contact state of short and conventional stems in different femoral canal types and stem positions using a CT-based 3-dimensional templating software. METHODS We reviewed 153 hips in 153 patients, grouped according to femoral canal type-normal (68), champagne-flute (41), and stove-pipe canal (44). We investigated the influence of stem position on the contact state by evaluating three situations of stem anteversion (original anteversion, +5°anteverted, and +5°retroverted), three stem positions, neutral +2°extended, and +2°flexed positions using Taperloc Complete MicroplastyⓇ stem. FINDINGS The contact values of all zones between both stems in all canal types exhibited no significant differences. The values in zones 1, 2, 6, and 7 of both stems in 5° retroverted and anteverted, 2° extended and flexed positions were not significantly different compared to those of the neutral position. However, the values in zones 3, 4, and 5 of both stems were significantly greater compared to those of the neutral position in 2° extended and flexed positions; these values were also significantly larger in all canal types for the conventional stem. INTERPRETATION We demonstrated that the short and conventional stems can achieve the same proximal cortical contact in any femoral canal, regardless of the stem position. However, extended and flexed stem positions increase the distal contact, especially in conventional stems. Furthermore, the distal contact increases for the retroverted stem insertions.
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Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Hideki Saka
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Tadashi Inoue
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuichi Kato
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yusuke Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima 739-0036, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Zhang Z, Xing Q, Li J, Jiang Z, Pan Y, Hu Y, Wang L. A comparison of short-stem prostheses and conventional stem prostheses in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:231. [PMID: 33708858 PMCID: PMC7940904 DOI: 10.21037/atm-20-4043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background In total hip arthroplasty (THA), short-stem prostheses (SS) were designed to achieve better preservation of proximal femoral bone stock and stability than conventional stem prostheses (CS), however these effects are controversial. We aimed perform a systematic review and meta-analysis to evaluate the effectiveness of SS and CS in primary THA. Methods Relevant randomized controlled trials (RCTs) involving the comparison of SS and CS in primary THA were screened using the electronic databases PubMed, Embase and Web of Science. Data were analyzed with the RevMan 5.3 software program and evaluated with mean difference (MD), risk ratio (RR) and 95% confidence intervals (CIs) by random or fixed-effect models. Results Sixteen RCTs involving 1,233 patients (1,486 hips) were included. Compared with CS, the incidence of thigh pain was significantly reduced with Proxima SS (RR 0.13, 95% CI, 0.03–0.51; P=0.004). Bone mineral density (BMD) with femoral neck-preserved SS [SS (I)] showed less decrease in Gruen zone 1 (MD 14.60, 95% CI, 10.67–18.54; P<0.00001) and Gruen zone 7 (MD 9.72, 95% CI, 5.21–14.23; P<0.0001) than CS. However, the changes of BMD were not significantly different between the SS without femoral neck preservation group [SS (II)] and the CS group. In addition, no significant differences were found in the revision rate, Harris Hip Score (HHS), or maximum total point motion (MTPM) between the SS and CS groups. Conclusions The results of this study showed that compared with CS, Proxima SS decreased the incidence of thigh pain and that SS (I) provided better proximal bone remodeling than CS. But the revision rates, HHS, and MTPM between SS and CS were similar. However, the findings of this meta-analysis require further verification in high-quality RCTs.
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Affiliation(s)
- Zhen Zhang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Qiqi Xing
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Jingyi Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Zichao Jiang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yixiao Pan
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yihe Hu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Long Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
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Gómez-Vallejo J, Roces-García J, Moreta J, Donaire-Hoyas D, Gayoso Ó, Marqués-López F, Albareda J. Biomechanical Behavior of an Hydroxyapatite-Coated Traditional Hip Stem and a Short One of Similar Design: Comparative Study Using Finite Element Analysis. Arthroplast Today 2021; 7:167-176. [PMID: 33553545 PMCID: PMC7856394 DOI: 10.1016/j.artd.2020.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background The objective is to compare, by the means of finite elements analysis, the biomechanical behavior of a conventional stem of proven performance with a short stem based on the same fixation principles. Methods A 3D femur was modeled from CT scan data, and real bone density measures were incorporated into it. Load stresses were applied to that bone in 3 different scenarios: without prosthesis, with the conventional stem, and with the short stem. Different bone loading patterns were compared by Gruen’s zones both visually and statistically using Welch’s test. Results The implantation of a stem generates a certain degree of stress shielding in the surrounding bone, but the pattern of the change is very similar in the compared stem models. Although there is statistical significance (P < 0.01) in the mean stress variation in most of the Gruen’s zones, the magnitude of the difference is always under 2 MPa (range: 0.01 – 1.74 MPa). Conclusions The bone loading patterns of the traditional stem and the short stem are very similar. Although there is no evidence of a link between biomechanics and clinical outcomes, our results may suggest that theoretical advantages of short stems can be exploited without the fear of altering bone loading patterns.
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Affiliation(s)
- Jesús Gómez-Vallejo
- Department of Orthopaedic Surgery, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Jorge Roces-García
- Department of Construction and Manufacturing Engineering, University of Oviedo, Oviedo, Spain
| | - Jesús Moreta
- Group of Lower Limb Reconstructive Surgery, Biocruces Bizkaia Health Research Institute, Osakidetza. Department of Orthopaedic Surgery and Traumatology, Hospital Galdakao-Usansolo, Bizkaia, Spain
| | | | - Óscar Gayoso
- Department of Orthopaedic Surgery, Hospital San Rafael, La Coruña, Spain
| | | | - Jorge Albareda
- Department of Orthopaedic Surgery, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Pardo F, Bordini B, Castagnini F, Giardina F, Faldini C, Traina F. Are powder-technology-built stems safe? A midterm follow-up registry study. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:10. [PMID: 33471238 PMCID: PMC7817598 DOI: 10.1007/s10856-020-06481-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Powder technology was developed to bring together the mechanical features and high porosity of titanium. However, the high porosity may theoretically compromise mechanical resistance. Literature is deficient about the use and safety profile of cementless femoral implants built using additive manufacturing (in particular electron beam melting technology, EBM). The purpose of this study was to evaluate the survival rates and the reason for revisions (especially implant breakage) of the first two EBM-built stems at a mid-term follow-up, using a joint arthroplasty registry. METHODS The registry of Prosthetic Orthopedic Implant (RIPO) was investigated about cementless stems implanted from 2010 to 2017. Stems built with EBM technology (Parva and Pulchra stems; Adler Ortho, Milan, Italy) were compared to all the other cementless stems implanted during the same period, acting as control group. The survival rates and reasons for revision were assessed. RESULTS No stem breakage occurred. At 5-year follow-up, the survival rates of the two cohorts were not statistically different (96.8% EBM stems, 98.0% standard cementless stems; p > 0.05). In the EBM stems, aseptic loosening occurred in 1.7% of the cases at the latest follow-up. CONCLUSIONS This large cohort showed that mechanical resistance is not a concern in EBM stems at mid-term follow-up. However, larger populations and longer follow-ups are needed to further validate these results.
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Affiliation(s)
- Francesco Pardo
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
| | - Federico Giardina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
| | - Cesare Faldini
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
- DIBINEM, University of Bologna, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
- DIBINEM, University of Bologna, Bologna, Italy
- University of Messina, Messina, Italy
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Chen Z, Li B, Chen K, Feng J, Wang Y, Liu Z, He C. Malalignment and distal contact of short tapered stems could be associated with postoperative thigh pain in primary total hip arthroplasty. J Orthop Surg Res 2021; 16:67. [PMID: 33468189 PMCID: PMC7816452 DOI: 10.1186/s13018-021-02215-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Short tapered stem placement has been extensively employed in total hip arthroplasty (THA). Suboptimal fixation tends to cause postoperative complications, such as thigh pain. However, it remains unclear whether poor seating/alignment of short tapered stems contributes to thigh pain. In this study, we retrospectively examined the factors that might be associated with thigh pain. METHODS Medical records of 230 patients who had undergone THAs at our hospital were reviewed retrospectively. All patients received the same mediolateral (ML) short tapered femoral stems. The association between thigh pain and patients' demographics, radiographic findings, or the type of fitting of the femoral stems was investigated. RESULTS In our cohort, 68 patients (27.8%) presented with thigh pain. Among 203 type I fit patients, 62 (30.5%) developed thigh pain, while only 6 out of 43 (12.2%) type II fit patients had thigh pain, with the differences being statistically significant (x2 = 6.706, p = 0.01). In addition, hip anteroposterior radiographs exhibited that the stem angulation (mean 2.52°), the variation in angulation (mean 1.32°), and the extent of femoral stem subsidence (mean 0.29 cm) were greater in patients with thigh pain than in their counterparts without thigh pain (all p < 0.05). CONCLUSION Malalignment and improper seating of short tapered stems could be at least one of the reasons for post-THA thigh pain. The distal contact between the stem tip and the medial femoral cortex might result in thigh pain. Our study suggested that distal implant contact should be avoided, and stem alignment should be meticulously performed in the placement of ML short tapered femoral stems for THA.
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Affiliation(s)
- Zhijie Chen
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Bin Li
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Kaizhe Chen
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Jianmin Feng
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Yi Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Zhihong Liu
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Chuan He
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China.
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Hasler J, Flury A, Dimitriou D, Holweg I, Helmy N, Finsterwald M. Mid-term subsidence and periprosthetic radiolucency of the AMIStem: a 5-year EBRA-FCA analysis. J Orthop Surg Res 2021; 16:19. [PMID: 33413463 PMCID: PMC7792117 DOI: 10.1186/s13018-020-02104-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/19/2020] [Indexed: 01/22/2023] Open
Abstract
Background There has been an evolution in cementless total hip arthroplasty (THA) with newer short stem designs aimed to preserve metaphyseal bone stock and facilitate implantation through minimally invasive approaches. While early subsidence has been correlated to aseptic loosening in conventional stems, there is a paucity of data regarding short stems. The current study aims to report on stem subsidence and mid-term clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, specifically designed for the direct anterior approach (DAA). Methods Ninety-four consecutive patients (100 hips) with a minimum follow-up of 5 years following cementless THA were included in this single-center retrospective study. Subsidence was evaluated using the “Ein-Bild-Roentgen-Analyse” (EBRA). Periprosthetic radiolucency allocated to the zones of Charnley and Gruen was assessed. Additionally, demographic and implant-related factors potentially associated with increased subsidence and clinical outcomes were evaluated. Results At the last follow-up, the average stem subsidence was 1.98 ± 1.20 mm, with 48% of the implants demonstrating subsidence of > 2 mm. Periprosthetic radiolucency of > 2 mm was found in 26% of the implants in zone 1 and in 9% in zone 7, respectively. Neither the amount of subsidence nor proximal periprosthetic radiolucency was associated with aseptic loosening or worse clinical outcomes. Conclusions Comparable to other proximally fixed short stem designs, the highest subsidence was observed within the first 3 months following implantation. No demographic or implant-related factors were found to have a statistically significant influence on stem subsidence. Periprosthetic radiolucency and subsidence of the AMISstem is not correlated with worse clinical outcomes at 5-year follow-up.
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Affiliation(s)
- Julian Hasler
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland.
| | - Andreas Flury
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Dimitris Dimitriou
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Iris Holweg
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Naeder Helmy
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Michael Finsterwald
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
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Zhen P, Chang Y, Yue H, Chen H, Zhou S, Liu J, He X. Primary total hip arthroplasty using a short bone-conserving stem in young adult osteoporotic patients with Dorr type C femoral bone. J Orthop Surg Res 2021; 16:17. [PMID: 33413495 PMCID: PMC7789779 DOI: 10.1186/s13018-020-01985-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dorr type C femoral bone exhibits a wide, stovepipe-shaped femoral canal, and thin cortices in the proximal femur. Dorr C bone combined with severe osteoporosis is an important challenge in primary hip arthroplasty. In this study, we assessed the effects of short metaphyseal fitting cementless stems on preformatted primary total hip arthroplasties in young adult osteoporotic patients with this femoral presentation. METHODS A total of 42 hip arthroplasties were performed in 35 young patients (range 20 to 36 years) using a short Tri-lock bone preservation metaphyseal-fitting cementless femoral component between 2012 and 2017. The mean age at surgery of the 27 male (33 hips) and 8 female (9 hips) patients was 27.5 years (range 20.3 to 35.8 years). The mean body mass index (BMI) was 20.2 kg/m2 (range, 16.8-23.2 kg/m2). According to Dorr's criteria, all 42 femora were classified as type C bone and all femurs suffered from severe osteoporosis (Singh index ≤ 3). RESULTS The mean follow-up period was 5.5 years (range 3.0 to 8.0 years). The clinical and functional results improved for the Harris hip score, WOMAC, and UCLA activity scores. The Harris Hip score improved from 48.0 ± 8.0 (range 38.0 to 61.0) preoperatively to 87.0 ± 9.0 (range 77.0 to 92.0) at 12 months after surgery and 91.0 ± 8.0 (range 85.0 to 98.0) at final follow-up. The preoperative UCLA activity score was 3.0 ± 0.5 points (range, 1.0-4.0 points), which significantly improved to 7.5 ± 0.7 points (range 6.0 to 8.0 points) at the final follow-up. No patient exhibited thigh pain at the final follow-up. The mean stem-to-canal fill percentages were 97% ± 2.1% (anteroposterior view at midstem). For stem alignment, 40 hips (95.2%) of the femoral stem were positioned neutrally to 3° of varus with reference to the femoral shaft axis. The remaining two were positioned at 4° varus to 4° valgus. Radiographic evaluation showed good osteointegration of the implants in follow-up. CONCLUSIONS Based on the tapered-wedge design and proximal porous coating, the shortened tapered conventional stem can achieve reliable stability through neck filling and metaphyseal fixation, which does not depend on the isthmus hoop stress. This stem was suitable in severe osteoporotic patients with type C bones in young adults who presented with a correspondingly straightened femoral canal with a wide isthmus and thin cortex.
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Affiliation(s)
- Ping Zhen
- Department of Joint Surgery, Institute of Orthopedics, The 940th Hospital of PLA Joint Logistics Support Force, South Binhe Road, No. 333, Lanzhou City, Gansu Province, 730050, PR China
| | - Yanfeng Chang
- Department of Joint Surgery, Institute of Orthopedics, The 940th Hospital of PLA Joint Logistics Support Force, South Binhe Road, No. 333, Lanzhou City, Gansu Province, 730050, PR China
| | - Heng Yue
- Department of Joint Surgery, Institute of Orthopedics, The Dingxi People's Hospital, Anding Road, Anding District, No. 22, Dingxi City, Gansu Province, 730050, PR China
| | - Hui Chen
- Department of Joint Surgery, Institute of Orthopedics, The 940th Hospital of PLA Joint Logistics Support Force, South Binhe Road, No. 333, Lanzhou City, Gansu Province, 730050, PR China
| | - Shenghu Zhou
- Department of Joint Surgery, Institute of Orthopedics, The 940th Hospital of PLA Joint Logistics Support Force, South Binhe Road, No. 333, Lanzhou City, Gansu Province, 730050, PR China
| | - Jun Liu
- Department of Joint Surgery, Institute of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xiwu Road, No. 157, Xi'an City, Shaanxi Province, 730050, PR China.
| | - Xiaole He
- Department of General Practice, Xijing Hospital of Air Force Military Medical University, Xi' an, 710032, China.
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Slullitel PA, Mahatma MM, Farzi M, Grammatopoulos G, Wilkinson JM, Beaulé PE. Influence of Femoral Component Design on Proximal Femoral Bone Mass After Total Hip Replacement: A Randomized Controlled Trial. J Bone Joint Surg Am 2021; 103:74-83. [PMID: 33079901 DOI: 10.2106/jbjs.20.00351] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In this randomized controlled trial (RCT), we compared bone remodeling and bone turnover between 2 total hip arthroplasty implants-the short, proximally porous-coated Tri-Lock Bone-Preservation Stem and a conventional, fully-coated Corail prosthesis-over a 2-year postoperative period. METHODS Forty-six participants received the Tri-Lock prosthesis and 40 received the Corail prosthesis. At baseline, the 2 groups had similar demographics, proximal femoral bone mineral density (BMD), bone turnover markers, radiographic canal flare index, and patient-reported outcome measure (PROM) scores. Outcomes were measured at weeks 26, 52, and 104. RESULTS Loss of periprosthetic bone, measured by high-sensitivity dual x-ray absorptiometry region-free analysis (DXA-RFA), was identified at the calcar and proximal-lateral aspect of the femur in both prosthesis groups (p < 0.05). However, the conventional prosthesis was associated with a smaller reduction in BMD compared with the bone-preservation prosthesis (p < 0.001). This effect was most prominent in the region of the femoral calcar and greater trochanter. A small gain in BMD was also identified in some areas, and this gain was greater with the conventional than the bone-preservation prosthesis (p < 0.001). The 2 groups had similar changes in bone turnover markers and improvement in PROM scores over the study period (p > 0.05). The adverse-event rate was also similar between the groups (p > 0.05). CONCLUSIONS This RCT shows that prostheses intended to preserve proximal femoral bone do not necessarily perform better in this regard than conventional cementless designs. DXA-RFA is a sensitive tool for detecting spatially complex patterns of periprosthetic bone remodeling. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Pablo A Slullitel
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.,Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Mohit M Mahatma
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Mohsen Farzi
- Centre for Computational Imaging and Simulation Technologies in Bioscience, University of Leeds, Leeds, United Kingdom
| | | | - J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Freitag T, Kutzner KP, Bieger R, Reichel H, Ignatius A, Dürselen L. Biomechanics of a cemented short stem: a comparative in vitro study regarding primary stability and maximum fracture load. Arch Orthop Trauma Surg 2021; 141:1797-1806. [PMID: 33755800 PMCID: PMC8437915 DOI: 10.1007/s00402-021-03843-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE In total hip arthroplasty, uncemented short stems have been used more and more frequently in recent years. Especially for short and curved femoral implants, bone-preserving and soft tissue-sparing properties are postulated. However, indication is limited to sufficient bone quality. At present, there are no curved short stems available which are based on cemented fixation. METHODS In this in vitro study, primary stability and maximum fracture load of a newly developed cemented short-stem implant was evaluated in comparison to an already well-established cemented conventional straight stem using six pairs of human cadaver femurs with minor bone quality. Primary stability, including reversible micromotion and irreversible migration, was assessed in a dynamic material-testing machine. Furthermore, a subsequent load-to-failure test revealed the periprosthetic fracture characteristics. RESULTS Reversible and irreversible micromotions showed no statistical difference between the two investigated stems. All short stems fractured under maximum load according to Vancouver type B3, whereas 4 out of 6 conventional stems suffered a periprosthetic fracture according to Vancouver type C. Mean fracture load of the short stems was 3062 N versus 3160 N for the conventional stems (p = 0.84). CONCLUSION Primary stability of the cemented short stem was not negatively influenced compared to the cemented conventional stem and no significant difference in fracture load was observed. However, a clear difference in the fracture pattern has been identified.
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Affiliation(s)
- Tobias Freitag
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Ralf Bieger
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Medical Centre, Helmholtzstr. 14, 89081, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Medical Centre, Helmholtzstr. 14, 89081, Ulm, Germany
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Buttaro MA, Slullitel PA, Oñativia JI, Nally F, Andreoli M, Salcedo R, Comba FM, Piccaluga F. 4- to 8-year complication analysis of 2 'partial collum' femoral stems in primary THA. Hip Int 2021; 31:75-82. [PMID: 31558044 DOI: 10.1177/1120700019879360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Compare the clinical and radiological outcome of CFP stem with the MiniHip design in a prospective series, with special interest in intraoperative periprosthetic fracture (IPPF). METHODS We prospectively followed 101 cases treated with the MiniHip stem (Group 1) and 89 with the CFP stem (Group 2) operated between 2010 and 2014. No significant demographic differences were observed between both groups. Median follow-up was 72 months. Average stem length was 41% shorter in the MiniHip group (p < 0.001). Radiological parameters were measured and a logistcic regression model was created to evaluate factors associated with IPPF. RESULTS Mean mHHS improved from 54 to 95 in the MiniHip group (p < 0.001) and from 64 to 98 in the CFP group (p < 0.001). No significant differences were observed in terms of loosening, infection or instability. We observed 7 IPPFs (3.68%), 3 in group 1 and 4 in group 2. After adjusting for confounders, CFP was not associated with a greater risk of IPPF (OR 3.23; 95% CI, 0.250-42.034, p = 0.368), however, a more complex fracture pattern was observed with this stem design. Prior acetabular fractures were associated with IPPF (OR 66.85; 95% CI, 1.142-3911, p = 0.043). Compared to Dorr A femurs, type Dorr B appeared protective against IPPF (OR 0.039; 95% CI, 0.001-1.109, p = 0.058). Valgus alignment tended to increase the risk of IPPF (OR 20.59; 95% CI 0.870-487.221, p = 0.061). CONCLUSIONS MiniHip showed similar radiological outcomes to CFP at short- to mid-term follow-up without increasing IPPFs with a shorter stem length. Given that CFP produced a more complex IPPF pattern, surgeons should be cautious with alignment of this particular design, especially in Dorr A femur.
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Affiliation(s)
- Martin A Buttaro
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Pablo A Slullitel
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - José I Oñativia
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Nally
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Mauro Andreoli
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Salcedo
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Fernando M Comba
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Piccaluga
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Malahias MA, Tejaswi P, Chytas D, Kadu V, Karanikas D, Thorey F. The clinical outcome of the Metha short hip stem: a systematic scoping review. Hip Int 2021; 31:24-33. [PMID: 32019377 DOI: 10.1177/1120700020903719] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Short femoral stems were designed to bridge the gap between conventional straight design stems and hip resurfacing prostheses in total hip arthroplasty (THA). A number of clinical trials have been recently conducted to assess the clinical and safety profile of the cementless, colarless, tapered Metha short hip stem in young or active middle-aged individuals. METHODS A systematic scoping review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. 4 reviewers independently conducted the search using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms "short" AND "hip" AND "stem". RESULTS From the initial 773 studies we finally chose 12 studies after applying our inclusion-exclusion criteria. The number of operated hips that were included in these studies was 5048 (mean BMI range: 22.7-35.2, mean age range: 44.4-60.4 years, mean follow-up range: 2-9 years). The mean modified Coleman methodology score was 52.3/100, while it ranged from 31/100 to 63/100. All mean clinical outcome scores that were used in the studies illustrated significant postoperative improvement when compared with the respective initial values. The revision rate of the Metha stem for component-related reasons was 2.5%, while the rate of major complications not requiring revision of the Metha stem was 2.8%. CONCLUSIONS The Metha stem performs well in young or active middle-aged THA patients. Further studies are required for the assessment of the long-term results.
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Affiliation(s)
- Michael-Alexander Malahias
- International Centre for Hip, Knee and Foot Surgery, Sports Traumatology, ATOS Hospital, Heidelberg, Germany.,2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Purnachandra Tejaswi
- International Centre for Hip, Knee and Foot Surgery, Sports Traumatology, ATOS Hospital, Heidelberg, Germany
| | - Dimitrios Chytas
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vikram Kadu
- Department of Orthopaedic, ACPM Medical College, Maharashtra, India
| | - Dimitrios Karanikas
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fritz Thorey
- International Centre for Hip, Knee and Foot Surgery, Sports Traumatology, ATOS Hospital, Heidelberg, Germany
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Mid-term results of 119 Taperloc Microplasty™ femoral stems after a mean 61 months (50-82) of follow-up. Orthop Traumatol Surg Res 2020; 106:1501-1506. [PMID: 33268300 DOI: 10.1016/j.otsr.2020.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Short stems are not all the same and do not meet the same objectives in terms of shape, fixation and biomechanics. The Taperloc Microplasty™ is a shortened stem. In France, no articles have been published on this subject and very few articles are available in the international literature. We therefore decided to analyse results for this stem after a mean follow-up of 61 months, asking the following questions: (1) Is the survival of the Taperloc Microplasty™ at least equivalent to the best conventional cementless prostheses on the market, i.e. with a 10-year revision rate of less than 5% according to NICE criteria? (2) Have the expected benefits of short stems been confirmed? HYPOTHESIS The Taperloc Microplasty™ prosthesis meets the NICE criteria with a revision rate of less than 5% at 10 years. MATERIALS AND METHODS This is a retrospective single-surgeon study of 119 prostheses implanted between April 2013 and December 2015. The inclusion criteria were hip arthrosis or avascular necrosis of the femoral head in patients under the age of 70 regardless of height or weight, excluding Dorr type C femurs. The series consisted of 108 patients (11 bilateral total hip arthroplasties (THA)) with a mean age of 58.8±10 years [17-70]; 81 were men and 38 were women. RESULTS The results were assessed in 110 hips (103 patients since 9 hips (7 patients) were lost to follow-up) at a mean follow-up of 61±8 months [50-82]. At follow-up the Postel-Merle d'Aubigné (PMA) score was 17.8±0.8 [12-18] and the Oxford score 13.1±3.5 [12-41] (p<0.05 versus pre operative). On X-rays, we identified 9 pedestal signs (7.5%) below the distal end of the stem, 6 calcar atrophies (5%), but no cortical hypertrophy greater than 2 mm, no stem subsidence greater than 5mm, and no radiolucent line indicating the absence of integration. The survivorship at 61 months was 100% (95% CI: 0.905; 1.095), taking femoral revision as the end-point and 98.2% (95% CI: 0.887; 1.077) considering revision for any reason. CONCLUSION The Taperloc Microplasty™ stem is equivalent to the best conventional cementless prostheses on the market in selected surgical indications after a mean follow-up of 61 months. The follow-up is still not sufficient to confirm all the benefits expected from this type of implant. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Hirao M, Miyatake K, Koga D, Takada R, Koyano G, Okawa A, Jinno T. Comparison of 5-year postoperative results between standard-length stems and short stems in one-stage bilateral total hip arthroplasty: a randomized controlled trial. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:743-753. [PMID: 33169175 DOI: 10.1007/s00590-020-02828-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 10/30/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Short stems have recently become popular in total hip arthroplasty. Previous studies aimed at elucidating the efficacy of short stems did not eliminate the influence of other factors aside from stem length. This study aimed to evaluate the usefulness of short stems compared with that of standard-length stems that have the same proximal morphology, surface coating, and material. METHODS This was a prospective randomized study comparing 5-year midterm outcomes in 29 patients who underwent one-stage bilateral total hip arthroplasty with short and standard-length stems inserted in each of the two femurs. Clinical, radiographical, and dual-energy X-ray absorptiometry outcomes were compared. RESULTS No significant differences were found in perioperative and radiographic characteristics (femoral neck anteversion, flare index, operation sequence, operation side, operation time, stem anteversion, and stem alignment). The number of joints with complications, appearance of radiopaque lines around the stems, or bone mineral density changed in stem regions 5 years postoperatively. However, greater micromotion of the stem was seen on the side of the short stem. Satisfactory improvement in hip function was seen on both sides. CONCLUSION Based on the 5-year midterm outcomes, both stems obtained satisfactory clinical outcomes despite the greater micromotion with short stems. Both stems attained bone ingrowth fixation. Moreover, the stems were not significantly different in terms of stress shielding; however, further long-term studies (> 5 years) are required to validate our findings related to stress shielding.
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Affiliation(s)
- Masanobu Hirao
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kazumasa Miyatake
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Daisuke Koga
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Ryohei Takada
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Gaku Koyano
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
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Kutzner KP, Ried E, Donner S, Bieger R, Pfeil J, Freitag T. Mid-term migration pattern of a calcar-guided short stem: A five-year EBRA-FCA-study. J Orthop Sci 2020; 25:1015-1020. [PMID: 32057589 DOI: 10.1016/j.jos.2020.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/15/2019] [Accepted: 01/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Short-term results of several short-stem designs have indicated early axial migration. Mid- and long-term results for most designs are lacking. The objective of this study was to evaluate the mid-term migration pattern of a calcar-guided short stem five years postoperative. METHODS Implant migration of 191 calcar-guided short stems was assessed by Ein-Bild-Roentgen-Analysis Femoral-Component- Analysis (EBRA-FCA) 5 years after surgery. Migration pattern of the whole group was analyzed and compared to the migration pattern of implants potentially being "at hazard" with a subsidence of more than 1.5 mm at 2 years postoperatively. Influence of preoperative Dorr types (A vs. B vs. C), age (<70 vs. >70 years), gender (female vs. male), weight (<90 kg vs. >90 kg), BMI (<30 vs. >30) and uni-vs. bilateral procedures on mid-term migration pattern was analyzed. Additionally outcome of varus- and valgus stem alignment was assessed. RESULTS Mean axial subsidence was 1.5 mm (SD 1.48 mm) at final follow-up. Two years after surgery 73 short stems were classified "at hazard". Of these stems, 69 cases showed secondary stabilisation in the following period, whereas 4 cases presented unstable with more than 1 mm of further subsidence. Stem revision was not required neither in the group of implants with early stabilisation nor the group with pronounced early onset migration. Male gender and heavy-weight patients had a significant higher risk for axial migration, as well as extensive valgus stem alignment, whereas for Dorr type B, compared to A, no statistical difference could be observed. CONCLUSIONS In most cases, even in the group of stems being "at hazard", settling could be documented. While different Dorr types did not show a statistically significant impact on axial migration, particularly in male and heavy-weight patients the risk of continuous subsidence is increased. In those 4 cases with further migration, undersizing of the stem could be recognized. At present, clinical consequences are still uncertain.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20. 65189 Wiesbaden, Germany.
| | - Emanuel Ried
- Division of Trauma Surgery, University Hospital Zürich (USZ), University of Zürich, Rämistr. 100. 8091 Zürich, Switzerland.
| | - Stefanie Donner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20. 65189 Wiesbaden, Germany.
| | - Ralf Bieger
- Department of Orthopaedic Surgery, University of Ulm (RKU), Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Joachim Pfeil
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20. 65189 Wiesbaden, Germany.
| | - Tobias Freitag
- Department of Orthopaedic Surgery, University of Ulm (RKU), Oberer Eselsberg 45, 89081, Ulm, Germany.
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Yan SG, Chevalier Y, Liu F, Hua X, Schreiner A, Jansson V, Schmidutz F. Metaphyseal anchoring short stem hip arthroplasty provides a more physiological load transfer: a comparative finite element analysis study. J Orthop Surg Res 2020; 15:498. [PMID: 33121506 PMCID: PMC7597026 DOI: 10.1186/s13018-020-02027-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/20/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Short stem total hip arthroplasty (SHA) preserves femoral bone stock and is supposed to provide a more natural load transfer compared to standard stem total hip arthroplasty (THA). As comparative biomechanical reference data are rare we used a finite element analysis (FEA) approach to compare cortical load transfer after implantations of a metaphyseal anchoring short and standard stem in native biomechanical femora. METHODS The subject specific finite element models of biomechanical femora, one native and two with implanted metaphyseal anchoring SHA (Metha, B. Braun Aesculap) and standard THA (CLS, Zimmer-Biomet), were generated from computed tomography datasets. The loading configuration was performed with an axial force of 1400 N. Von Mises stress was used to investigate the change of cortical stress distribution. RESULTS Compared to the native femur, a considerable reduction of cortical stress was recorded after implantation of SHA and standard THA. The SHA showed less reduction proximally with a significant higher metaphyseal cortical stress compared to standard THA. Moreover, the highest peak stresses were observed metaphyseal for the SHA stem while for the standard THA high stress pattern was observed more distally. CONCLUSIONS Both, short and standard THA, cause unloading of the proximal femur. However, the metaphyseal anchoring SHA features a clearly favorable pattern in terms of a lower reduction proximally and improved metaphyseal loading, while standard THA shows a higher proximal unloading and more distal load transfer. These load patterns implicate a reduced stress shielding proximally for metaphyseal anchoring SHA stems and might be able to translate in a better bone preservation.
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Affiliation(s)
- Shuang G Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, No.1 Baicao Road, Hefei, 230088, China.
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany.
| | - Yan Chevalier
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany
| | - Fanxiao Liu
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Xingyi Hua
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, No.1 Baicao Road, Hefei, 230088, China
| | - Anna Schreiner
- BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany
| | - Florian Schmidutz
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany
- BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
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Loppini M, Della Rocca A, Ferrentino D, Pizzi C, Grappiolo G. Blood loss in primary total hip arthroplasty with a short versus conventional cementless stem: a retrospective cohort study. Arch Orthop Trauma Surg 2020; 140:1551-1558. [PMID: 32743702 DOI: 10.1007/s00402-020-03561-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/24/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION To evaluate the impact of short cementless stem on several clinical and radiographic outcomes, with particular focus on blood loss, in comparison with conventional cementless stem in total hip arthroplasty (THA). MATERIALS AND METHODS Patients undergoing THA with GTS short stem or CLS conventional stem were included. Clinical data were retrospectively collected including preoperative and postoperative day 1 value for haemoglobin (HB); rate of postoperative blood transfusions; intraoperative bone infractions; stem alignment; 5-year follow-up Harris Hip Score (HHS) and rate of stem revision at 5 years of follow-up of the short and conventional cementless stem. RESULTS GTS and CLS stem group included 374 and 321 patients, respectively. The mean difference between the preoperative and postoperative day 1 HB value was 3.98 g/dL (SD 1.12) and 3.67 g/dL (SD 1.19) in the GTS and CLS group, respectively, which correspond to a crude effect (β) of 0.32 (95% CI 0.15; 0.49) and adjusted effect of 0.11 (95% CI - 0.08; 0.3). GTS group reported a significantly higher number of patients with excellent results in terms of HHS (p = 0.001). The rate of intraoperative bone infractions was 1.6% and 0.3% in the GTS and CLS group, respectively (p = 0.013). At radiographic assessment, the rate of varus position of the stem was 14% in the GTS group and 6% in the CLS group (p < 0.0001). The rate of stem revision at 5 years of follow-up was 0.8% and 0.4% in the GTS and CLS group, respectively (p = 0.63). CONCLUSIONS GTS short stem was not associated with a clinically significant lower blood loss in the immediately postoperative period. Unadjusted exploratory analyses show that GTS stem provides the same results of CLS stem in terms of HHS and rate of stem revision at 5 years of follow-up.
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
- Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Antonello Della Rocca
- Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Davide Ferrentino
- Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Costanza Pizzi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Guido Grappiolo
- Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
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80
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Kheir MM, Drayer NJ, Chen AF. An Update on Cementless Femoral Fixation in Total Hip Arthroplasty. J Bone Joint Surg Am 2020; 102:1646-1661. [PMID: 32740265 DOI: 10.2106/jbjs.19.01397] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael M Kheir
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nicholas J Drayer
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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81
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Mid-term results of short-stem total hip arthroplasty in patients with Crowe type I and II developmental dysplasia of the hip. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:319-325. [PMID: 32875473 DOI: 10.1007/s00590-020-02777-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study aimed to evaluate the clinical and radiographic mid-term results of short-stem THA in patients with DDH. METHODS We reviewed 32 cases that underwent Metha stem between November 2010 and February 2015. WOMAC scores, Oxford Hip Scores (OHS) and Harris Hip Scores (HHS) were recorded to evaluate the clinical results. The appearance of bone trabeculae development and stress shielding was analyzed. RESULTS The mean age of patients was 50.3 years (33-67) with the mean follow-up of 77 months (60-106). According to Crowe classification, 13 cases were graded as Crowe I and 19 cases as Crowe II. According to Dorr classification, 17 cases were graded as Dorr A and 15 cases as Dorr B. The postoperative WOMAC scores decreased, and OHS and HHS increased significantly compared with preoperative (p < 0.001). The caput-column-diaphysis angles decreased significantly (p < 0.001) and limb length discrepancy decreased significantly (p = 0.013) after surgery. The radiographic change around the stem showed bone trabeculae development at zones 1 (93.9%), 2 (93.9%), 3 (25%), 5 (6.3%), 6 (96.9%) and 7 (90.6%). There was grade 1 stress shielding in 30 cases (93.9%). There was no stem subsidence greater than 2 mm in all hips, no sciatic nerve injury or no dislocation. Neither acetabulum nor femoral stem was defined as definite loosening, and none of the implants was revised. CONCLUSIONS The short stem showed promising mid-term clinical results in patients with DDH. The radiographic results demonstrated that the short stem provided physiological proximal load transfer with less stress shielding, being a useful alternative for femoral reconstruction.
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82
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Customised proximal femoral nail in treatment of intertrochanteric fracture with ipsilateral femoral shaft malunion: A case report. Trauma Case Rep 2020; 29:100348. [PMID: 32793796 PMCID: PMC7414000 DOI: 10.1016/j.tcr.2020.100348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/22/2022] Open
Abstract
Peritrochanteric fractures are the most common fragility fractures for which patient are admitted in hospital and often require surgical interventions. With increasing life expectancy and early age of presentation, revision surgeries are increasing due to re-trauma, implant failure, infections etc. Here we present the case of a 65 years female, with inter trochanteric fracture femur right side with ipsilateral malunited proximal femur fracture, which was managed with customised proximal femoral nail. This case exemplifies the need for novel techniques and implants in our armamentarium to deal with such unusual fractures in elderly population.
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83
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Abstract
AIMS Short, bone-conserving femoral components are increasingly used in total hip arthroplasty (THA). They are expected to allow tissue-conserving implantation and to render future revision surgery more straightforward but the long-term data on such components is limited. One such component is the global tissue-sparing (GTS) stem. Following the model for stepwise introduction of new orthopaedic implants, we evaluated early implant fixation and clinical outcome of this novel short-stem THA and compared it to that of a component with established good long-term clinical outcome. METHODS In total, 50 consecutive patients ≤ 70 years old with end-stage symptomatic osteo-arthritis were randomized to receive THA with the GTS stem or the conventional Taperloc stem using the anterior supine intermuscular approach by two experienced hip surgeons in two hospitals in the Netherlands. Primary outcome was implant migration. Patients were followed using routine clinical examination, patient reported outcome using Harris Hip Score (HHS), Hip Disability And Osteoarthritis Outcome Score (HOOS), EuroQol five-dimension questionnaire (EQ5D), and Roentgen Stereophotogrammetric Analysis (RSA) at three, six, 12, and 24 months. This study evaluated the two-year follow-up results. RESULTS In addition to the initial migration pattern of distal migration (subsidence, Y-translation) and retroversion (Y-rotation) also exhibited by the Taperloc stem, the GTS stem showed an initial migration pattern of varization (X-translation combined with Z-rotation) and posterior translation (Z-translation). However, all components stabilized aside from one Taperloc stem which became loose secondary to malposition and was later revised. Clinical outcomes and complications were not statistically significantly different with the numbers available. CONCLUSION A substantially different and more extensive initial migration pattern was seen for the GTS stem compared to the Taperloc stem. Although implant stabilization was achieved, excellent long-term survival similar to that of the Taperloc stem should not be inferred. Especially in the absence of clinically proven relevant improvement, widespread usage should be postponed until long-term safety has been established. Cite this article: Bone Joint J 2020;102-B(6):699-708.
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Affiliation(s)
- Marc J Nieuwenhuijse
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Stephan B W Vehmeijer
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Nina M C Mathijsen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Stefan B Keizer
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
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84
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Melnic CM, Aurigemma P, Lee JA, Dwyer M, Bedair HS. Catastrophic Failure of a MiniHip Femoral Stem: A Case Report. JBJS Case Connect 2020; 10:e0270. [PMID: 32044777 DOI: 10.2106/jbjs.cc.19.00270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE The patient is a 63-year-old man who previously underwent a right total hip arthroplasty with the Corin MiniHip femoral stem. Within the first few months postoperatively, he had a fall that resulted in subsidence of his femoral prosthesis and subsequent revision shortly thereafter with a 10-mm skirted cobalt chrome femoral head. Eight years after the index procedure, the patient heard a crack and then collapsed while putting on bicycle shorts. Workup demonstrated a fracture of the stem at the base of the neck of the implant. Femoral stem revision with a diaphyseal engaging, modular implant, and dual mobility hip construct was performed. CONCLUSION Atraumatic catastrophic failure of the femoral stem implant may be associated with long skirted femoral heads that create excessive bending moments on the stem and revision surgery.
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Affiliation(s)
- Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital/Newton Wellesley Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philip Aurigemma
- Department of Orthopaedic Surgery, Newton Wellesley Hospital, Newton, Massachusetts
| | - Jo Ann Lee
- Department of Orthopaedic Surgery, Newton Wellesley Hospital, Newton, Massachusetts
| | - Maureen Dwyer
- Department of Orthopaedic Surgery, Newton Wellesley Hospital, Newton, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital/Newton Wellesley Hospital, Harvard Medical School, Boston, Massachusetts
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85
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Christiansen JD, Ejaz A, Nielsen PT, Laursen M. An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction. J Bone Joint Surg Am 2020; 102:128-136. [PMID: 31596796 DOI: 10.2106/jbjs.19.00104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) with a diaphyseal stem may risk bone loss. In order to save proximal bone stock in young patients with a high activity level and a long life expectancy, the interest in short stems has evolved. The purpose of this prospective observational cohort study was to evaluate the fixation of, and bone remodeling around, the Primoris femoral neck-preserving hip implant. METHODS Fifty younger patients with end-stage osteoarthritis were managed with the Primoris hip implant. We evaluated bone mineral density (BMD) using dual x-ray absorptiometry (DXA) and implant migration using radiostereometric analysis (RSA). A region-of-interest (ROI) protocol for 4 ROIs was applied to assess BMD. The association between BMD and migration was evaluated to determine the fixation of the Primoris implant and bone remodeling in the proximal part of the femur. Follow-up evaluation was performed at regular intervals from day 1 (baseline) until 24 months after surgery. RESULTS The major stem migrations were subsidence (Y axis; mean, 0.38 mm) at 6 weeks and varus tilt (rotation) (Z axis; mean, 0.93°) at 6 to 12 months. In ROI4 (the calcar area), a significant gain in bone was found with a mean difference of 4.1% (95% confidence interval [CI], 0.8% to 7.4%; p < 0.02) at 24 months postoperatively. Significant bone loss was found in ROI1 and ROI2, with a mean difference of -4.9% (95% CI, -7.4% to -2.4%; p = 0.0003) and -8.9% (95% CI, -11.5% to -6.2%; p = 0.0001), respectively. Linear regression and multivariate regression analysis showed a significant negative association between maximal total point motion and BMD (p = 0.02, R = 15%; and p < 0.05, R = 26%, respectively). CONCLUSIONS The Primoris component showed satisfactory primary stability with promising results at the 24-month follow-up. DXA scans showed limited stress-shielding with the proximal loading pattern of the Primoris. Better bone quality was associated with less implant migration. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Janus D Christiansen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ashir Ejaz
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul T Nielsen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark
| | - Mogens Laursen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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86
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Primary stability of calcar-guided short-stem total hip arthroplasty in the treatment of osteonecrosis of the femoral head: migration analysis using EBRA-FCA. Arch Orthop Trauma Surg 2020; 140:2091-2100. [PMID: 33011847 PMCID: PMC7674354 DOI: 10.1007/s00402-020-03610-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Osteonecrosis of the femoral head (ONFH) is a disabling condition that often results in secondary arthritis necessitating total hip arthroplasty (THA). Short-stem THA has constantly gained popularity. It remains controversial, whether ONFH represents a risk factor for failure after the implantation of short stems with pronounced metaphyseal anchorage. The potential spread of the osteonecrotic area and bone marrow edema into the metaphyseal bone might result in compromised stability. Early implant migration is considered predictive of subsequent aseptic loosening. The purpose of this study was a migration analysis of a modern, calcar-guided short-stem implant in patients with ONFH in a mid-term follow-up. MATERIALS AND METHODS This retrospective analysis investigated the migration pattern of 45 calcar-guided short stems in patients with ONFH, using Einzel-Bild-Roentgen-Analyse Femoral-Component-Analysis (EBRA-FCA). Influencing factors such as ARCO categories, age, gender, body weight and BMI were analyzed. Complications and adverse events were documented. RESULTS At mid-term [48.1 months (SD 20.7 months)], mean axial migration was 1.56 mm (SD 1.77 mm). Mean migration rate stabilized after 2 years. No influence of ARCO categories, age and BMI was found. A tendency of increased axial migration was observed in male patients and in overweight patients. No revision surgeries had to be performed during follow-up. CONCLUSION The results indicate a migration pattern comparable to that of primary osteoarthritis patients with slight initial migration under full load followed by subsequent stabilization in the metaphyseal femur. The 100% survival rate at mid-term supports the usage of this short-stem design in patients with ONFH.
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87
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Klug A, Gramlich Y, Hoffmann R, Pfeil J, Drees P, Kutzner KP. Trends in Total Hip Arthroplasty in Germany from 2007 to 2016: What Has Changed and Where Are We Now? ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 159:173-180. [PMID: 31711254 DOI: 10.1055/a-1028-7822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The number of total hip arthroplasties (THA) is rising in many industrialized nations. At the same time, the evidence regarding different types of prostheses and fixation techniques is constantly evolving. Therefore, this study aimed to analyze changes in THA by these advancements during the last decade. METHODS A retrospective analysis of data provided by the Federal Statistical Office of Germany from 2007 to 2016 was conducted using codes from the German procedure classification system and associated International Statistical Classification of Diseases and Related Health Problems codes. THA procedures were evaluated according to diagnoses, sex, and age of patients, along with the distribution of different prosthesis types. Additionally, changes in these parameters over time were analyzed. RESULTS From 2007 to 2016 a total of 2 157 041 primary THA procedures were performed in Germany, with an increase of 14.4% over this period. Overall, cementless standard THA (STHA) was used most frequently (50.0%), followed by hybrid variants (18.8%), hemiarthroplasties (15.9%), cemented standard THA (cSTHA; 9.2%), cementless short-stem THA (ssTHA; 4.8%), and hip resurfacing (HR; 0.9%) techniques. During the study period, the number of cSTHA and HR decreased significantly, whereas the use of STHA and ssTHA rose substantially, with a significantly higher application of these procedures in the elderly population. While osteoarthritis of the hip joint was the main indication for THA, several procedure-specific differences were identified. CONCLUSION The present data clearly demonstrate an increase in the use of cementless fixation for THA in Germany during the last decade and document a rise in ssTHA in recent years with, in contrast, the use of HR decreasing to a minimum.
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Affiliation(s)
- Alexander Klug
- Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main
| | - Yves Gramlich
- Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main
| | - Reinhard Hoffmann
- Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main
| | - Joachim Pfeil
- Klinik für Orthopädie und Unfallchirurgie, St. Josefs Hospital Wiesbaden
| | - Philipp Drees
- Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin Mainz
| | - Karl Philipp Kutzner
- Klinik für Orthopädie und Unfallchirurgie, St. Josefs Hospital Wiesbaden.,Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin Mainz
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88
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Klasan A, Bäumlein M, Dworschak P, Bliemel C, Neri T, Schofer MD, Heyse TJ. Short stems have lower load at failure than double-wedged stems in a cadaveric cementless fracture model. Bone Joint Res 2019; 8:472-480. [PMID: 31728187 PMCID: PMC6825045 DOI: 10.1302/2046-3758.810.bjr-2019-0051.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objectives Periprosthetic femoral fractures (PFFs) have a higher incidence with cementless stems. The highest incidence among various cementless stem types was observed with double-wedged stems. Short stems have been introduced as a bone-preserving alternative with a higher incidence of PFF in some studies. The purpose of this study was a direct load-to-failure comparison of a double-wedged cementless stem and a short cementless stem in a cadaveric fracture model. Methods Eight hips from four human cadaveric specimens (age mean 76 years (60 to 89)) and eight fourth-generation composite femurs were used. None of the cadaveric specimens had compromised quality (mean T value 0.4 (-1.0 to 5.7)). Each specimen from a pair randomly received either a double-wedged stem or a short stem. A materials testing machine was used for lateral load-to-failure test of up to a maximal load of 5000 N. Results Mean load at failure of the double-wedged stem was 2540 N (1845 to 2995) and 1867 N (1135 to 2345) for the short stem (p < 0.001). All specimens showed the same fracture pattern, consistent with a Vancouver B2 fracture. The double-wedged stem was able to sustain a higher load than its short-stemmed counterpart in all cases. Failure force was not correlated to the bone mineral density (p = 0.718). Conclusion Short stems have a significantly lower primary load at failure compared with double-wedged stems in both cadaveric and composite specimens. Surgeons should consider this biomechanical property when deciding on the use of short femoral stem. Cite this article: A. Klasan, M. Bäumlein, P. Dworschak, C. Bliemel, T. Neri, M. D. Schofer, T. J. Heyse. Short stems have lower load at failure than double-wedged stems in a cadaveric cementless fracture model. Bone Joint Res 2019;8:489–494. DOI: 10.1302/2046-3758.810.BJR-2019-0051.R1.
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Affiliation(s)
- Antonio Klasan
- Center for Orthopedics and Traumatology, University Hospital Marburg, Marburg, Germany; Sydney Orthopaedic Research Institute, Australia
| | - Martin Bäumlein
- Center for Orthopedics and Traumatology, University Hospital Marburg, Marburg, Germany
| | - Philipp Dworschak
- Center for Orthopedics and Traumatology, University Hospital Marburg, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopedics and Traumatology, University Hospital Marburg, Marburg, Germany
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital St Etienne, Saint-Étienne, France
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Kutzner KP, Donner S, Loweg L, Rehbein P, Dargel J, Drees P, Pfeil J. Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases. J Orthop Traumatol 2019; 20:31. [PMID: 31673809 PMCID: PMC6823459 DOI: 10.1186/s10195-019-0537-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In recent years, a variety of short stems have been introduced. To date, mid- and long-term results of calcar-guided short-stem designs have been rarely available. MATERIALS AND METHODS Two hundred and sixteen calcar-guided short stems were included in combination with a cementless cup in a prospective study. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfaction on visual analogue scale (VAS) were assessed during a median follow-up of 61.7 months. Standardised radiographs were analysed at predefined time points regarding radiological alterations such as bone resorption and remodelling, radiolucency, osteolysis and cortical hypertrophy using modified Gruen zones. RESULTS At mid-term follow-up, no revision surgery of the stem had to be performed in the whole collective. At 5 years, HHS was 97.8 (SD 4.7), satisfaction on VAS was 9.7 (SD 0.7), rest pain on VAS was 0.1 (SD 0.5), and load pain on VAS was 0.6 (SD 1.2). Compared to the 2-year results, femoral bone resorption increased significantly at the 5-year follow-up (3.9% versus 42.3%). Rate of femoral cortical hypertrophy remained stable, occurring in a total of 9 hips (4.5%). At the 5-year follow-up, 2 stems (1.0%) showed non-progressive radiolucent lines with a maximum width of 2 mm. Signs of osteolysis were not observed. Compared to the 2-year follow-up, no further subsidence was observed. CONCLUSIONS The rate of stem revision (0%) at the mid-term follow-up was remarkable and indicates the principle of using a calcar-guided short stem as being a safe procedure. However, signs of bone-remodelling, indicating some amount of stress-shielding, must be acknowledged at 5 years depending on stem alignment and type of anchorage. LEVEL OF EVIDENCE IV, Prospective observational study Trial registration German Clinical Trials Register, DRKS00012634, 07/07/2017 (retrospectively registered).
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany. .,Department for Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Stefanie Donner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Lennard Loweg
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Jens Dargel
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department for Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Joachim Pfeil
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
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90
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Donner S, Rehbein P, Schneider M, Pfeil J, Drees P, Kutzner KP. Return to Sports and Recreational Activity After Single-Stage Bilateral Short-Stem Total Hip Arthroplasty: 5-Year Results of a Prospective Observational Study. Orthop J Sports Med 2019; 7:2325967119872746. [PMID: 31632996 PMCID: PMC6767735 DOI: 10.1177/2325967119872746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Single-stage bilateral total hip arthroplasty (THA) is an alternative to
staged unilateral THA in patients suffering from bilateral hip arthritis;
however, there is still broad concern regarding the safety and reliability
of this procedure. Short-stem THA has emerged in recent years. To date, no
data are available on sports and recreational activity levels after
single-stage bilateral short-stem THA in the general patient population. Hypothesis: Patients who have undergone single-stage bilateral short-stem THA return to a
satisfying level of sports and recreational activity at midterm
follow-up. Study Design: Case series; Level of evidence, 4. Methods: A total of 54 consecutive patients (108 hips) were prospectively included.
Midterm follow-up was performed in 51 patients (94.4%). The Western Ontario
and McMaster Universities Osteoarthritis Index (WOMAC) score and the Harris
Hip Score (HHS) were assessed clinically after a mean of 5.2 years. After a
mean of 4.9 years, activity levels were assessed using the University of
California, Los Angeles (UCLA) activity scale via a questionnaire.
Additionally, a detailed evaluation of sports behavior was conducted using
an additional questionnaire. Pain and satisfaction with sporting ability
were assessed using a visual analog scale (VAS). Complications and revisions
were documented. Results: Patients had a mean WOMAC score of 98.0 (range, 60.0-100.0) and HHS score of
97.8 (range, 65.0-100.0) at final follow-up. The mean UCLA activity score
was 4.7 (range, 2.0-10.0). An increasing number of patients were active in
sports at follow-up compared with before surgery (76.5% vs 60.8%,
respectively); 2 patients (3.9%) stopped participating in sports on a
regular basis, and 10 (19.6%) commenced with sports after surgery. The most
popular activities before surgery were cycling (31.4%), hiking (29.4%),
swimming (21.6%), and fitness/weight training (15.7%). At follow-up, most
patients were engaged in cycling (35.3%) and fitness/weight training
(33.3%), followed by swimming (25.5%) and hiking (19.6%). The duration
(hours per week) and frequency (times per week) of sporting activities
remained stable. The mean VAS pain level during sports was 1.3 (range,
0.0-7.0). No revision surgery had to be performed. Conclusion: After single-stage bilateral short-stem THA, the study patients returned to
satisfying levels of activity at midterm follow-up. Postoperatively, few
patients were engaged in high-impact sports; however, more patients
commenced with lower impact activities. Satisfaction with sporting abilities
was high, and the complication rate in total was low.
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Affiliation(s)
- Stefanie Donner
- Department of Orthopaedic Surgery and Traumatology, St Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedic Surgery and Traumatology, St Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Michael Schneider
- Department of Orthopaedic Surgery and Traumatology, St Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Joachim Pfeil
- Department of Orthopaedic Surgery and Traumatology, St Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St Josefs Hospital Wiesbaden, Wiesbaden, Germany.,Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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91
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Tsitlakidis S, Vot L, Westhauser F, Jaeger S, Klotz MC. Periprosthetic fracture morphology of a femoral neck prosthesis: An in vitro study. Proc Inst Mech Eng H 2019; 233:1175-1182. [PMID: 31545137 DOI: 10.1177/0954411919877286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Femoral neck prostheses have been developed for the treatment of osteoarthritis in young and active patients. The concept combines a bone-conserving and minimal invasive technique with proximal load transferring by metaphyseal anchoring, which results in a more physiological loading pattern. However, little is known about the morphology of periprosthetic fractures. Thus, the aim of this study was to describe fracture patterns and to determine patient-specific factors favoring periprosthetic fracture. This study was performed as a biomechanical experimental study using 10 fresh frozen femora and 10 Silent-Hip femoral neck implants (DePuy International Ltd., Leeds, UK). In order to simulate physiological loading, a static muscle reconstruction (abductor muscles and iliotibial band) and a dynamic simulation of the gait cycle were applied. During biomechanical testing (50% and 100% of normal weight-bearing), three periprosthetic fractures with two different morphologies occurred. The first pattern corresponds to an abrupt breakaway. The second type was of spiral configuration extending to the diaphyseal region and emerging from an initial fissure. Specimen-specific factors favoring periprosthetic fracture were body mass index and varus angle of the implant. Periprosthetic fractures may extend to the subtrochanteric/diaphyseal region and may be of spiral configuration. According to the finding of this study, body mass index and varus/valgus position of the implant are important factors influencing the risk of periprosthetic fractures. Furthermore, partial weight-bearing as part of the postoperative regimen may be favorable.
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Affiliation(s)
- Stefanos Tsitlakidis
- Clinic of Orthopedics & Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Leo Vot
- Laboratory of Biomechanics and Implant Research, Clinic of Orthopedics & Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Westhauser
- Clinic of Orthopedics & Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic of Orthopedics & Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias C Klotz
- Clinic of Orthopedics & Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.,Clinic for Orthopedic & Trauma Surgery, Kepler University Hospital, Linz, Austria
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92
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Tsitlakidis S, Westhauser F, Horsch A, Beckmann N, Bitsch R, Klotz M. Femoral neck prostheses: A systematic analysis of the literature. Orthop Rev (Pavia) 2019; 11:8204. [PMID: 31579193 PMCID: PMC6769360 DOI: 10.4081/or.2019.8204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/07/2019] [Indexed: 11/23/2022] Open
Abstract
Primary total hip arthroplasty (THA) is one of the most successful surgical procedures. Considering the demographic change the use of new ultra-short femoral implants has gained importance especially when treating young patients. Main features are bone conservation, metaphyseal anchoring and thus reducing stress shielding by proximal load transferring. The objective of this study is to give an overview over the subject of femoral neck prostheses. A systematic review was conducted. A total number of 27 publications were taken into this systematic review. Over all, just a few follow-up, biomechanical and radiostereometric studies have been conducted in the past. Still no long-term results (>10 years of follow-up) are available. The available mid-term results indicate unsatisfactory survival rates. Aseptic loosening was the most common reason for revision. Valgus angle and good bone mineral density were considered to be crucial for primary stability of femoral neck prostheses. Register data report a very low percentage of femoral neck prostheses in THA with even more diminishing implantation rates. To conclude, further studies are necessary in order to provide evidence-based recommendations. Currently, due to the inhomogeneous and poor data a reasonable and legitimate recommendation cannot be given.
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Affiliation(s)
- Stefanos Tsitlakidis
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Westhauser
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Axel Horsch
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Nicholas Beckmann
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rudi Bitsch
- Clinic of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Klotz
- Clinic for Orthopedic and Trauma Surgery, Kepler University Hospital, Linz, Austria
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93
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Jacquel A, Le Viguelloux A, Valluy J, Saffarini M, Bonin N. A shortened uncemented stem offers comparable positioning and increased metaphyseal fill compared to a standard uncemented stem. J Exp Orthop 2019; 6:28. [PMID: 31240502 PMCID: PMC6593034 DOI: 10.1186/s40634-019-0197-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/14/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Shortened stems are increasingly used in uncemented total hip arthroplasty (THA) as they represent a compromise between the metaphyseal anchorage of short stems and the facilitated axial alignment of standard stems. The purpose of this study was to compare the metaphyseal canal-fill ratio (CFR) and axial alignment of a shortened double-tapered stem with those of a standard stem. The hypothesis was that the shortened stem would achieve greater metaphyseal fill and comparable axial alignment. METHODS The authors reviewed routine follow-up anteroposterior radiographs taken 2 months after THA to evaluate metaphyseal fill and axial alignment of a shortened stem (n = 96) and a standard stem (n = 101). The CFR was calculated at the level of the tip and superior margin of the lesser trochanter. Stem alignment was defined as the angle between the stem axis and the proximal anatomic femoral axis. Stems were classified as being in varus or valgus alignment if they deviated by more than 3° from the anatomic axis of the femur. RESULTS Hips implanted with shortened and standard stems had comparable demographics and axial alignment (1.1° ± 1.7° vs 0.8° ± 1.2°; p = 0.331). However, varus alignment was observed in 5% of shortened stems compared to only 1% of standard stems, though this difference was not significant (p = 0.111). The femoral CFR was greater using shortened stems than using standard stems, both at the level of the tip of the lesser trochanter (0.91 ± 0.05 vs 0.85 ± 0.08; p < 0.001) and at its superior margin (0.76 ± 0.06 vs 0.72 ± 0.07; p < 0.001). CONCLUSIONS Compared to the standard stem, the shortened stem had increased metaphyseal filling and equivalent alignment. These findings suggest that shortened stems could provide adequate metaphyseal fixation and correct alignment. Further studies remain necessary to evaluate how shortened stems perform in terms of osseointegration, clinical outcomes and survival.
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Affiliation(s)
- Alexandre Jacquel
- Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon-Ortho-Clinic, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Augustin Le Viguelloux
- Centre Hospitalier William Morey, 4 Rue Capitaine Drillien, 71100, Chalon Sur Saône, France
| | - Jeremy Valluy
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland
| | - Mo Saffarini
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland.
| | - Nicolas Bonin
- Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon-Ortho-Clinic, 8 Avenue Ben Gourion, 69009, Lyon, France
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94
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Tatani I, Panagopoulos A, Diamantakos I, Sakellaropoulos G, Pantelakis S, Megas P. Comparison of two metaphyseal-fitting (short) femoral stems in primary total hip arthroplasty: study protocol for a prospective randomized clinical trial with additional biomechanical testing and finite element analysis. Trials 2019; 20:359. [PMID: 31208433 PMCID: PMC6580512 DOI: 10.1186/s13063-019-3445-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 05/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Total hip replacement has recently followed a progressive evolution towards principles of bone- and soft-tissue-sparing surgery. Regarding femoral implants, different stem designs have been developed as an alternative to conventional stems, and there is a renewed interest towards short versions of uncemented femoral implants. Based on both experimental testing and finite element modeling, the proposed study has been designed to compare the biomechanical properties and clinical performance of the newly introduced short-stem Minima S, for which clinical data are lacking with an older generation stem, the Trilock Bone Preservation Stem with an established performance record in short to midterm follow-up. METHODS/DESIGN In the experimental study, the transmission of forces as measured by cortical surface-strain distribution in the proximal femur will be evaluated using digital image correlation (DIC), first on the non-implanted femur and then on the implanted stems. Finite element parametric models of the bone, the stem and their interface will be also developed. Finite element predictions of surface strains in implanted composite femurs, after being validated against biomechanical testing measurements, will be used to assist the comparison of the stems by deriving important data on the developed stress and strain fields, which cannot be measured through biomechanical testing. Finally, a prospective randomized comparative clinical study between these two stems will be also conducted to determine (1) their clinical performance up to 2 years' follow-up using clinical scores and gait analysis (2) stem fixation and remodeling using a detailed radiographic analysis and (3) incidence and types of complications. DISCUSSION Our study would be the first that compares not only the clinical and radiological outcome but also the biomechanical properties of two differently designed femoral implants that are theoretically classified in the same main category of cervico-metaphyseal-diaphyseal short stems. We can hypothesize that even these subtle variations in geometric design between these two stems may create different loading characteristics and thus dissimilar biomechanical behaviors, which in turn could have an influence to their clinical performance. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number, ID: ISRCTN10096716 . Retrospectively registered on May 8 2018.
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Affiliation(s)
- I Tatani
- Orthopaedic Department, University Hospital of Patras, Patras, Greece
| | - A Panagopoulos
- Orthopaedic Department, University Hospital of Patras, Patras, Greece.
| | - I Diamantakos
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
| | - G Sakellaropoulos
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Sp Pantelakis
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
| | - P Megas
- Orthopaedic Department, University Hospital of Patras, Patras, Greece
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95
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Abstract
AIMS Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components. MATERIALS AND METHODS A literature review was performed using the EMBASE, Medline, and Cochrane databases. Strict inclusion and exclusion criteria were used to identify studies reporting clinical and radiological follow-up for short-stemmed hip arthroplasties. RESULTS A total of 28 studies were eligible for inclusion. This included 5322 hips in 4657 patients with a mean age of 59 years (13 to 94). The mean follow-up was 6.1 years (0.5 to 20). The mean Harris Hip Score improved from 46 (0 to 100) to 92 (39 to 100). The mean Oxford Hip Score improved from 25 (2 to 42.5) to 35 (12.4 to 48). The mean Western Ontario & McMaster Universities Osteoarthritis Index improved from 54 (2 to 95) to 22 (0 to 98). Components were aligned in a neutral coronal alignment in up to 90.9% of cases. A total of 15 studies reported component survivorship, which was 98.6% (92% to 100%) at a mean follow-up of 12.1 years. CONCLUSION Short-stemmed femoral implants show similar improvement in clinical and radiological outcomes compared with conventional length implants. Only mid-term survivorship, however, is known. An abundance of short components have been developed and used commercially without staged clinical trials. Long-term survival is still unknown for many of these components. There remains tension between innovation and the moral duty to ensure that the introduction of new implants is controlled until safety and patient benefit are demonstrated. Implant innovation and subsequent use should be driven by proven clinical outcomes, rather than market and financial forces, and ethical practice must be ensured. Cite this article: Bone Joint J 2019;101-B:502-511.
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Affiliation(s)
- S Lidder
- Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Australia
| | - D J Epstein
- Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Australia
| | - G Scott
- Bone and Joint Research Unit, The Royal London Hospital, London, UK
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96
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Gielis WP, van Oldenrijk J, Ten Cate N, Scholtes VAB, Geerdink CH, Poolman RW. Increased Persistent Mid-Thigh Pain After Short-Stem Compared With Wedge-Shaped Straight-Stem Uncemented Total Hip Arthroplasty at Medium-Term Follow-Up: A Randomized Double-Blinded Cross-Sectional Study. J Arthroplasty 2019; 34:912-919. [PMID: 30773357 DOI: 10.1016/j.arth.2019.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/06/2018] [Accepted: 01/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Femoral prosthesis design may impact the frequency of mid-thigh pain. We compared current, incidental, and persistent mid-thigh pain between the short-stem, Collum Femoris femur prosthesis, and the wedge shaped straight-stem, Zweymüller femur prosthesis and studied the associations between demographics, radiographic measurements, and mid-thigh pain. METHODS We contacted patients from a randomized controlled trial who underwent uncemented total hip arthroplasty (THA) for hip osteoarthritis at a mean follow-up of 44 months (range 24-64 months). Patients were specifically assessed for current (during assessment), incidental (any time postoperatively for >1 week) mid-thigh pain, and persistent (any time postoperatively for >2 years) mid-thigh pain. Furthermore, we used regression analysis to study associations between demographics, radiographic measurements, and mid-thigh pain. RESULTS One hundred forty of 150 patients (93%) responded to our assessment. Mean age at the time of operation was 62 years (±7.0). Current mid-thigh pain occurred in 16 patients (23%) in the Collum Femoris Preserving (CFP) group compared with 10 patients (14%) in the Zweymüller group (P = .192). Incidental mid-thigh pain occurred in 24 patients (34%) in the CFP group compared with 15 patients (21%) in the Zweymüller group (P = .090). Persistent mid-thigh pain was found in 13 patients (19%) in the CFP group compared with five patients (7%) in the Zweymüller group (P = .043). Varus malalignment (odds ratio 1.819 [95% confidence interval 1.034-3.200]) and leg lengthening (odds ratio 1.107 per cm lengthening [95% confidence interval 1.026-1.195]) showed significant associations with mid-thigh pain. CONCLUSIONS We found more persistent mid-thigh pain after short-stem uncemented THA compared to wedge-shaped straight-stem uncemented THA during medium-term follow-up. Varus malalignment and leg lengthening were associated with mid-thigh pain.
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Affiliation(s)
- Willem Paul Gielis
- Department of Orthopedic Surgery, Joint Research, Amsterdam, The Netherlands; Department of Orthopedic Surgery, UMC Utrecht, Utrecht, The Netherlands
| | - Jakob van Oldenrijk
- Department of Orthopedic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Nick Ten Cate
- Department of Orthopedic Surgery, Joint Research, Amsterdam, The Netherlands
| | | | - Carel H Geerdink
- Department of Orthopedic Surgery, Ikazia Hospital, Rotterdam, The Netherlands
| | - Rudolf W Poolman
- Department of Orthopedic Surgery, Joint Research, Amsterdam, The Netherlands
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97
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Gkagkalis G, Goetti P, Mai S, Meinecke I, Helmy N, Bosson D, Kutzner KP. Cementless short-stem total hip arthroplasty in the elderly patient - is it a safe option?: a prospective multicentre observational study. BMC Geriatr 2019; 19:112. [PMID: 30995903 PMCID: PMC6472082 DOI: 10.1186/s12877-019-1123-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/27/2019] [Indexed: 12/15/2022] Open
Abstract
Background Due to its bone preserving philosophy, short-stem total hip arthroplasty (THA) has primarily been recommended for young and active patients. However, there may be benefits for elderly patients given a less invasive operative technique due to the short curved implant design. The purpose of this study was to compare the clinical and radiological outcomes as well as perioperative complications of a calcar-guided short stem between a young (< 60 years) and a geriatric (> 75 years) population. Methods Data were collected in a total of 5 centers, and 400 short-stems were included as part of a prospective multicentre observational study between 2010 and 2014 with a mean follow-up of 49.2 months. Preoperative femur morphology was analysed using the Dorr classification. Clinical and radiological outcomes were assessed in both groups as well as perioperative complications, rates and reasons for stem revision. Results No differences were found for the mean visual analogue scale (VAS) values of rest pain, load pain, and satisfaction, whereas Harris Hip Score (HHS) was slightly better in the young group. Comparing both groups, none of the radiological parameters that were assessed (stress-shielding, cortical hypertrophy, radiolucency, osteolysis) reached differences of statistical significance. While in young patients aseptic loosening is the main cause of implant failure, in the elderly group particularly postoperative periprosthetic fractures due to accidental fall have to be considered to be of high risk. The incidence of periprosthetic fractures was found to be 0% in Dorr type A femurs, whereas in Dorr types B and C fractures occurred in 2.1 and 22.2% respectively. Conclusions Advanced age alone is not necessarily to be considered as contra-indications for calcar-guided short-stem THA, although further follow-up is needed. However, markedly reduced bone quality with femur morphology of Dorr type C seems to be associated with increased risk for postoperative periprosthetic fractures, thus indication should be limited to Dorr types A and B. Trial registration German Clinical Trials Register; DRKS00012634, 07.07.2017 (retrospectively registered).
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Affiliation(s)
- Georgios Gkagkalis
- Department of Orthopaedic Surgery, Hôpital du Sacré-Cœur, Université de Montréal, 5400 boul. Gouin Ouest, Montréal, QC, H4J 1C5, Canada.,Department of Orthopaedic Surgery, Nyon Hospital, Chemin Monastier 10, 1260, Nyon, Switzerland
| | - Patrick Goetti
- Department of Orthopaedic Surgery and Traumatology, Lausanne University Hospital - CHUV, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Sabine Mai
- Vitos Orthopaedic Clinic Kassel, Wilhelmshöher Allee 345, 34131, Kassel, Germany
| | - Ingmar Meinecke
- Helios Park-Clinic Leipzig, Strümpellstr. 41, 04289, Leipzig, Germany
| | - Näder Helmy
- Bürgerspital Solothurn, Schöngrünstr. 42, 4500, Solothurn, Switzerland
| | - Dominique Bosson
- Department of Orthopaedic Surgery, Nyon Hospital, Chemin Monastier 10, 1260, Nyon, Switzerland
| | - Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.
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98
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Lee SJ, Yoon KS. Favorable Functional Recovery and Stem Stability after Hip Arthroplasty with a Short Metaphyseal Stem in Elderly Patients with Osteoporotic Femoral Neck Fractures. Hip Pelvis 2019; 31:11-17. [PMID: 30899710 PMCID: PMC6414405 DOI: 10.5371/hp.2019.31.1.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/06/2019] [Accepted: 01/28/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Short stems have recently become widely used; however, concerns about the initial secure fixation of a short stem in osteoporotic bone remain. The aim of this study was to evaluate the short-term clinical and radiological results of using a short cementless metaphyseal stabilizing tapered stem for senile osteoporotic femoral neck fractures. Materials and Methods Thirty-eight arthroplasties (31 bipolar hemiarthroplasties and 7 total hip arthroplasties) were performed for osteoporotic femoral neck fractures in patients older than 65 years (10 males and 28 females). The mean age was 76.1 years and the mean follow-up was 2.9 years. We retrospectively evaluated clinical results, focusing on walking performance, thigh pain, and radiologic results, with special regard to signs of stem stability and osteointegration. Results Mean Harris hip score was 84.3 points and 68.4% of patients regained their preoperative walking performance. No patients complained about thigh pain. No osteolysis or loosening was observed during the follow-up, and all but 1 stem showed signs of stable bone ingrowth. Conclusion Short, metaphyseal stabilizing tapered stems could be a reliable treatment option for osteoporotic femoral neck fractures.
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Affiliation(s)
- Soong Joon Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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99
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Drosos GI, Touzopoulos P. Short stems in total hip replacement: evidence on primary stability according to the stem type. Hip Int 2019; 29:118-127. [PMID: 30569737 DOI: 10.1177/1120700018811811] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND: As the prevalence of total hip replacement is increasing in younger patients, less invasive implants (short stems) are becoming more favourable. However, despite the advantages of these stems, clinical results with a follow-up of more than 10 years are limited to a very few stem designs. There has been an increase in publications recently - mechanical and clinical studies - concerning the primary stability of short stems. Primary stem stability is an important factor as it reflects final stem stabilisation and is related to the clinical results of the prosthesis. METHOD: We conducted a systematic review of the literature to retrieve evidence concerning primary implant stability in short stems - as expressed by implant micromotion and stem subsidence - according to our previously proposed short-stem classification. RESULTS: Mechanical in vitro studies on stem micromotion are very few and limited to type 2 "partial collum" short stems. The results are comparable to those of stems with a known long-term excellent clinical course. Clinical results concerning stem migration patterns are also limited to some of the commercially available short stems. Although comparative studies are very few, the results for most of the short stems are similar to those of standard stems. CONCLUSION: There are promising results concerning biomechanical studies of the initial micromotion of short stems, as well as clinical results of stem migration patterns. Long-term clinical studies are needed in order to confirm these findings. The existing literature concerns very few of the many commercially available implants.
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Affiliation(s)
- Georgios I Drosos
- 1 Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,2 Democritus University of Thrace, Komotini, Greece
| | - Panagiotis Touzopoulos
- 1 Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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100
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Freitag T, Fuchs M, Woelfle-Roos JV, Reichel H, Bieger R. Mid-term migration analysis of a femoral short-stem prosthesis: a five-year EBRA-FCA-study. Hip Int 2019; 29:128-133. [PMID: 29739256 DOI: 10.1177/1120700018772277] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: The objective of this study was to evaluate the mid-term migration pattern of a femoral short stem. METHODS: Implant migration of 73 femoral short-stems was assessed by Ein-Bild-Roentgen-Analysis Femoral-Component-Analysis (EBRA-FCA) 5 years after surgery. Migration pattern of the whole group was analysed and compared to the migration pattern of implants "at risk" with a subsidence of more than 1.5 mm 2 years postoperative. RESULTS: Mean axial subsidence was 1.1 mm (-5.0 mm to 1.5 mm) after 60 months. There was a statistical significant axial migration until 2 years postoperative with settling thereafter. 2 years after surgery 18 of 73 Implants were classified "at risk." Nevertheless, all stems showed secondary stabilisation in the following period with no implant failure neither in the group of implants with early stabilisation nor the group with extensive early onset migration. CONCLUSION: In summary, even in the group of stems with more pronounced early subsidence, delayed settling occurred in all cases. The determination of a threshold of critical early femoral short stem subsidence is necessary because of the differing migration pattern described in this study with delayed settling of the Fitmore stem 2 years postoperatively compared to early settling within the first postoperative year described for conventional stems.
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Affiliation(s)
- Tobias Freitag
- 1 Department of Orthopaedic Surgery, University of Ulm, Germany
| | - Michael Fuchs
- 1 Department of Orthopaedic Surgery, University of Ulm, Germany.,2 Centre for Musculoskeletal Surgery, Orthopaedic Department Charite, Berlin, Germany
| | | | - Heiko Reichel
- 1 Department of Orthopaedic Surgery, University of Ulm, Germany
| | - Ralf Bieger
- 1 Department of Orthopaedic Surgery, University of Ulm, Germany
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