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Regenbrecht B, Yaseen A, Wagener G, Wild M. Cemented Calcar-Guided Short-Stem Prostheses in Geriatric Patients: Short-Term Results from a Prospective Observational Study. Antibiotics (Basel) 2024; 13:739. [PMID: 39200040 PMCID: PMC11350790 DOI: 10.3390/antibiotics13080739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 09/01/2024] Open
Abstract
Both cementless and cemented stems have exhibited favorable long-term outcomes in total hip arthroplasty. Nonetheless, in elderly patients, cemented hips offer an advantage due to their reduced risk of periprosthetic fractures. This study aimed to assess the initial outcomes of 28 patients who underwent unilateral cemented total hip arthroplasty utilizing a calcar-guided A2 stem (ARTIQO GmbH, Lüdinghausen, Germany). Various types of antibiotic-loaded bone cement were employed. During follow-up, we recorded demographic data and comorbidities and employed standardized clinical assessment tools, including the Harris Hip Score. Radiographic assessments included preoperative, postoperative, and follow-up imaging to evaluate subsidence, osteolysis, and bone resorption. The results indicated that among the 28 patients, 5 withdrew consent and 2 patients passed away from unrelated causes. Additionally, one prosthesis was explanted due to the undersizing of the cement stopper, which resulted in an inadequate cement mantle. As a result, 20 patients underwent a 1-year follow-up, revealing noteworthy enhancements in clinical scores, with no instances of radiolucent lines or osteolysis. No infections were detected. In summary, our short-term experience with this particular cemented short-stem design yielded promising results, exhibiting excellent functional outcomes, no aseptic loosening attributable to the stem, and no infections. Further clinical studies and registry data are essential to corroborate these findings.
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Affiliation(s)
| | - Ahmed Yaseen
- Universitätsklinik für Orthopädie und Traumatologie, A-6020 Innsbruck, Austria
| | - Gideon Wagener
- Klinik Lilienthal GmbH & Co. KG, 28865 Lilienthal, Germany
| | - Michael Wild
- Department of Orthopedics, Trauma and Hand Surgery, Klinikum Darmstadt, 64283 Darmstadt, Germany
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Morlock M, Perka C, Melsheimer O, Kirschbaum SM. Influence of the type of stem and its fixation on revision and immediate postoperative mortality in elective total hip arthroplasty. Bone Joint J 2024; 106-B:130-136. [PMID: 38423088 DOI: 10.1302/0301-620x.106b3.bjj-2023-0820.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Aims Despite higher rates of revision after total hip arthroplasty (THA) being reported for uncemented stems in patients aged > 75 years, they are frequently used in this age group. Increased mortality after cemented fixation is often used as a justification, but recent data do not confirm this association. The aim of this study was to investigate the influence of the design of the stem and the type of fixation on the rate of revision and immediate postoperative mortality, focusing on the age and sex of the patients. Methods A total of 333,144 patients with primary osteoarthritis (OA) of the hip who underwent elective THA between November 2012 and September 2022, using uncemented acetabular components without reconstruction shells, from the German arthroplasty registry were included in the study. The revision rates three years postoperatively for four types of stem (uncemented, uncemented with collar, uncemented short, and cemented) were compared within four age groups: < 60 years (Young), between 61 and 70 years (Mid-I), between 71 and 80 years (Mid-II), and aged > 80 years (Old). A noninferiority analysis was performed on the most frequently used designs of stem. Results The design of the stem was found to have no significant influence on the rate of revision for either sex in the Young group. Uncemented collared stems had a significantly lower rate of revision compared with the other types of stem for females in the Mid-I group. There was a significantly higher rate of revision for uncemented stems in females in the Mid-II group compared with all other types of stem, while in males the rate for uncemented stems was only significantly higher than the rate for cemented stems. Cemented stems had a significantly lower revision rate compared with uncemented and short stems for both sexes in the Old cohort, as did females with collared stems. The rate of immediate postoperative mortality was similar for all types of stem in the Old age group, as were the American Society of Anesthesiologists grades. Conclusion In patients aged > 80 years, uncemented and short stems had significantly higher revision rates compared with cemented and collared stems, especially in females. The design of the stem and type of fixation have to be analyzed in more detail than only considering cemented and uncemented fixation, in order to further improve the success of THA.
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Affiliation(s)
- Michael Morlock
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Carsten Perka
- CharitéCenter for Orthopedics and Trauma Surgery, Center für Muskuloskeletale Chirurgie, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | | | - Stephanie M Kirschbaum
- CharitéCenter for Orthopedics and Trauma Surgery, Center für Muskuloskeletale Chirurgie, Charité- Universitätsmedizin Berlin, Berlin, Germany
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Weenders SGM, Merfort R, Eschweiler J, Hildebrand F, Gruner A, Heller KD. Ten-year follow-up and clinical outcome of a metaphyseal anchoring short hip stem prosthesis: a retrospective single-centre analysis. INTERNATIONAL ORTHOPAEDICS 2024; 48:419-426. [PMID: 37672119 DOI: 10.1007/s00264-023-05958-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE Short stems for total hip arthroplasty are an alternative to traditional conventional long stems. Short stems are designed to facilitate minimal-invasive surgery, improve bone-stock preservation, and mimic a physiological load distribution. However, there is little evidence of the long-term outcome of short stems. This study aims to analyze the ten year survival rates and clinical outcome of one specific metaphyseal short hip stem implant. METHODS We retrospectively analyzed the patient records of the patients who underwent a total hip arthroplasty with a monoblock partial collum sparing metaphyseal short hip stem prosthesis in 2008 and 2009 in our clinic. Patients were contacted, and clinical follow-up was recorded using the German version of the modified Harris Hip Score. Furthermore, complications, revision surgery, and post-operative radiographs were analyzed. RESULTS Data from 339 primary implantations in 322 patients were retrieved. The mean follow-up was 10.6 years. Seven patients underwent a revision. The ten year survival rate with any revision surgery as the endpoint was 97.5%. The mean modified Harris Hip Score was 86 points (range 30 to 91 points). Five patients had an intraoperative fracture of the femur (1.6%). Two patients (0.6%) had a dislocation of the hip. The stem tip-to-cortex distance, measured in the anterior posterior view, was 2.6 mm (range 0 to 8.3 mm). CONCLUSION The ten year survival rate of our used monoblock partial collum sparing metaphyseal short hip stem implant is comparable to traditional stems for total hip arthroplasty.
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Affiliation(s)
- S G M Weenders
- Clinic for Orthopaedic Surgery, Herzogin Elisabeth Hospital, Leipzigerstraße 24, 38124, Braunschweig, Germany.
| | - R Merfort
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - J Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - F Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - A Gruner
- Clinic for Orthopaedic Surgery, Herzogin Elisabeth Hospital, Leipzigerstraße 24, 38124, Braunschweig, Germany
| | - K D Heller
- Clinic for Orthopaedic Surgery, Herzogin Elisabeth Hospital, Leipzigerstraße 24, 38124, Braunschweig, Germany
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Jahnke A, Harz T, Fonseca Ulloa CA, Ishaque BA, Rickert M. Development and Finite Element (FE) analysis of a novel short hip stem concept. J Orthop 2023; 46:117-123. [PMID: 37994362 PMCID: PMC10659989 DOI: 10.1016/j.jor.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 11/24/2023] Open
Abstract
Introduction In order to improve the anchorage behavior of short hip stems, this development project aims at designing a short hip stem concept that preserves the femoral neck and minimizes interference with the physiological stress distribution of the femur. The new design will be evaluated according to ISO 7206-4 which is the standard for testing Implants for surgery. Methods Basic CAD models based on an established short stem prosthesis were created and evaluated using finite element analysis. The best design was further developed to achieve a more deformable stem while maintaining stability. The model was validated through in vitro testing. Results The "H-Beam" short stem showed a higher degree of deformation of approximately 142-144% compared to the established short stem. The FE model had a relative error of 0.98% and 1.07% compared to the in vitro tests. An operating procedure was outlined for this new short stem design. Discussion The FE model is deemed valid due to small differences in comparison to in vitro testing. The short-stem prosthesis is more flexible and can be easily adapted to individual anatomy during surgery. The prosthesis length is similar to conventional prostheses, but the new stem design could allow better and faster osteointegration while preserving the cancellous bone structure.
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Affiliation(s)
- Alexander Jahnke
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany
| | - Torben Harz
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany
| | | | - Bernd Alexander Ishaque
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstrasse 33, 35392, Giessen, Germany
| | - Markus Rickert
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstrasse 33, 35392, Giessen, Germany
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Soliman MM, Islam MT, Chowdhury MEH, Alqahtani A, Musharavati F, Alam T, Alshammari AS, Misran N, Soliman MS, Mahmud S, Khandakar A. Advancement in total hip implant: a comprehensive review of mechanics and performance parameters across diverse novelties. J Mater Chem B 2023; 11:10507-10537. [PMID: 37873807 DOI: 10.1039/d3tb01469j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
The UK's National Joint Registry (NJR) and the American Joint Replacement Registry (AJRR) of 2022 revealed that total hip replacement (THR) is the most common orthopaedic joint procedure. The NJR also noted that 10-20% of hip implants require revision within 1 to 10 years. Most of these revisions are a result of aseptic loosening, dislocation, implant wear, implant fracture, and joint incompatibility, which are all caused by implant geometry disparity. The primary purpose of this review article is to analyze and evaluate the mechanics and performance factors of advancement in hip implants with novel geometries. The existing hip implants can be categorized based on two parts: the hip stem and the joint of the implant. Insufficient stress distribution from implants to the femur can cause stress shielding, bone loss, excessive micromotion, and ultimately, implant aseptic loosening due to inflammation. Researchers are designing hip implants with a porous lattice and functionally graded material (FGM) stems, femur resurfacing, short-stem, and collared stems, all aimed at achieving uniform stress distribution and promoting adequate bone remodeling. Designing hip implants with a porous lattice FGM structure requires maintaining stiffness, strength, isotropy, and bone development potential. Mechanical stability is still an issue with hip implants, femur resurfacing, collared stems, and short stems. Hip implants are being developed with a variety of joint geometries to decrease wear, improve an angular range of motion, and strengthen mechanical stability at the joint interface. Dual mobility and reverse femoral head-liner hip implants reduce the hip joint's dislocation limits. In addition, researchers reveal that femoral headliner joints with unidirectional motion have a lower wear rate than traditional ball-and-socket joints. Based on research findings and gaps, a hypothesis is formulated by the authors proposing a hip implant with a collared stem and porous lattice FGM structure to address stress shielding and micromotion issues. A hypothesis is also formulated by the authors suggesting that the utilization of a spiral or gear-shaped thread with a matched contact point at the tapered joint of a hip implant could be a viable option for reducing wear and enhancing stability. The literature analysis underscores substantial research opportunities in developing a hip implant joint that addresses both dislocation and increased wear rates. Finally, this review explores potential solutions to existing obstacles in developing a better hip implant system.
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Affiliation(s)
- Md Mohiuddin Soliman
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohammad Tariqul Islam
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Muhammad E H Chowdhury
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Abdulrahman Alqahtani
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia
- Department of Biomedical Technology, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Farayi Musharavati
- Department of Mechanical & Industrial Engineering, Qatar University, Doha 2713, Qatar.
| | - Touhidul Alam
- Pusat Sains Ankasa (ANGKASA), Institut Perubahan Iklim, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Selangor, Malaysia.
| | - Ahmed S Alshammari
- Department of Electrical Engineering, College of Engineering, University Hail, Hail 81481, Saudi Arabia.
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
| | - Norbahiah Misran
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohamed S Soliman
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
- Department of Electrical Engineering, Faculty of Energy Engineering, Aswan University, Aswan, 81528, Egypt
| | - Sakib Mahmud
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Amith Khandakar
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
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Mauch M, Brecht H, Clauss M, Stoffel K. Use of Short Stems in Revision Total Hip Arthroplasty: A Retrospective Observational Study of 31 Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1822. [PMID: 37893539 PMCID: PMC10608113 DOI: 10.3390/medicina59101822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Implantation of a short femoral stem in revision total hip arthroplasty (rTHA) could reduce the perioperative time, soft tissue damage, and preserve the bone stock of the proximal femur. The objective of this study was to describe the clinical and radiographic outcomes after the use of short stems in rTHA with a follow-up of 1 to 5 years. Materials and Methods: This retrospective, single center, and observational study analyzed the data of 31 patients (12 female, 19 male) with a median (interquartile range) age of 68.2 years (61.2-78.4) and BMI of 26.7 kg/m2 (24.6-29.4) who received an uncemented short femoral stem in rTHA between 2015 and 2020. Clinical outcomes were extracted from medical reports and assessed using the modified Harris Hip Score (mHHS), the numerical rating scale (NRS) for pain and satisfaction, and the UCLA Physical Activity Score. Radiographs were analyzed for stem subsidence, fixation, and bone parameters. The Wilcoxon test was used for pre-post rTHA differences (p < 0.05); clinical relevance was interpreted based on effect sizes according to Cohen's d. Results: All the clinical outcome measures improved significantly (p ≤ 0.001) at follow-up compared to preoperative status, with large effect sizes (Cohen's d) ranging from 2.8 to 1.7. At the last follow-up, the median (interquartile) mHHS was 80.9 (58.6-93.5). Stem fixation was stable in all cases. Complications included stem subsidence of 3 mm (n = 1) and 10 mm (n = 1), heterotopic ossification Brooker stage III (n = 2), intraoperative femur perforation (n = 1), periprosthetic fracture Vancouver type A (n = 1), and dislocation (n = 2). Conclusions: The good clinical results in our selective study population of patients with mild to moderate bone deficiency, supported by large effect sizes, together with a complication rate within the normal range, support the consideration of short stems as a surgical option after a thorough preoperative analysis.
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Affiliation(s)
- Marlene Mauch
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Hendrik Brecht
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
| | - Martin Clauss
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
- Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, 4031 Basel, Switzerland
| | - Karl Stoffel
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
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Van Veghel MHW, Hannink G, Lewis PL, Holder C, Van Steenbergen LN, Schreurs BW. Short-stem hip arthroplasty in Australia and the Netherlands: a comparison of 12,680 cases between the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and the Dutch Arthroplasty Register (LROI). Acta Orthop 2023; 94:453-459. [PMID: 37656438 PMCID: PMC10473243 DOI: 10.2340/17453674.2023.18491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND PURPOSE We compared the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and the Dutch Arthroplasty Register (LROI) regarding patient, prosthesis, and procedure characteristics as well as revision rates for uncemented short-stem total hip arthroplasties (THAs). PATIENTS AND METHODS All THAs with an uncemented short-stemmed femoral component performed between 2009 and 2021 were included from the AOANJRR (n = 9,328) and the LROI (n = 3,352). Kaplan-Meier survival analyses and multivariable Schemper's weighted Cox regression analyses with data from 2009-2021 and 2015-2021 were performed with overall revision as endpoint. RESULTS In Australia, the proportion of male patients (51% vs. 40%), patients with ASA III-IV score (30% vs. 3.7%), BMI ≥ 30.0 (39% vs. 19%), and femoral heads of 36 mm (58% vs. 20%) were higher than in the Netherlands. Short-stem THAs in Australia and the Netherlands had comparable 10-year revision rates (3.4%, 95% confidence interval [CI] 2.9-4.0 vs. 4.8%, CI 3.7-6.3). Multivariable Cox regression analyses with data from 2009-2021 showed a higher risk for revision of short-stem THAs performed in the Netherlands (HR 1.8, CI 1.1-2.8), whereas the risk for revision was comparable (HR 0.9, CI 0.5-1.7) when adjusted for more potential confounders using data from 2015-2021. CONCLUSION Short-stem THAs in Australia and the Netherlands have similar crude and adjusted revision rates, which are acceptable at 10 years of follow-up.
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Affiliation(s)
- Mirthe H W Van Veghel
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia
| | - Carl Holder
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Liza N Van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), 's-Hertogenbosch, the Netherlands
| | - B Willem Schreurs
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands; Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), 's-Hertogenbosch, the Netherlands
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Van Veghel MHW, Hannink G, Van Oldenrijk J, Van Steenbergen LN, Schreurs BW. A comparison of uncemented short versus standard stem length in total hip arthroplasty: results from the Dutch Arthroplasty Register. Acta Orthop 2023; 94:330-335. [PMID: 37417696 DOI: 10.2340/17453674.2023.13652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND PURPOSE We aimed to compare revision rates between uncemented short and standard stems in total hip arthroplasties (THAs) and the corresponding patient-reported outcome measures (PROMs). PATIENTS AND METHODS We included all short (C.F.P., Fitmore, GTS, Metha, Nanos, Optimys, Pulchra, and Taperloc Microplasty) and standard stems in uncemented THAs registered between 2009 and 2021 in the Dutch Arthroplasty Register. Kaplan-Meier survival and multivariable Cox regression analyses were performed with overall and femoral stem revision as endpoints. RESULTS Short stems were used in 3,352 and standard stems in 228,917 hips. 10-year overall revision rates (4.8%, 95% confidence interval [CI] 3.7-6.3 vs. 4.5%, CI 4.4-4.6) and femoral stem revision rates (3.0%, CI 2.2-4.2 vs. 2.3%, CI 2.2-2.4) were comparable for short- and standard-stem THAs. Today's predominant short stems (Fitmore and Optimys) showed short-term revision rates similar to that of standard-stem THAs. Other, less frequently used short stems had higher 10-year overall (6.3%, CI 4.7-8.5) and femoral stem (4.5%, CI 3.1-6.3) revision rates. Multivariable Cox regression also showed a higher risk for overall (HR 1.7, CI 1.0-2.9) and femoral stem revision (HR 2.0, CI 1.1-3.5) using the latter short stems compared with standard stems. An exploratory analysis of PROMs showed no difference. CONCLUSION There was no overall difference in revision rates but a tendency toward increased revision of short stems both for the whole THA and for the stem itself. The less frequently used short stems had increased revision risk. No difference in PROMs was shown.
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Affiliation(s)
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen
| | - Jakob Van Oldenrijk
- Erasmus University Medical Center, Department of Orthopedics and Sport Medicine, Rotterdam
| | - Liza N Van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), 's-Hertogenbosch, the Netherlands
| | - B Willem Schreurs
- Department of Orthopedics, Radboud University Medical Center, Nijmegen; Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), 's-Hertogenbosch, the Netherlands
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Grimberg AW, Steinbrück A. [10 Years of the German Arthroplasty Registry-EPRD: what has been achieved?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04385-3. [PMID: 37221298 DOI: 10.1007/s00132-023-04385-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/25/2023]
Abstract
The German Arthroplasty Registry (EPRD) has been accumulating data on hip and knee arthroplasty procedures for 10 years. Even though the EPRD is a voluntary registry, it currently includes more than 2 million documented surgical procedures in Germany. This ranks the EPRD as the third largest registry in the world. The highly granular classification of the EPRD product database, which currently includes more than 70,000 components, is set to become the international standard. The linkage of hospital case data with specific implant component data and routine data from health insurance providers enables robust arthroplasty survival analyses. This provides hospitals, manufacturers, and the specialist community with access to specific results that contribute to improving arthroplasty quality. The registry is gaining increasing international recognition by publishing in peer-reviewed journals. An application procedure also allows "third-party" data access. Furthermore, the EPRD has also established an early warning system to detect anomalies in outcome. Software-based detection of potential implant component mismatches allows notification of hospitals concerned. In 2023, the EPRD will trial extending its data collection to include patient satisfaction surveys (i.e., patient-reported outcome measures), and subsequently to surgeon-specific data.
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Affiliation(s)
- Alexander W Grimberg
- EPRD Deutsche Endoprothesenregister gGmbH, Str. des 17. Juni 106-108, 10623, Berlin, Deutschland.
| | - Arnd Steinbrück
- EPRD Deutsche Endoprothesenregister gGmbH, Str. des 17. Juni 106-108, 10623, Berlin, Deutschland
- Orthopädisch-Chirurgisches Kompetenzzentrum Augsburg (OCKA), Augsburg, Deutschland
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10
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Radaelli M, Buchalter DB, Mont MA, Schwarzkopf R, Hepinstall MS. A New Classification System for Cementless Femoral Stems in Total Hip Arthroplasty. J Arthroplasty 2023; 38:502-510. [PMID: 36122690 DOI: 10.1016/j.arth.2022.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/18/2022] [Accepted: 09/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The growing variety of total hip arthroplasty implants necessitates a standardized, simple, and brand-neutral language to precisely classify femoral components. Although previous classifications have been useful, they need updating to include stems that have current surface treatment technologies, modularity, collar features, and other geometric characteristics. METHODS To accomplish this, we propose a new classification system for stems based on 3 distinguishing stem features: (1) geometry, (2) location of modularity, and (3) length. RESULTS Our system allows for the easy classification of all currently used stem types. CONCLUSIONS One goal of this endeavor is to improve clinical record keeping to facilitate study comparisons as well as literature reviews.
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Affiliation(s)
- Marco Radaelli
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Daniel B Buchalter
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Gabrion M, Rattier S, Blondin E, Michaud A, Mertl P, Gabrion A. Survival and radioclinical evaluation of the Optimys™ short stem at more than 6years' mean follow-up: A retrospective study of 108 cases. Orthop Traumatol Surg Res 2023; 109:103470. [PMID: 36336294 DOI: 10.1016/j.otsr.2022.103470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The short stems developed in recent years offer an interesting alternative to standard long stems. The Optimys™ short stem has been widely studied, but not according to the National Institute for Health and Care Excellence (NICE) criteria. We therefore conducted a retrospective study of Optimys™ at a minimum 5years' follow-up, to assess: (1) survival on NICE criteria, (2) complications, (3) functional results, and (4) subsidence, restoration of offset and bone remodeling. HYPOTHESIS Optimys™ shows survival comparable to that of other non-cemented standard and short stems, with a<0.5% per year revision rate or<2.5% at 5years on NICE criteria. MATERIAL AND METHODS A single-center retrospective study included 108 Optimys™ stems at a mean 76.5months' follow-up (range: 60-112months). Clinical [Harris, Oxford-12 and forgotten hip (French version: SHO-12) scores] and radiologic data were collected pre- and postoperatively. Analysis focused on implant survival, complications, functional results and radiological results (restoration of offset, bone remodeling, subsidence and osseointegration) and risk factors for stem migration. RESULTS At a mean 76.5months' follow-up (range: 60-112months), Optimys™ survival was 97.7% (95% CI: 0.945-1). Oxford and Harris scores improved significantly: respectively, 16.1 vs. 44.7 [Δ=28.598; 95% CI: 27.410-29.785 (p<0.001)] and 45.3 vs. 95 [Δ=49.662; 95% CI: 47.442-51.882 (p<0.001)]. Mean forgotten hip score (SHO-12) at last follow-up was 82.7±19.6 (range: 35.4-100.0). There was 1 case of aseptic revision at 11months for femoral osseointegration defect. Mean subsidence was 1.64mm (range: 0-20.63mm); no predisposing factors could be identified. Femoral offset increased by a mean 2.41±4.53mm (range: -10.10 to 14.70mm). CONCLUSION The present study reports good survival for the Optimys™ stem, which meets NICE criteria. Radiologic and clinical results were encouraging, with a low rate of subsidence, comparable to other series, but with increased femoral offset. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Matthieu Gabrion
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France.
| | - Simon Rattier
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Emile Blondin
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Audrey Michaud
- Direction de la recherche clinique et de l'innovation, site Sud - Hall 1 - 1(er) étage zone administrative, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Patrice Mertl
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, pôle santé, 3, rue des Louvels, CS 13036, 80036 Amiens, France
| | - Antoine Gabrion
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, pôle santé, 3, rue des Louvels, CS 13036, 80036 Amiens, France
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Nelson JT, Zheng H, Hallstrom BR, Hughes RE, Mont MA, Masini MA. Are Short Stems Associated With Higher Fracture Rates and Early Revision Rates in Primary Total Hip Arthroplasty? A Noninferiority Analysis. J Arthroplasty 2023:S0883-5403(23)00008-6. [PMID: 36639113 DOI: 10.1016/j.arth.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/22/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This study aimed to determine if "short" femoral stems were noninferior to (at least as good as) standard-length stems in regards to 90-day periprosthetic fracture and 1-year revision rates. METHODS Using the MARCQI implant registry, a retrospective study of statewide data was carried out on 64,084 total hip arthroplasties (THAs) between 2012 and 2017. We noticed an increase in the use of "short" uncemented femoral hip stems during THA. Chi-square tests were used to test homogeneity of categorical variables. The covariates included in the analyses were identified using modern epidemiological methods. A Type I probability of 0.05 was used as the level of statistical significance. Inverse probability of treatment weighting (IPTW) was used to mitigate confounding variables. RESULTS One hundred and seven stems were implanted by surgeons in the state of Michigan. They were classified according to the Khanuja Classification System as Type 2A (trapezoidal, double-tapered calcar loading, n = 3,281), Type 3 (calcar loading with lateral flare, n = 1,898), and Type 4 (shortened, tapered, conventional, n = 19,580), and were compared to standard-length, type 5, stems (n = 33,322) in regards to the 2 outcomes (periprosthetic fractures and 1-year revision rates). Overall, 1-year revision and the 90-day fracture rates were 1.3% (791/57,853) and 1.1% (631/57,968), respectively. Noninferiority was established for all short stems at the clinical threshold of an odds ratio (OR) of 1.5 with P-values <0.05 for 90-day fractures. In regards to 1-year revision rates, noninferiority was also established for Type 3 and 4 stems (P < .05). CONCLUSION The increased use of "short stems" in Michigan did not lead to increased 1-year revision or 90-day fracture rates.
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Affiliation(s)
- Joseph T Nelson
- Dignity Health Medical Group, Arizona Creighton University School of Medicine- Phoenix, Phoenix, Arizona
| | - Huiyong Zheng
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brian R Hallstrom
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Richard E Hughes
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael A Mont
- Northwell Health Orthopaedic Institute at Lenox Hill, New York, New York
| | - Michael A Masini
- Department of Orthopedic Surgery, St. Joseph Mercy Hospital, Ann Arbor, Michigan
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Reinbacher P, Smolle MA, Friesenbichler J, Draschl A, Leithner A, Maurer-Ertl W. Three-year migration analysis of a new metaphyseal anchoring short femoral stem in THA using EBRA-FCA. Sci Rep 2022; 12:17173. [PMID: 36229640 PMCID: PMC9561653 DOI: 10.1038/s41598-022-22160-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 10/10/2022] [Indexed: 01/04/2023] Open
Abstract
Cementless calcar-guided femoral short stems in total hip arthroplasty (THA) have become increasingly popular over the years. Early distal migration of femoral stems measured by Einzel-Bild-Roentgen Analyse, Femoral Component Analyse (EBRA-FCA) has been reported to be a risk factor for aseptic loosening. The aim of this study was to analyse axial migration behavior and subsidence of a new short stem (launched in 2015) over a follow-up period of 3 years. According to the study protocol, 100 hip osteoarthritis patients who consecutively received an unilateral cementless calcar-guided short stem (ANA.NOVA proxy) at a single department were prospectively included in this mid-term follow-up study. Thirteen patients were lost to follow-up, resulting in 87 patients with unilateral THA who fulfilled the criteria for migration analysis with EBRA-FCA. The cohort comprised 41 males (mean age: 60 ± 16.5; mean BMI (Body Mass Index): 30 ± 13) and 46 females (mean age: 61 ± 15.5; mean BMI: 27 ± 10). Seven standardized radiographs per patient were analyzed with EBRA-FCA. An average migration of 2.0 mm (0.95-3.35) was observed within the first 3 years. The median increase during the first year was higher than in the second and third year (1.2 mm [IQR: 0.5-2.15] vs. 0.3 mm [IQR: 0.1-0.6 mm] vs. 0.25 mm [IQR: 0.1-0.5 mm]. Detected migration did not lead to stem loosening, instability, dislocation, or revision surgery in any patient. A higher risk for subsidence was observed in male and heavyweight patients, whereas the female gender was associated with a lower risk. No correlation between migration and revision could be observed. Although moderate subsidence was detectable, the performance of the short stem ANA.NOVA proxy is encouraging. Yet, its use may be re-considered in overweight and male patients due to more pronounced subsidence.
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Affiliation(s)
- Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Maria Anna Smolle
- 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
| | - Alexander Draschl
- 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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Meier MP, Bauer IJ, Maheshwari AK, Husen M, Jäckle K, Hubert J, Hawellek T, Lehmann W, Saul D. Predicting the Exception-CRP and Primary Hip Arthroplasty. J Clin Med 2021; 10:4985. [PMID: 34768504 PMCID: PMC8584609 DOI: 10.3390/jcm10214985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND While primary hip arthroplasty is the most common operative procedure in orthopedic surgery, a periprosthetic joint infection is its most severe complication. Early detection and prediction are crucial. In this study, we aimed to determine the value of postoperative C-reactive protein (CRP) and develop a formula to predict this rare, but devastating complication. METHODS We retrospectively evaluated 708 patients with primary hip arthroplasty. CRP, white blood cell count (WBC), and several patient characteristics were assessed for 20 days following the operative procedure. RESULTS Eight patients suffered an early acute periprosthetic infection. The maximum CRP predicted an infection with a sensitivity and specificity of 75% and 56.9%, respectively, while a binary logistic regression reached values of 75% and 80%. A multinominal logistic regression, however, was able to predict an early infection with a sensitivity and specificity of 87.5% and 78.9%. With a one-phase decay, 71.6% of the postoperative CRP-variance could be predicted. CONCLUSION To predict early acute periprosthetic joint infection after primary hip arthroplasty, a multinominal logistic regression is the most promising approach. Including five parameters, an early infection can be predicted on day 5 after the operative procedure with 87.5% sensitivity, while it can be excluded with 78.9% specificity.
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Affiliation(s)
- Marc-Pascal Meier
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37075 Göttingen, Germany; (M.-P.M.); (I.J.B.); (K.J.); (T.H.); (W.L.)
| | - Ina Juliana Bauer
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37075 Göttingen, Germany; (M.-P.M.); (I.J.B.); (K.J.); (T.H.); (W.L.)
| | - Arvind K. Maheshwari
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Martin Husen
- Department of Orthopedic Surgery, Rochester, MN 55905, USA;
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, 45147 Essen, Germany
| | - Katharina Jäckle
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37075 Göttingen, Germany; (M.-P.M.); (I.J.B.); (K.J.); (T.H.); (W.L.)
| | - Jan Hubert
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20521 Hamburg, Germany;
| | - Thelonius Hawellek
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37075 Göttingen, Germany; (M.-P.M.); (I.J.B.); (K.J.); (T.H.); (W.L.)
| | - Wolfgang Lehmann
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37075 Göttingen, Germany; (M.-P.M.); (I.J.B.); (K.J.); (T.H.); (W.L.)
| | - Dominik Saul
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37075 Göttingen, Germany; (M.-P.M.); (I.J.B.); (K.J.); (T.H.); (W.L.)
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA;
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