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McCrosson M, Broadfoot J, Yeager M, Marquess B, Scheinberg M, Naranje S. Femoral stem taper geometry and porous coating in cementless direct anterior primary total hip arthroplasty. J Orthop 2023; 46:169-173. [PMID: 38031626 PMCID: PMC10682507 DOI: 10.1016/j.jor.2023.11.009] [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: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study aims to compare the clinical outcomes and complications between a fully coated, dual-tapered hip stem versus a proximally coated, triple-tapered hip stem in patients undergoing cementless direct anterior (DA) primary total hip arthroplasty (THA). Methods A retrospective analysis was conducted on patients who underwent primary THA with either a fully coated, dual-tapered hip stem or a proximally coated, triple-tapered stem with at least a 1-year follow up. Exclusion criteria included any patients that did not receive either femoral stem, those undergoing bilateral THA, those with a surgical approach other than DA, those with an indication other than osteoarthritis, avascular necrosis (AVN), or femoral neck fracture, and those that had a cemented femoral component. Complications and clinical outcomes were assessed. Statistical analyses were conducted to identify significant differences between the groups. Results A total of 95 patients were included in the study. The average ages for the dual-tapered and triple-tapered stem cohorts were 63.6 and 59.5, respectively (p = 0.168). At 1-year follow-up, no significant differences were seen between the groups in terms of ambulatory status, ROM, and patient satisfaction (p = 0.414, p = 0.106, and p = 0.126). 6 (18 %) of the patients receiving the dual-tapered, fully coated hip stem had at least one complication while 8 (13 %) of the triple-tapered, proximally coated hip stem patients did (p = 0.550). Conclusion Both hip stem cohorts demonstrated comparable clinical outcomes and complication rates in patients undergoing primary DA THA and we believe that either hip stem may be a reasonable choice for patients. Future studies with larger sample sizes and longer follow-up periods are warranted to validate these findings.
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Affiliation(s)
- Matthew McCrosson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Jackson Broadfoot
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Matthew Yeager
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Ben Marquess
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Mila Scheinberg
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Sameer Naranje
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
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Jeong SJ, Park CW, Cho K, Jeong J, Lim SJ, Park YS. Rectangular Taper Stem Designs Are Associated With a Higher Risk for Periprosthstic Femoral Fractures After Cementless Total Hip Arthroplasty. J Arthroplasty 2023; 38:2379-2385. [PMID: 37271230 DOI: 10.1016/j.arth.2023.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Periprosthetic femoral fractures (PFFs) remain a major concern following cementless total hip arthroplasty (THA). This study aimed to evaluate the association between different types of cementless tapered stems and the risk of postoperative PFF. METHODS A retrospective review of primary THAs performed at a single center from January 2011 to December 2018 included 3,315 hips (2,326 patients). Cementless stems were classified according to their design. The incidence of PFF was compared between flat taper porous-coated stems (type A), rectangular taper grit-blasted stems (type B1), and quadrangular taper hydroxyapatite-coated stems (type B2). Multivariate regression analyses were performed to identify independent factors related to PFF. The mean follow-up duration was 61 months (range, 12 to 139). Overall, 45 (1.4%) postoperative PFFs occurred. RESULTS The incidence of PFF was significantly higher in type B1 stems than in type A and type B2 stems (1.8 versus 0.7 versus 0.7%; P = .022). Additionally, more surgical treatments (1.7 versus 0.5 versus 0.7%; P = .013) and femoral revisions (1.2 versus 0.2 versus 0%; P = .004) were required for PFF in type B1 stems. After controlling for confounding variables, older age, diagnosis of hip fracture, and use of type B1 stems were significant factors associated with PFF. CONCLUSION Type B1 rectangular taper stems were found to have higher risks for postoperative PFF and PFF requiring surgical management than type A and type B2 stems in THA. Femoral stem geometry should be considered when planning for cementless THA in elderly patients who have compromised bone quality.
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Affiliation(s)
- Sang-Jin Jeong
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan-Woo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungjun Cho
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jusam Jeong
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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3
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Han KS, Kang SR, Yoon SJ. Does the Periprosthetic Fracture Pattern Depend on the Stem Fixation Method in Total Hip Arthroplasty? Clin Orthop Surg 2023; 15:42-49. [PMID: 36778997 PMCID: PMC9880517 DOI: 10.4055/cios22004] [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: 01/04/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background Management of periprosthetic femoral fractures (PFFs) is reportedly challenging. Different patterns of PFFs would occur based on whether stem fixation was primarily cemented or cementless and whether these patterns would be associated with clinical outcomes, such as subsidence, fracture union, and complications, after stem revision. Methods A retrospective comparative study was performed, involving 52 PFF patients treated with tapered fluted modular stems (TFMSs). In the 52 patients with Vancouver B2 or B3, including 21 cemented stems and 31 cementless stems, fracture patterns and bone stock were analyzed. Clinical outcomes after revision surgery using the TFMSs were compared between the two groups. Results Transverse or short oblique type PFFs occurred around the cemented stem with loosening at the bone-cement interface. The Paprosky type III femoral deficiency and Vancouver type B3 fracture were observed more frequently in the cemented stem group. Otherwise, spiral fractures occurred more frequently in the cementless group (p < 0.001). Excessive subsidence of > 5 mm was observed more frequently in the cemented stem group (p < 0.001). The re-revision rates were higher in the cemented group than in the cementless group (p = 0.047). Conclusions In our study, it was found that the patterns of transverse or oblique PFFs were more frequently produced with cemented stems, while long spiral fractures were more frequent with cementless stems. Stem subsidence and reoperation related to complications were more common in patients with PFFs around cemented stems than those with PFFs around cementless stems.
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Affiliation(s)
- Kap-Soo Han
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Seung-rok Kang
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Sun-Jung Yoon
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.,Department of Orthopedic Surgery, Jeonbuk National University Medical School, Jeonju, Korea
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Kang JS, Nam YC, Kwon DG, Ryu DJ. Results of Hip Arthroplasty Using a COREN Stem at a Minimum of Ten Years. Hip Pelvis 2022; 34:211-218. [PMID: 36601611 PMCID: PMC9763833 DOI: 10.5371/hp.2022.34.4.211] [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: 08/10/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose We report on the 10-year clinical hip function and radiologic outcomes of patients who underwent hip arthroplasty using a COREN stem. Materials and Methods A consecutive series of 224 primary cementless hip arthroplasty implantations were performed using a COREN stem between 2009 and 2011; among these, evaluation of 128 hips was performed during a minimum follow-up period of 10 years. The mean age of patients was 65.4 years (range, 40-82 years) and the mean duration of follow-up was 10.8 years (range, 10-12 years). Evaluation of clinical hip function and radiologic implant outcomes was performed according to clinical score, thigh pain, and radiologic analysis. Results Dramatic improvement of the mean Harris hip score (HHS) from 59.4 preoperatively to 93.5 was observed at the final follow-up (P≤0.01). Stable fixation was demonstrated for all implants with no change in position except for one case of Vancouver type B2 periprosthetic femur fracture. A radiolucent line (RLL) was observed in 16 hips (12.5%). Thigh pain was observed in only two hips (1.6%) at the final follow-up. There were no cases of osteolysis around the stem. The survival rate for the COREN stem was 97.7%. Conclusion Good long-term survival with excellent clinical and radiological outcomes can be achieved using the COREN femoral stem regardless of Dorr type.
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Affiliation(s)
- Joon Soon Kang
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Yoon Cheol Nam
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Dae Gyu Kwon
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Dong Jin Ryu
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
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5
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Park CW, Eun HJ, Oh SH, Kim HJ, Lim SJ, Park YS. Femoral Stem Survivorship in Dorr Type A Femurs After Total Hip Arthroplasty Using a Cementless Tapered Wedge Stem: A Matched Comparative Study With Type B Femurs. J Arthroplasty 2019; 34:527-533. [PMID: 30545654 DOI: 10.1016/j.arth.2018.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/16/2018] [Accepted: 11/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is a lack of understanding on relationship between the femoral geometry and outcomes of total hip arthroplasty (THA). We investigated clinical and radiographic outcomes of THA using a cementless tapered wedge stem in patients with Dorr type A proximal femoral morphology and compared with those of type B femurs at a minimum follow-up of 5 years. METHODS We analyzed 1089 hips (876 patients) that underwent THA using an identical cementless tapered wedge stem. We divided all femurs into 3 types (Dorr type A, B, and C). Type A and B femurs were statistically matched with age, gender, body mass index, and diagnosis by using propensity score matching. Clinical, radiographic results, and stem survivorship were compared between the matched 2 groups. RESULTS A total of 611 femurs (56%) were classified as type A, 427 (39%) as type B, and 51 (5%) as type C. More radiolucent lines around femoral stems were found in type A femurs (7.8%) than in type B femurs (2.5%) (P < .001). Patients with radiolucency showed worse Harris Hip Score (86.2 points) compared with those without radiolucency (93.0 points) (P < .001). The stem survivorship of type A femur (97.8%) was lower than that of type B femur (99.5%) (P = .041). The reasons for femoral revision in type A femurs were periprosthetic fracture (67%), aseptic loosening (22%), and deep infection (11%). CONCLUSIONS This study showed a higher rate of complications after THAs using a cementless tapered wedge stem in Dorr type A femurs than those performed in type B femurs.
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Affiliation(s)
- Chan-Woo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyeon-Jun Eun
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Hak Oh
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun-Jun Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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6
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Peitgen DS, Innmann MM, Merle C, Gotterbarm T, Moradi B, Streit MR. Cumulative Long-Term Incidence of Postoperative Periprosthetic Femoral Fractures Using an Uncemented Tapered Titanium Hip Stem: 26- to 32-Year Results. J Arthroplasty 2019; 34:77-81. [PMID: 30274947 DOI: 10.1016/j.arth.2018.08.038] [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] [Received: 07/22/2018] [Revised: 08/12/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although falling is becoming a major problem in the elderly, little is known about the long-term incidence of postoperative periprosthetic femoral fractures (PFF) after total hip arthroplasty (THA) using uncemented stems with a minimum follow-up of 26 years postoperatively. METHODS In a consecutive series, the cumulative incidence of PFF after uncemented THA using a straight, collarless, tapered titanium stem was retrospectively reviewed in 354 hips (326 patients). After a mean follow-up of 28 (26-32) years postoperatively, 179 hips had died and 5 hips had been lost to follow-up. Kaplan-Meier survival analysis was used to estimate cumulative percentage probability of PFF. RESULTS At final follow-up, a total of 27 fractures in 27 patients had occurred. In 15 hips, the stem had to be revised, and in 10 the fracture was treated by open reduction and internal fixation. Two patients declined further surgery. The cumulative percentage probability of PFF was 1.6% (95% confidence interval, 0.7 to 3.8) at 10 years and 13.2% (95% confidence interval, 8.5 to 20.2) at 29 years after primary THA. There was no association between the occurrence of fracture and gender, age at primary THA, cup revision, or canal fill index. CONCLUSION Our findings indicate that PFF is the major mode of failure in the long term after uncemented THA using a tapered titanium stem. More research is needed to evaluate the reasons and risk factors for PFF after THA, thus providing better prophylaxis for those at risk and to compare the long-term incidence using different fixation methods and implants. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- David S Peitgen
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Moritz M Innmann
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Christian Merle
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Tobias Gotterbarm
- Department of Orthopedics, Kepler University Hospital, Linz, Austria
| | - Babak Moradi
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Marcus R Streit
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
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7
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Lee JM, Sim YS, Choi DS. Hip Arthroplasty Using the Bencox® Hip System: An Evaluation of a Consecutive Series of One Thousand Cases. Hip Pelvis 2018; 30:210-218. [PMID: 30534539 PMCID: PMC6284079 DOI: 10.5371/hp.2018.30.4.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 11/05/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose This is a report on the outcomes associated with a consecutive series of 1,000 cementless hip arthroplasties utilizing the Bencox® hip stem–the first Korean-developed hip prosthesis. Materials and Methods A consecutive series of 1,000 hip arthroplasties using the Bencox® hip stem were analyzed, starting from its initial release (September 2006) until June 2014. Patients in this consecutive series underwent surgery for fractures (n=552), arthritis (n=155), avascular necrosis (n=209), and revisions (n=84). Of these 1,000 cases, patients with a minimum follow-up of at least 1 year (n=616) were retrospectively analyzed for radiographic and clinical outcomes (i.e., Harris hip score). The stability of the prosthesis was evaluated by examining subsidence. Results During the follow-up period (mean follow-up period of 54.8 months), there were 2 cases requiring revision of the femoral stem–both were caused by periprosthetic fractures and neither involved stem loosening. The mean Harris hip score during follow-up was 95.5. Bone ongrowth occurred in 95% of patients; no cases of subsidence or aseptic loosening of the stem were detected, and no cases of postoperative complications such as ceramic breakage were observed. Conclusion Clinical and radiographic evaluations of hip arthroplasty using the Bencox® hip stem revealed excellent outcomes with an average of 54.8 month follow-up in a consecutive series of 1,000 cases.
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Affiliation(s)
- Joong-Myung Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Young-Suk Sim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dae-Sung Choi
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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8
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Kim MW, Chung YY, Lee JH, Park JH. Outcomes of Surgical Treatment of Periprosthetic Femoral Fractures in Cementless Hip Arthroplasty. Hip Pelvis 2016; 27:146-51. [PMID: 27536618 PMCID: PMC4972719 DOI: 10.5371/hp.2015.27.3.146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 08/19/2015] [Accepted: 08/19/2015] [Indexed: 11/24/2022] Open
Abstract
Purpose We aimed to evaluate the results of surgical treatment of periprosthetic femoral fractures in cementless total hip arthroplasty (THA). Materials and Methods From June 2002 to May 2012, 40 patients who could be followed-up for more than 1 year after surgery were enrolled in this study. The mean duration of follow-up was 28.5 months (range, 15-97 months) and the average age at the time of surgery was 71.5 years (range, 38-89 years). The fracture types were determined by using the Vancouver classification. Among intraoperative fractures, there were type A in 3 hips, type B2 in 2 hips and type B3 in one. Among postoperative fractures, type AG was present in 5 hips, type AL in 2 hips, type B1 in 15 hips, type B2 in 6 hips, type B3 in 3 hips, and type C in 3 hips. Evaluation of the results was based on bony union, stability of the prosthesis, postoperative complications, and Harris hip score at the final follow-up. Results Bony union was achieved in all but one case and the average time for bony union was 21 weeks. The mean Harris hip score was 86 at the final follow-up. Clinical results were above good in 34 of 40 hips (85.0%). Stem loosening occurred in one patient with a type B1 fracture treated with open reduction and plate fixation. Nonunion was observed in 1 patient with an AG type fracture. Conclusion Open reduction and fixation using a plate with a screw and cerclage wiring provided good results for periprosthetic fractures in patients who had a stable femoral stem without bone defects. Revision surgery with a cementless long stem should be considered in patients with an unstable stem or suspected stability in B1 type of THA using a proximal fixation type.
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Affiliation(s)
- Min-Wook Kim
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Young-Yool Chung
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Jung-Ho Lee
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Ji-Hoon Park
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
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Brand S, Ettinger M, Omar M, Hawi N, Krettek C, Petri M. Concepts and Potential Future Developments for Treatment of Periprosthetic Proximal Femoral Fractures. Open Orthop J 2015; 9:405-11. [PMID: 26401164 PMCID: PMC4578140 DOI: 10.2174/1874325001509010405] [Citation(s) in RCA: 6] [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: 04/15/2015] [Revised: 07/08/2015] [Accepted: 07/22/2015] [Indexed: 11/22/2022] Open
Abstract
Periprosthetic proximal femoral fractures are a major challenge for the orthopaedic surgeon, with a continuously increasing incidence due to aging populations and concordantly increasing numbers of total hip replacements. Surgical decision-making mainly depends on the stability of the arthroplasty, and the quality of bone stock. As patients final outcomes mainly depend on early mobilization, a high primary stability of the construct is of particular relevance. Osteosynthetic procedures are usually applied for fractures with a stable arthroplasty, while fractures with a loosened endoprosthesis commonly require revision arthroplasty. Osteoporotic bone with insufficient anchoring substance for screws poses one major concern for cases with well-fixed arthroplasties. Complication rates and perioperative mortality have remained unacceptably high, emphasizing the need for new innovations in the treatment of periprosthetic fractures. Transprosthetic drilling of screws through the hip stem as the most solid and reliable part in the patient might represent a promising future approach, with auspicious results in recent biomechanical studies.
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Affiliation(s)
| | - Max Ettinger
- Orthopaedic Department, Hannover Medical School, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, Germany
| | - Nael Hawi
- Trauma Department, Hannover Medical School, Germany
| | | | - Maximilian Petri
- Trauma Department, Hannover Medical School, Germany ; Steadman Philippon Research Institute, Vail, CO, USA
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Hamadouche M, Stern LLD. Periprosthetic fractures and complicated arthroplasties. INTERNATIONAL ORTHOPAEDICS 2015; 39:1671-2. [PMID: 26278676 DOI: 10.1007/s00264-015-2977-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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11
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Bicortical screw fixation provides superior biomechanical stability but devastating failure modes in periprosthetic femur fracture care using locking plates. INTERNATIONAL ORTHOPAEDICS 2015; 39:1749-55. [PMID: 25947899 DOI: 10.1007/s00264-015-2787-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The incidence of periprosthetic fractures is inevitably increasing. Sufficient stabilisation and proper screw placement next to large-volume implants remains difficult. Modern locking plates allow polyaxial, thus bicortical, screw placement around a prosthetic stem. This study analysed the biomechanical properties of different screw configurations in a locking plate construct of a periprosthetic femoral fracture model. METHODS A total of 20 Sawbones were used to stabilise a Vancouver-B1 femoral fracture with a locking plate using either four monocortical screws or three bicortical screws for proximal fixation. These were loaded with an increasing axial compression until failure. RESULTS Bicortical screw purchase was significantly superior to monocortical regarding load to failure (1,510 N ± 284 N versus 2,350 N ± 212 N, p < 0.001) and maximal number of cycles (6803 ± 760 versus 4041 ± 923, p < 0.001). However, the mode of failure in the bicortical group was a severe comminuted fracture pattern as opposed to the monocortical group in which a pull-out of the screws without further damage to the bone was observed. CONCLUSIONS Bicortical screw placement enhances the primary stability in treating periprosthetic femoral fractures. Notably, the mode of failure may limit the salvage options in case of revision surgery.
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12
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Interposition sleeve as treatment option for interprosthetic fractures of the femur: a biomechanical in vitro assessment. INTERNATIONAL ORTHOPAEDICS 2015; 39:1743-7. [PMID: 25913266 DOI: 10.1007/s00264-015-2788-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The number of patients having hip and knee arthroplasties on the ipsilateral leg is going to rise. In this regard, the prevalence of interprosthetic femoral fractures is going to increase further. The treatment of these fractures is difficult and sometimes it is impossible to perform an osteosynthesis because of worse bone quality. The goal of this study was to investigate the use of an interposition sleeve as an alternative treatment option for interprosthetic fractures with major bone loss. METHODS Six human cadaveric femurs were instrumented using cemented hip- and knee prosthesis. Interprosthetic fractures were induced during a four-point-bending test and then treated using the interposition sleeve. Afterwards the constructs were tested using the four-point-bending test again. RESULTS Load-to-failure of the construct before fracturing was significantly higher than after treatment with the interposition sleeve (10681 N vs. 5083 N; p = 0.002). The failure mechanism of the femurs with the interposition sleeve was plastic deformation of the hip or knee prosthesis. The interposition sleeve did not fail in any specimen. CONCLUSION The interposition sleeve is a valuable treatment option for interprosthetic fractures in situations in which osteosynthesis is impossible or insecure due to major bone defects. However, fracture healing should be preferred whenever possible.
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13
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Sidler-Maier CC, Waddell JP. Incidence and predisposing factors of periprosthetic proximal femoral fractures: a literature review. INTERNATIONAL ORTHOPAEDICS 2015; 39:1673-82. [PMID: 25813458 DOI: 10.1007/s00264-015-2721-y] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/21/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this review article was to investigate the incidence and predisposing factors for periprosthetic proximal femoral fractures (PFF) following total hip arthroplasty. METHODS We performed a comprehensive search of the medical literature in MEDLINE and EMBASE databases to review articles related to PFF, their incidence and risk factors. RESULTS AND CONCLUSIONS The incidence of PPF after primary THA was, in general, lower than after revision THA both for intra- and postoperative PFF. The rate of intraoperative PFF ranged from 0.1% to 27.8% and of postoperative PFF from 0.07% to 18%. Predisposing factors for intraoperative PFF are osteoporosis, rheumatoid arthritis, femoral preparation and surgical technique used to insert the rasp or femoral component, the use of press-fit cementless stems, and revision THA. In case of postoperative PFF, the following seem to be significant risk factors: advanced age, female gender, post-traumatic osteoarthritis, osteoporosis and rheumatoid arthritis, proximal femoral deformities, previous surgery of the affected hip, implant type (especially cementless stems and press-fit implantation), technical errors such as cortical perforation, cortical stress risers, low-energy trauma, osteolysis, loosening and revision THA.
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