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Staunton P, Alhojailan K, Desgagne C, Epure L, Zukor D, Huk O, Antoniou J. Acute Periprosthetic Hip Fractures With Short, Uncemented Femoral Stems. J Arthroplasty 2024; 39:S248-S253. [PMID: 38851408 DOI: 10.1016/j.arth.2024.05.087] [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: 12/12/2023] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Uncemented femoral stems in hip arthroplasty have shown excellent long-term results, and several systematic studies indicate satisfactory performance of short stems. However, biomechanical and finite element analysis studies have suggested that shorter stems allow greater micromotion, producing greater strain at the implant-bone interface, which potentially increases the risk for periprosthetic fracture (PPF). We sought to assess this risk within our unit. METHODS Our institution's arthroplasty database was searched for all primary total hip arthroplasties using short femoral stems performed between July 14, 2009 and August 29, 2022. The overall PPF rate and the PPF rate for individual femoral stems were established. Preoperative X-rays for each case were analyzed to characterize individual proximal femoral geometry. A data analysis was performed to identify risk factors for PPF. RESULTS For the time period assessed, 3,192 short femoral stems were implanted. This included 1,561 of stem A and 1,631 of stem B. Women constituted 55.37% of the cohort. The average patient age was 66 years (range, 22 to 95). The PPF rate was 0.6%, with 19 PPFs identified at a follow-up of 3 months. There was a significantly higher fracture rate in stem A (0.96%) compared to stem B (0.25%) (P ≤ .01). Proximal femoral geometry, age, and sex were not determined to be risk factors for PPF in our cohort. Individual surgeons and surgical approaches appeared to confer no increased risk. There was no significant difference in average stem length, but multivariate analysis identified stem type and stem length as an independent risk factor for PPF. CONCLUSIONS Our study identified individual stem and stem length as independent risk factors for PPF within our cohort. PPF is a multifactorial issue, and consensus on emerging risk factors such as implant design will hopefully inform decisions that can provide further risk reduction for individual patients.
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Affiliation(s)
- Peter Staunton
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | - Khalifa Alhojailan
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | | | - Laura Epure
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada
| | - David Zukor
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | - Olga Huk
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | - John Antoniou
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
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Lou Y, Wu J, Zhong Y, Tong P, Du W. Etiology, pathology, and treatment of osteonecrosis of the femoral head in adolescents: A comprehensive review. Medicine (Baltimore) 2024; 103:e39102. [PMID: 39058826 PMCID: PMC11272257 DOI: 10.1097/md.0000000000039102] [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: 02/09/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Femoral head necrosis is a common refractory disease in orthopedics, and shows a trend of getting younger. The occurrence of femoral head necrosis in adolescents is related to the use of glucocorticoids, autoimmune diseases, trauma, and other factors. Because adolescent patients are in the period of physical development, high activity requirements, and have fertility needs in the future, treatment is relatively difficult. Early artificial joint replacement may have problems such as wear and loosening, so total hip replacement is not the preferred treatment for adolescent patients with femoral head necrosis. This article will elaborate the research progress of femoral head necrosis in adolescents from 3 aspects, and summarize the benefits and side effects of core decompression combined with autologous stem cell transplantation in the treatment of early femoral head necrosis, so as to provide clinical ideas for the treatment of femoral head necrosis in adolescents.
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Affiliation(s)
- Yuhan Lou
- Jinhua Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Jiawen Wu
- Jinhua Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Ying Zhong
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wenxi Du
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Hong SH, Han SB. Midterm Comparative Analysis of Short Femoral Stem Survivorship in Dorr Type A Femurs. Clin Orthop Surg 2024; 16:201-209. [PMID: 38562642 PMCID: PMC10973610 DOI: 10.4055/cios23268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 04/04/2024] Open
Abstract
Background Proximal-distal mismatch has emerged as a prominent concern in Dorr type A femoral morphology, prompting the exploration of short stems as promising alternatives to conventional stems. This study aimed to evaluate clinical and radiographic outcomes of total hip arthroplasty (THA) using short femoral stems in Dorr type A proximal femoral morphology with a minimum follow-up of 5 years. Methods Patients with short femoral stems in Dorr type A between 2011 and 2017 were included. Patients with the Short Modular Femoral (SMF) stem and Metha stem were recruited and patients with a shortened tapered stem (Tri-Lock BPS) were matched by propensity score matching based on age, sex, body mass index, calcar to canal ratio, and diagnosis. Patient-reported outcomes and the presence of thigh pain were assessed at 5 years postoperatively. Revision rate, complication rate, and radiographic outcomes were also assessed and compared. Results Twenty-two cases (81%) in the SMF stem and 43 cases (65%) in the Metha stem had more than 5 years of follow-up data available. The SMF stem showed a higher failure rate than the other 2 groups, with 18% requiring revision surgery in the SMF stem compared to 4.6% in the Metha stem, and 2.3% in the Tri-Lock BPS. The SMF stem showed considerable complications such as stem position change and lateral cortical hypertrophy with inferior clinical outcomes than the other 2 stem groups. When the Metha stem and the Tri-Lock BPS groups were compared, more intraoperative fractures were observed in the Metha stem, whereas stress shielding and anterior thigh pain were significantly more prevalent in the Tri-Lock BPS. Conclusions The SMF stem might be less reliable than previously reported, showing a high failure rate and increased radiologic complications. Thus, its use for THA in Dorr Type A femurs needs caution. On the other hand, the Metha stem showed comparable outcomes to the shortened tapered Tri-Lock BPS.
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Affiliation(s)
- Seok Ha Hong
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Beom Han
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Hinz N, Marsoni G, Mittelstädt H, Sonnabend F, Wallroth K, Johl C, Weigert U, Anderl C, Ortmaier R, Zeleny N, Schulz AP. Short stem hip arthroplasty with the optimys prosthesis is a safe and effective option for obese patients: a mid-term follow-up multicenter study. Arch Orthop Trauma Surg 2024; 144:1401-1414. [PMID: 37924371 PMCID: PMC10896938 DOI: 10.1007/s00402-023-05105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/09/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION Short stems are a valuable option in young patients undergoing total hip arthroplasty (THA) because of their bone stock preserving properties facilitating revision hip arthroplasty. Although the effect of obesity on conventional THA is well studied, data about short stem THA in obese patients are lacking. Therefore, this study aimed to investigate the influence of obesity on complications, revisions, and outcome after short stem THA. MATERIALS AND METHODS This multicenter, observational cohort study included patients undergoing short stem THA with the optimys prosthesis. Follow-up examinations were performed at specific intervals up to 7 years postoperatively. Operation characteristics, general and specific complications, revisions, VAS rest pain, VAS load pain, VAS patient satisfaction, and Harris Hip Score (HHS) were recorded and statistically compared between obese (BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) patients. RESULTS Of the 224 patients included with a mean follow-up of 87.2 months (range 81.9-104.0), 69 were assigned to the OB group and 155 to the non-OB group. A minimally invasive approach was significantly less often selected in obese patients (p = 0.049), whereas operating time and length of hospital stay were not significantly different. The rate of general and specific complications did not significantly differ between both groups. Survival of the optimys prosthesis was 99.1% at 7-year follow-up and one patient per group had to undergo revision surgery. VAS rest pain, load pain, and satisfaction improved from preoperatively to postoperatively in both groups without a significant difference between both groups. While the HHS was improved from preoperatively to postoperatively, obese patients showed a significantly lower HHS at the 7-year follow-up (p = 0.01) but still exhibited an excellent scoring above the PASS threshold. CONCLUSION Short stem THA with the optimys prosthesis is a safe and effective option also in obese patients with an excellent clinical outcome and a low complication rate.
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Affiliation(s)
- Nico Hinz
- BG Hospital Hamburg, Trauma Surgery, Orthopedics and Sports Traumatology, Bergedorfer Strasse 10, 21033, Hamburg, Germany.
| | - Giulia Marsoni
- Erzgebirgsklinikum, Orthopedics and Trauma Surgery, Jahnsdorfer Strasse 7, 09366, Stollberg, Germany
| | - Hagen Mittelstädt
- University Medical Center Schleswig-Holstein, Campus Lübeck, Orthopaedic and Trauma Surgery, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Falk Sonnabend
- Helios Klinik Köthen, Orthopedics, Hallesche Strasse 29, 06366, Köthen, Germany
| | - Karsten Wallroth
- Erzgebirgsklinikum, Orthopedics and Trauma Surgery, Jahnsdorfer Strasse 7, 09366, Stollberg, Germany
| | - Carsten Johl
- Klinikum Dahme-Spreewald, Orthopedics and Trauma Surgery, Schillerstrasse 29, 15907, Lübben, Germany
| | - Ulrich Weigert
- Practice for Orthopedics and Trauma Surgery, Friedrichstrasse 1-3, 15537, Erkner, Germany
| | - Conrad Anderl
- Ordensklinikum Linz Barmherzige Schwestern, Orthopedics, Seilerstätte 4, 4010, Linz, Austria
| | - Reinhold Ortmaier
- Ordensklinikum Linz Barmherzige Schwestern, Orthopedics, Seilerstätte 4, 4010, Linz, Austria
| | | | - Arndt-Peter Schulz
- BG Hospital Hamburg, Trauma Surgery, Orthopedics and Sports Traumatology, Bergedorfer Strasse 10, 21033, Hamburg, Germany
- Medical Faculty, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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Anderl C, Johl C, Krüger T, Hubel W, Weigert U, Mittelstaedt H, Ortmaier R. Subsidence after calcar-guided short stem total hip arthroplasty: five-year results of a prospective multicentre study. INTERNATIONAL ORTHOPAEDICS 2024; 48:229-234. [PMID: 37606768 DOI: 10.1007/s00264-023-05934-3] [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: 05/15/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Calcar-guided short-stem total hip arthroplasty (THA) has shown excellent clinical outcomes. However, the migration pattern of such prostheses and its effect on clinical outcomes are less known. Therefore, we assessed the five-year subsidence after calcar-guided short-stem THA and its implications on clinical outcomes, patient-related factors, and complications. METHODS In this prospective multicentre study, we enrolled 213 patients (224 hips) who underwent calcar-guided short-stem THA mostly for degenerative hip diseases. We examined patients radiographically and clinically after six to 12 weeks, one year, two years, and five years. We evaluated subsidence using Einzel-Bild-Roentgen-Analyse femoral component analysis, assessed clinical outcomes, and systematically recorded all complications. RESULTS Overall, 131 patients (133 hips) were available for final follow-up at a median of 60 months (range, 2 to 72 months). We found a mean subsidence of 0.63 ± 1.22 mm at three months, 1.03 ± 1.60 mm at one year, 1.21 ± 1.91 mm at two years, and 1.54 ± 1.97 mm at five years. Patient-related factors (sex, age, weight, and BMI) did not significantly impact subsidence at five years (P > 0.05). Additionally, the Harris hip score, pain, and satisfaction improved significantly at five years compared to pre-operative values (P < 0.0001). Lastly, five patients underwent revision. CONCLUSION Calcar-guided short-stems revealed the highest subsidence rate within the first three months after THA and stabilisation after one year through the final follow-up examination. Moreover, patient-related factors had no influence on subsidence. Finally, clinical scores and patient satisfaction remained high at five years.
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Affiliation(s)
- Conrad Anderl
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Linz, Austria.
| | - Carsten Johl
- Klinikum Dahme-Spreewald GmbH, Lübben (Spreewald), Germany
| | - Thomas Krüger
- Abteilung Für Orthopädie Und Unfallchirurgie, Collm Klinik Oschatz GmbH, Oschatz, Germany
| | - Wilmar Hubel
- Kreiskrankenhaus Stollberg GmbH, Stollberg, Germany
| | - Ulrich Weigert
- Praxis Für Orthopädie Und Unfallchirurgie, Erkner, Germany
| | - Hagen Mittelstaedt
- UKSH Campus Lübeck, Klinik Für Orthopädie und Unfallchirurgie Sektion Orthopädie, Lübeck, Germany
| | - Reinhold Ortmaier
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Linz, Austria
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Hayashi S, Kuroda Y, Nakano N, Matsumoto T, Tachibana S, Kuroda R. Comparison study of periprosthetic bone remodeling between simultaneous bilateral total hip arthroplasty and unilateral total hip arthroplasty: a matched cohort study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2767-2772. [PMID: 37572119 DOI: 10.1007/s00264-023-05918-3] [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: 06/07/2023] [Accepted: 07/25/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE The load-bearing pattern of periprosthetic bone may differ between patients who underwent simultaneous bilateral and unilateral total hip arthroplasty (THA). We investigated the differences in periprosthetic bone remodeling after simultaneous bilateral total hip arthroplasty and unilateral total hip arthroplasty. METHODS This retrospective cohort study enrolled 154 consecutive patients undergoing THA using full hydroxyapatite (HA) compaction short stems. Patient characteristics including age, body mass index, University of California Los Angeles (UCLA) activity score, and bone shape of the proximal femur were adjusted by propensity score matching. Subsequently, periprosthetic bone mineral density changes were compared between simultaneous bilateral and unilateral THA. RESULTS We found that bone mineral density loss in the simultaneous bilateral THA group was significantly higher in zones 6 and 7 at 24 months after THA (zone 6, p = 0.019; zone 7, p = 0.041). Periprosthetic bone mineral density loss was not associated with clinical factors, including age, body mass index, and daily activity. Additionally, we demonstrated that periprosthetic bone mineral density loss was higher in zones 1, 4, 6, and 7 of patients with a normal hip on the contralateral side after unilateral THA (zone 1, p = 0.041; zone 4, p = 0.041; zone 6, p = 0.037; zone7, p = 0.019). CONCLUSIONS The postoperative periprosthetic bone remodeling was lower in patients who underwent simultaneous bilateral THA than in those who underwent unilateral THA, even though patient characteristics were adjusted by propensity matching. Further observation of periprosthetic bone mineral density loss is needed to clarify the differences between the groups.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shotaro Tachibana
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Mittelstaedt H, Anderl C, Ortmaier R, Johl C, Krüger T, Wallroth K, Weigert U, Schagemann JC. Subsidence analysis of a cementless short stem THA using EBRA-FCA - A seven-year prospective multicentre study. J Orthop 2023; 43:93-100. [PMID: 37575949 PMCID: PMC10415660 DOI: 10.1016/j.jor.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023] Open
Abstract
Background Metaphyseal fixation of short stem THA allows for minimally invasive surgery, less bone removal, improved bone load transfer and reduced stress shielding. Short stems facilitate the anatomic restoration i.a. of leg length, femoroacetabular offset, and center of rotation. However, metaphyseal fixation might cause impaired primary and/or secondary stability resulting in an inherent tendency for early axial migration and aseptic loosening eventually. The objective of this study was to investigate the long-term outcome and migration pattern of a calcar-guided short stem. Methods In a prospective multicenter study, 213 patients (224 THAs) were enrolled. Patients were followed for up to 84 months postoperatively. Clinical outcome was assessed using the Harris Hip Score and the VAS for pain and satisfaction. Standardized and calibrated radiographs were screened i.a. for stress shielding and loosening. Einzel-Bild-Roentgen-Analyse - femoral component analysis (EBRA-FCA) was used to detect longitudinal subsidence. Results At 7 year follow-up, n = 139/224 cases were available for analysis. All clinical parameters improved significantly (p < 0.001) and improvement persisted. There were no radiographic changes indicating stress shielding. EBRA-FCA revealed a mean subsidence of -1.44 mm followed by a stabilization. Weight >80 kg (p = 0.115), BMI <30 kg/m2 (p = 0.282), male gender (p = 0.246), and age <65 years (p = 0.304) seemed to be associated with a higher risk for migration. The cumulative revision rate was 2.23%. Revisions due to stem migration (0.89%) occurred early (mean time between index surgery and revision: 3.3 months). Conclusions If at all, there appears to be a pronounced initial subsidence, which stabilizes thereafter. Stem migration was rarely a compelling reason for failure or revision. Demographics do not seem to have a significant effect on migration pattern. The absence of radioluce lines, resorption or hypertrophy of the proximal femora support the hypothesis of a reduced stress shielding for metaphyseal anchoring short stems.
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Affiliation(s)
- Hagen Mittelstaedt
- UKSH Campus Lübeck, Klinik für Orthopädie und Unfallchirurgie Sektion Orthopädie, Ratzeburger Allee, Lübeck, Germany
| | - Conrad Anderl
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Seilerstätte, Linz, Austria
| | - Reinhold Ortmaier
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Seilerstätte, Linz, Austria
| | - Carsten Johl
- Klinikum Dahme-Spreewald GmbH, Lübben (Spreewald), Germany
| | - Thomas Krüger
- Helios Klinik Köthen, Hallesche Straße, Köthen (Anhalt), Germany
| | - Karsten Wallroth
- Kreiskrankenhaus Stollberg GmbH, Jahnsdorfer Straße Stollberg, Stollberg, Germany
| | - Ulrich Weigert
- Praxis für Orthopädie und Unfallchirurgie, Friedrichstraße, Erkner, Germany
| | - Jan C. Schagemann
- UKSH Campus Lübeck, Klinik für Orthopädie und Unfallchirurgie Sektion Orthopädie, Ratzeburger Allee, Lübeck, Germany
- Christophorus Kliniken Coesfeld, Südring 41, 48653, Coesfeld, Germany
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Burchard R, Graw JA, Soost C, Schmitt J. Stress shielding effect after total hip arthroplasty varies between combinations of stem design and stiffness-a comparing biomechanical finite element analysis. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05825-7. [PMID: 37269400 PMCID: PMC10345085 DOI: 10.1007/s00264-023-05825-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/22/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Total hip arthroplasty (THA) has become a highly frequent orthopaedic procedure. Multiple approaches have been made to design the femoral component for THA with a mechanical behaviour as close as possible to a natural femur. The aim of this study was to compare different combinations of design and biomechanical properties of THA prostheses and their impact on stress shielding of the periprosthetic bone. METHODS Virtual implantation of different stem designs (straight standard stem, straight short stem, anatomical short stem) by finite element analysis based on in vivo data from computer tomography was performed. For each stem, three grades of stiffness were generated, followed by a strain analysis. RESULTS Reduction of stem stiffness led to less stress shielding. Implantation of an anatomical short-stem prosthesis with low stiffness provided the most physiological strain-loading effect (p < 0.001). CONCLUSION A combination of a short and an anatomically designed stem with a low stiffness might provide a more physiological strain transfer during THA. Biomechanical properties of the femoral component for THA should be considered as a multifactorial function of dimensions, design, and stiffness.
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Affiliation(s)
- Rene Burchard
- University of Marburg, Marburg, Germany.
- Department of Orthopedics and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany.
- Department of Orthopedics and Trauma Surgery, Lahn-Dill-Kliniken, Rotebergstr. 2, 35683, Dillenburg, Germany.
| | - Jan A Graw
- Department of Anesthesiology and Intensive Care Medicine, Ulm University Hospital, Ulm, Germany
| | | | - Jan Schmitt
- University of Marburg, Marburg, Germany
- Department of Orthopedics and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany
- Department of Orthopedics and Trauma Surgery, Lahn-Dill-Kliniken, Rotebergstr. 2, 35683, Dillenburg, Germany
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9
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Al-Hajaj Z, Avval PT, Bougherara H. Computational prediction of the long-term behavior of the femoral density after THR using the Silent Hip stem. Comput Methods Biomech Biomed Engin 2023; 26:373-382. [PMID: 35436164 DOI: 10.1080/10255842.2022.2064712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Aseptic loosening due to the progressive periprosthetic bone resorption following total hip replacement is a crucial concern, that causes complications and failure of the arthroplasty surgery. The mismatch in stiffness between the hip implant and the surrounding femoral bone is one of the key factors leading to bone density resorption. This paper aimed to investigate the long-term response of the femoral bone after THR using the Silent Hip stem. For this purpose, a validated thermodynamic-based computational model was used to compute the change in bone density before and after THR. This model incorporated essential factors involved in bone remodeling process, such as mechanical loading, and biochemical affinities. The results of the numerical simulations using 3D finite element analysis were analyzed in five zones of interest qualitatively and quantitatively. Bone density predictions showed notable bone resorption in cervical areas, specifically in zone 1 and zone 5 of -18.7% and -14%, respectively. Conversely, bone formation was observed in the greater trochanter area (zone 2) of +25%. Stress shielding seemed to occur at cervical area due to the reduction in the mechanical loading in this region. Based on the quantitative analysis of the bone density distribution throughout the femoral bone, it appears that the Silent Hip stem achieved less bone resorption compared to conventional hip stem designs reported in the literature, which could be used for active patients.
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Affiliation(s)
- Zainab Al-Hajaj
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, ON, Canada.,Department of Mechanical Engineering, Australian College of Kuwait, Safat, Kuwait
| | - Pouria Tavakkoli Avval
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, ON, Canada.,Wearable, Interactive, and Mobile Technologies Access Centre in Health, Centennial College, Toronto, ON, Canada
| | - Habiba Bougherara
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, ON, Canada
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10
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Li Z, Li M, Yao X, Liu B, Liu S, Liu Z, Zhang B, Han Y. Bone Remodelling of the Proximal Femur After Hip Revision with a Metaphyseal-Fixation Femoral Stem Component. Ther Clin Risk Manag 2023; 19:171-181. [PMID: 36820321 PMCID: PMC9938707 DOI: 10.2147/tcrm.s393876] [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] [Received: 10/29/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Background Whether hip revision with a metaphyseal-fixation femoral stem component can restore the bone mass of the proximal femur remains unclear. The aims of this study were to identify whether the bone mineral density (BMD) of the proximal femur increases following hip revision with a metaphyseal-fixation femoral stem and to identify the factors associated with BMD recovery. Methods This was a retrospective study involving 36 patients who underwent hip arthroplasty with a metaphyseal-diaphyseal fixation stem (standard length stem) and had indications for hip revision, which was performed with a proximal press-fit short-stem prosthesis for each patient. Dual-energy X-ray absorptiometry (DEXA) was used to obtain, evaluate, and compare the BMD at baseline and one year and two years postoperatively. The proximal femur was divided into several independent areas according to the Gruen zone (Gruen 1 to Gruen 7 from the greater trochanter counterclockwise to the lesser trochanter). Logistic regression analyses were used to assess potential factors significantly associated with an increase in BMD. Results An increased BMD was obviously identified in the proximal femur. Two years after the surgery, the BMD of the Gruen 1, Gruen 2, Gruen 6, and Gruen 7 areas had increased by 22.6%, 12.6%, 16.2% and 24.2%, respectively, relative to baseline. Three independent risk factors associated with bone mineral density recovery were identified: age (OR=1.100, 95% CI=1.005-1.203, P=0.038), osteoporosis (OR=14.921, 95% CI=1.223-182.101, P=0.034) and fair to poor hip function (OR=13.142, 95% CI=1.024-168.582, P=0.048). Conclusion This study confirms that metaphyseal-fixation stem hip revision can indeed help restore bone mass in the proximal femur, especially in the Gruen 1, Gruen 2, Gruen 6 and Gruen 7 zones. It was also found that advanced age, osteoporosis, and fair to poor hip joint function were three important risk factors affecting the recovery of proximal femur bone mass after surgery. Trial Registration Retrospectively registered.
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Affiliation(s)
- Zhijie Li
- Department of Osteonecrosis and Hip Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, People’s Republic of China,Orthopedics Department, Affiliated Hospital of Hebei Engineering University, Handan, People’s Republic of China
| | - Mengnan Li
- Department of Osteonecrosis and Hip Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, People’s Republic of China
| | - Xiaowei Yao
- Orthopedics Department, Hebei Provincial Chest Hospital, Shijiazhuang, People’s Republic of China
| | - Bo Liu
- Department of Osteonecrosis and Hip Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, People’s Republic of China
| | - Sikai Liu
- Department of Osteonecrosis and Hip Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, People’s Republic of China
| | - Zeming Liu
- Department of Osteonecrosis and Hip Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, People’s Republic of China
| | - Binquan Zhang
- Department of Osteonecrosis and Hip Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, People’s Republic of China
| | - Yongtai Han
- Department of Osteonecrosis and Hip Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, People’s Republic of China,Correspondence: Yongtai Han, Email
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11
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Hochreiter J, Böhm G, Fierlbeck J, Anderl C, Birke M, Münger P, Ortmaier R. Femoral antetorsion after calcar-guided short-stem total hip arthroplasty: A cadaver study. J Orthop Res 2022; 40:2127-2132. [PMID: 34873734 PMCID: PMC9540338 DOI: 10.1002/jor.25228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 10/19/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
Calcar-guided short stems in total hip arthroplasty (THA) permit surgeons to successfully reconstruct postoperative femoroacetabular offset, accurately restore leg length, and adequately re-establish a wide range of caput-collum-diaphyseal angles. However, their effect on femoral antetorsion is less known. Indeed, controlling antetorsion of the femoral stem can be challenging because of the differences in individual femoral geometry and curvature. Therefore, we investigated if calcar-guided short-stem THA alters femoral antetorsion and compared it with conventional-stem THA. Using 12 Thiel-fixed, full-body cadaver specimens from donors without known hip disorders, we compared an uncemented calcar-guided femoral short-stem prosthesis with an uncemented conventional straight-stem prosthesis. In a paired study setup, each specimen received a calcar-guided short stem on one side and a conventional stem on the other. On the acetabular side, all specimens received a press-fit, monobloc acetabular cup. Femoral antetorsion angles were measured using the Waidelich method, and pre- and post-operative angles of both sides were recorded. The mean preoperative femoral antetorsion angles were similar in both groups (24.8° ± 7.5° vs. 23.8° ± 6.1°, p = 0.313). Mean postoperative femoral antetorsion angles were 23.0° ± 5.5° in short-stem and 13.5° ± 7.1° in conventional-stem hips. Short-stem hips had a small but nonsignificant difference in femoral antetorsion angles pre- and post-operatively (1.8° ± 3.2°, p = 0.109), while the difference for conventional-stem hips was much larger and highly significant (10.3° ± 5.8°, p < 0.001). Calcar-guided short-stem THA effectively restores femoral antetorsion. However, how this affects long-term clinical outcomes and complications warrants further exploration.
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Affiliation(s)
- Josef Hochreiter
- Department of Orthopedic Surgery, Ordensklinikum Linz GmbHBarmherzige Schwestern HospitalLinzAustria,Department of Orthopedics and TraumatologyParacelsus Medical UniversitySalzburgAustria
| | - Gernot Böhm
- Department of Diagnostic and Interventional RadiologyOrdensklinikum Linz GmbHLinzAustria
| | - Johann Fierlbeck
- Institute for Clinical InnovationParacelsus Medical UniversitySalzburgAustria
| | - Conrad Anderl
- Department of Orthopedic Surgery, Ordensklinikum Linz GmbHBarmherzige Schwestern HospitalLinzAustria
| | - Marco Birke
- Institute of Anatomy and Cell BiologyParacelsus Medical UniversitySalzburgAustria
| | | | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Linz GmbHBarmherzige Schwestern HospitalLinzAustria,Department of Orthopedics and TraumatologyParacelsus Medical UniversitySalzburgAustria,Research Unit of Orthopedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT Private University for Health SciencesMedical Informatics and Technology GmbHHall in TirolAustria
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12
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Del Río-Arteaga M, Payo-Ollero J, Vallejo M, Serrano-Toledano D, García-Benítez B, Ribera J. Short neck-preserving femoral stem for total hip arthroplasty: medium-term results of a 68-case series. Arch Orthop Trauma Surg 2022; 142:2093-2101. [PMID: 34302520 DOI: 10.1007/s00402-021-04069-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Short stems seem to be a good alternative for young patients as they offer promising results, rapid recovery and preservation of metaphyseal bone stock. This is one of the few studies in the literature to report medium-term clinical-radiological results for short hip stems. MATERIALS AND METHODS This prospective study evaluated 68 short femoral stems in 63 patients treated with total hip replacement. Clinical, functional and quality-of-life outcomes were measured at 6 and 12 months, and annually thereafter until the end of follow-up. The radiological analysis included measurements of potential leg length discrepancies, stem alignment and signs compatible with stress shielding. RESULTS Fifty-four males (59 hips) and nine females (9 hips) of an average age of 44.3 years (range, 25-68) were studied. The most common diagnosis was osteoarthritis (51.5%). Mean overall follow-up was 7.8 years (range, 5.8-9.8). The overall survival rate was 97.1% (95% CI 88.7-99.7%). Surgery resulted in an increase of 42.3 ± 1.1 points in the modified Harris Hip Score and 21.9 ± 0.6 points in the Oxford Hip Score (p < 0.001, respectively). Moreover, the pain score as measured on a numerical rating scale (NRS) improved from 95.8 to 36.3. As regards function, an improvement was observed from 3.2 ± 0.8 points to 6.8 ± 1.14 points on the University of California at Los Angeles activity score (p < 0.001, respectively). The radiological analysis showed an absence of radiolucencies or stress-shielding throughout the series. The complications rate at the end of follow-up was 5.7%. CONCLUSIONS The use of ultra-short cylindrical stems with complete anchorage in the femoral neck was shown to offer promising medium-term results. Such stems appear to be a good option for young patients, who are likely to require several revisions over their lifetime.
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Affiliation(s)
- Marta Del Río-Arteaga
- Orthopaedic Surgery and Traumatology Department, Hospital San Juan de Dios del Aljarafe, Av. San Juan de Dios, s/n, 41930, Bormujos, Sevilla, Spain.
| | - Jesús Payo-Ollero
- Orthopaedic Surgery and Traumatology Department, Hospital Viamed Santa Ángela de la Cruz, Av. de Jerez, 59, 41014, Sevilla, Spain
| | - Mercedes Vallejo
- Musculoskeletal Radiology Department, Hospital Virgen del Rocio, Av. Manuel Siurot s/n, 41013, Sevilla, Spain
| | - David Serrano-Toledano
- Orthopaedic Surgery and Traumatology Department, Hospital Viamed Santa Ángela de la Cruz, Av. de Jerez, 59, 41014, Sevilla, Spain
| | - Boris García-Benítez
- Orthopaedic Surgery and Traumatology Department, Hospital San Juan de Dios del Aljarafe, Av. San Juan de Dios, s/n, 41930, Bormujos, Sevilla, Spain
| | - Juan Ribera
- Orthopaedic Surgery and Traumatology Department, Hospital Viamed Santa Ángela de la Cruz, Av. de Jerez, 59, 41014, Sevilla, Spain
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13
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Anderl C, Steinmair M, Hochreiter J. Bone Preservation in Total Hip Arthroplasty. J Arthroplasty 2022; 37:1118-1123. [PMID: 35121089 DOI: 10.1016/j.arth.2022.01.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/27/2021] [Accepted: 01/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Preserving bone stock in younger and more active patients after total hip arthroplasty (THA) is important for future revision. Newer prosthesis designs, including short femoral stems and isoelastic acetabular cups, are likely to preserve more bone stock. However, long-term follow-up studies on bone remodeling after short-stem THA with an isoelastic monoblock acetabular cup are few. Therefore, we evaluated bone preservation after THA using these prostheses at a 5-year follow-up. METHODS This prospective observational study is a 5-year follow-up of our previously reported 2-year observational study on the same cohort of patients. We included 45 patients with primary osteoarthritis treated with a calcar-guided femoral short-stem prosthesis and a monoblock press-fit acetabular cup. We evaluated bone mineral density (BMD) around the prostheses using dual-energy X-ray absorptiometry and reported functional outcomes preoperatively and at 3, 12, 24, and 60 months postoperatively. All complications were recorded. RESULTS At the final follow-up, the BMD was comparable with that at 24 months in Gruen zones 3, 4, 5, 6, and 7, whereas it significantly differed in Gruen zones 1 (P < .0001) and 2 (P < .004). On the acetabular side, the BMD leveled off similarly in all DeLee and Charnley zones between 24 and 60 months (P > .05). Moreover, all measured clinical outcomes significantly improved (P < .001). One perioperative dislocation was reported. CONCLUSION Patients undergoing THA with a calcar-guided femoral short-stem prosthesis and a monoblock acetabular cup can expect preservation of bone stock over a longer follow-up with excellent clinical outcomes and few complications.
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Affiliation(s)
- Conrad Anderl
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Martin Steinmair
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Josef Hochreiter
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
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14
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Liu Y, Wei WX, Zeng Y, Ma J, Yang J, Shen B. Comparison of Femoral Bone Mineral Density Changes around 3 Common Designs of Cementless Stems after Total Hip Arthroplasty-A Retrospective Cohort Study. Orthop Surg 2022; 14:1059-1070. [PMID: 35466536 PMCID: PMC9163965 DOI: 10.1111/os.13265] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
Objective The aim of this study was to compare the periprosthetic BMD changes around Tri‐Lock “Bone Preserving Stem” with the other two common and longer stems (Corail and Summit) after THA. Methods It was a retrospective cohort study followed patients underwent the total hip arthroplasty from January 2013 to December 2015. They were selected and followed from January 2013 to Janaury 2020. Patients without osteoporosis underwent hip replacements with three aimed stems were included. Among the 138 patients included, 49 patients received the Tri‐Lock stem, 44 patients received the Corail stem, and 45 patients received the Summit stem. The periprosthetic BMD changes evaluated by the Dual energy X‐ray absorptiometry (iDXA) measurement according to the seven Gruen zones was the primary outcome. The Radiographic changes including spot welds, pedestal sign and grade of stress shielding was evaluated by the consecutive hip images. Einzel‐Bild‐Roentgen‐Analyze‐femoral component analysis (EBRA‐FCA) was used to measure the stem migration at 5 years postoperatively. Patient‐reported outcomes (PROMs) and adverse events were assessed and compared in three groups. Finally, the subgroups for the periprosthetic BMD changes, radiological and clinical outcomes were made based on the age, gender and length of follow‐up. Results A total of 138 patients were retrospectively followed for an average of 4.66 years. Excepting the different stems used in three groups, the age, gender and other characteristics of patients included were similar between groups. There was no significant difference between the three groups in periprosthetic BMD changes over postoperative 5 years. The Summit stem shown more BMD loss in Gruen zone 1 compared with the Tri‐Lock and Corail stems without significant difference (7.49%, −1.89% and −2.62%, respectively, P = 0.42). And the most prominent BMD loss was found in Gruen zone 7 for all three stems (−12.60%, −11.84%, and −9.56%, respectively, P = 0.91). The spot weld was significantly more common around the Corail stem, while there was no difference in the stem migration between three groups. Patient reported outcomes (PROMs) were significantly improved compared with the preoperative values. Regarding the rate of postoperative complications, two patients underwent the dislocation and 25 patients sometimes felt mild to moderate thigh pain. Subgroup analysis showed that female patients older than 50 years lost more BMD and had lower clinical scores, while the stem stability was not good enough in male patients. Conclusions The Tri‐Lock Bone Preserving Stem did not show significant difference in periprosthetic BMD changes compared with the other two conventional longer stems at 5 years after THA.
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Affiliation(s)
- Yuan Liu
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wen-Xing Wei
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Zeng
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Ma
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bin Shen
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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15
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Hakim R, Weinstein A, Dabby D, Rozen N, Shabshin N, Rubin G. Successful reconstruction of natural femoral anteversion using a short femoral stem in total hip arthroplasty surgery. J Int Med Res 2022; 50:3000605221091500. [PMID: 35443831 PMCID: PMC9047853 DOI: 10.1177/03000605221091500] [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] [Indexed: 11/29/2022] Open
Abstract
Objective Total hip arthroplasty (THA) involves postoperative risks, such as thigh
pain, periprosthetic fractures, and stress yielding. Short, anatomical,
metaphyseal-fitting, cementless femoral stems were developed to reduce these
postoperative risks. This study aimed to examine the “MiniMAX” prosthesis,
which is a new generation, short, anatomical femoral stem made by
Medacta. Methods Patients underwent a low-dose computed tomography scan. Femoral anteversion
was measured. We assessed the position and anteversion of the femoral
component and compared them with the unoperated side. We also assessed the
patients’ satisfaction and functional levels at 6 months postsurgery using
the Harris Hip Score (HHS) and the Oxford Hip Score (OHS). Results Nineteen individuals were recruited in this study. We found no significant
difference in femoral anteversion between the operated hip and the native
hip. Using the HHS and OHS questionnaires, we found clinical improvement in
the 6-month postoperative scores compared with the preoperative scores. Discussion The new-generation, short, anatomical femoral stem made by Medacta is
successful in reproducing natural femoral anteversion, while also improving
patients’ functioning and lifestyle. Future large-scale, prospective
comparison trials are required to further investigate this topic.
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Affiliation(s)
- Raja Hakim
- Orthopedic Department, Emek Medical Center, Afula, Israel
| | | | - Dan Dabby
- Orthopedic Department, Emek Medical Center, Afula, Israel
| | - Nimrod Rozen
- Orthopedic Department, Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Nogah Shabshin
- Orthopedic Department, Emek Medical Center, Afula, Israel.,Penn Medicine, Philadelphia, PA, USA
| | - Guy Rubin
- Orthopedic Department, Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion, Haifa, Israel
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16
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Djebara AE, El Yagoubi A, Mertl P, El Fatayri B, Dehl M, Gabrion A. Comparison of periprosthetic bone mineral density between two types of short-stems in total hip arthroplasty with a mean follow-up of 4 years. Orthop Traumatol Surg Res 2022; 108:103044. [PMID: 34389498 DOI: 10.1016/j.otsr.2021.103044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The use of short stems in primary hip arthroplasty has grown considerably in recent years, with a large variety of designs and stabilization methods available. Few studies have directly compared how these designs and fixation modes influence the bone mineral density (BMD) that is said to be better preserved with shorter implants. This led us to carry out a medium-term retrospective comparative study to (1) specify how the design of two different types of short stems influences the periprosthetic BMD, (2) compare the radiological and clinical outcomes of these stems. HYPOTHESIS The periprosthetic BMD of a short stem varies based on the implant's design. MATERIALS AND METHODS Ninety-three patients underwent total hip arthroplasty (THA) with a short stem between July 2012 and July 2014. Two groups of patients were formed: Vitae™ short stem (Adler Ortho, Milan, France), Optimys™ short stem (Mathys, Bettlach, Switzerland). The Vitae group consisted of 46 patients, while the Optimys group consisted of 47 patients. The mean age was 66 years, and the mean body mass index (BMI) was 26 kg/m2. The groups had comparable age, BMI, sex, Harris Hip score and preoperative radiological features. Periprosthetic BMD of the two types of implants was determined between the 1st and 4th year postoperative using dual-energy x-ray absorptiometry (DEXA) in the Gruen zones. The radiological and clinical outcomes were also determined. RESULTS There was a significant decrease in BMD in zone 7(-5.8%±0.1 CI95%[-0.09; -0.02] (p=0.003)), zone 2 (-4.8% ±0.1 CI95%[-0.093; -0.003] (p=0.038)) and zone 6 (-11% ±0.2 CI95%[-0.19; -0.03] (p=0.009)) in the patients with Vitae stems and in zone 2 (-13.7%±0.3 CI95%[-0.25; -0.03] (p=0.018)) in the patients with Optimys stems. A significant difference in BMD in zone 7 at 1 year (p=0.014) and 4 years (p=0.001) postoperative and in zone 6 (p=0.011) at 4 years postoperative existed between groups, with the Optimys group having higher BMD. There was a significant increase in femoral offset in the Optimys group but not the Vitae group: Δoffset=-0.50 mm±5.2 CI95%[-2.05; 1.05] (p=0.522) and Δoffset=2.79 mm±4.2 CI95%[1.21; 4.37] (p=0.001). The Harris Hip score was not significantly different between the two groups at 4 years postoperative (95.3±2.5 [88; 99] vs. 95.2±2.6 [88; 99] (p=0.991)). DISCUSSION The design of short stems appears to influence the distribution of loads and the periprosthetic BMD. These stems are associated with very good radiological and clinical results in the medium term. Bone remodeling appears to continue beyond 1 year after the THA procedure. LEVEL OF EVIDENCE III; Retrospective case-control study.
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Affiliation(s)
- Az-Eddine Djebara
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 80480 Salouël, France.
| | - Abdelkader El Yagoubi
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 80480 Salouël, France
| | - Patrice Mertl
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 80480 Salouël, France
| | - Bachar El Fatayri
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 80480 Salouël, France
| | - Massinissa Dehl
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 80480 Salouël, France
| | - Antoine Gabrion
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 80480 Salouël, France
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17
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He S, Zhao Y, Wang L, Bao Y, Xu R. Finite element analysis of optimal design of distal geometry of cementless femoral prosthesis. Niger J Clin Pract 2022; 25:1476-1483. [DOI: 10.4103/njcp.njcp_1888_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Necas L, Hrubina M, Melisik M, Cabala J, Cibula Z, Daniel M. Total hip arthroplasty with ultra-short uncemented stem in patients with osteonecrosis of the femoral head: mid-term results. Hip Int 2021; 33:463-470. [PMID: 34493111 DOI: 10.1177/11207000211043481] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mid-term results (clinical and radiographic) of ultra-short anatomical cementless stem total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH) has not often been presented. The aim of this study is to evaluate THA using the Proxima stem in patients with ONFH in the mid-term. METHODS The study consists of 73 patients (97 THAs) with a Proxima stem implanted between 2006 and 2015. The mean age of patients was 47.4 years, with a mean follow-up 105.2 months. The clinical results include preoperative and postoperative Harris Hip Scores (HHSs). Radiological follow-up reports on stem migration, bony trabecular development and radiolucent lines. The complications and revisions were registered. Kaplan-Meier survival analysis was performed to determine the implant survival. RESULTS The average HHS improved significantly from 40.3 preoperatively to 98.0 at the final evaluation (p ˂ 0.0001). Stem migration (subsidence and "varisation") was observed in 11 hips (in 9 of them up to 6th postoperative month without any further progression, in 2 with progressive migration and radiological loosening). Bony trabecular development was detected in modified Gruen zones (1,2,4,6,7 for Proxima stem): in zone 1 (0%), 2 (67.0%), 4 (64.9%), 6 (64.9%), 7 (0%). Radiolucent lines were observed in 1 cup and 6 stems (2 were loose, 4 with fibrous stable fixation). Complications were found in 5 hips (5.1%): squeezing hip once, repeated dislocation in 1, 1 early deep infection, and 2 loose stems. 2 hips (2.1%) were revised (dislocation, infection). The implant survival was 98.9% and 97.9% clinically and radiologically, respectively. CONCLUSIONS Observations in the mid-term show that the clinical and radiological results of the Proxima stem in patients with ONFH are promising. The stem design preserves the proximal femoral bone stock. The bony trabecular appearance confirms physiological proximal femoral load transmission.
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Affiliation(s)
- Libor Necas
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.,University Department of Orthopaedic Surgery, University Hospital Martin, Martin, Slovak Republic
| | - Maros Hrubina
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.,University Department of Orthopaedic Surgery, University Hospital Martin, Martin, Slovak Republic
| | - Marian Melisik
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.,University Department of Orthopaedic Surgery, University Hospital Martin, Martin, Slovak Republic
| | - Juraj Cabala
- University Department of Orthopaedic Surgery, University Hospital Martin, Martin, Slovak Republic
| | - Zoltan Cibula
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.,University Department of Orthopaedic Surgery, University Hospital Martin, Martin, Slovak Republic
| | - Matej Daniel
- Department of Mechanics, Biomechanics and Mechatronics, Faculty of Mechanical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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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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20
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Lawrie CM, Barrack RL, Nunley RM. Modular dual mobility total hip arthroplasty is a viable option for young, active patients : a mid-term follow-up study. Bone Joint J 2021; 103-B:73-77. [PMID: 34192909 DOI: 10.1302/0301-620x.103b7.bjj-2021-0145.r1] [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: 11/05/2022]
Abstract
AIMS Dual mobility (DM) implants have been shown to reduce the dislocation rate after total hip arthroplasty (THA), but there remain concerns about the use of cobalt chrome liners inserted into titanium shells. The aim of this study was to assess the clinical outcomes, metal ion levels, and periprosthetic femoral bone mineral density (BMD) at mid-term follow-up in young, active patients receiving a modular DM THA. METHODS This was a prospective study involving patients aged < 65 years, with a BMI of < 35 kg/m2, and University of California, Los Angeles activity score of > 6 who underwent primary THA with a modular cobalt chrome acetabular liner, highly cross-linked polyethylene mobile bearing, and a cementless titanium femoral stem. Patient-reported outcome measures, whole blood metal ion levels (μg/l), and periprosthetic femoral BMD were measured at baseline and at one, two, and five years postoperatively. The results two years postoperatively for this cohort have been previously reported. RESULTS A total of 43 patients were enrolled. At minimum follow-up of five years, 23 (53.4%) returned for clinical and radiological review, 25 (58.1%) had metal ion analysis performed, 19 (44.2%) underwent dual energy x-ray absorptiometry scans, and 25 (58%) completed a pain-drawing questionnaire. The mean modified Harris Hip Scores improved significantly from 54.8 (SD 19) preoperatively to 93.08 (SD 10.5) five years postoperatively (p < 0.001). One patient was revised for aseptic acetabular loosening. The mean cobalt levels increased from 0.065 μg/l (SD 0.03) to 0.08 (SD 0.05) and the mean titanium levels increased from 0.35 (SD 0.13) to 0.78 (SD 0.29). The femoral BMD ratio decreased in Gruen Zone 1 (91.9%) at five years postoperatively compared with the baseline scores at six weeks potoperatively. The femoral BMD ratio was maintained in Gruen zones 2 to 7. CONCLUSION The use of a modular DM component and a cementless, tapered femoral stem shows excellent mid-term survivorship with minimal concerns for corrosion and metal ion release in a cohort of young, active patients undergoing primary THA. Cite this article: Bone Joint J 2021;103-B(7 Supple B):73-77.
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Affiliation(s)
- Charles Murray Lawrie
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Robert L Barrack
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Ryan M Nunley
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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21
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Guo J, Tan J, Peng L, Song Q, Kong HR, Wang P, Shen HY. Comparison of Tri-Lock Bone Preservation Stem and the Conventional Standard Corail Stem in Primary Total Hip Arthroplasty. Orthop Surg 2021; 13:749-757. [PMID: 33675168 PMCID: PMC8126948 DOI: 10.1111/os.12946] [Citation(s) in RCA: 10] [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: 08/22/2020] [Revised: 11/16/2020] [Accepted: 01/16/2021] [Indexed: 02/05/2023] Open
Abstract
Objective To compare the clinical and radiographic outcomes between the Tri‐Lock Bone Preservation Stem (BPS) and the conventional standard Corail stem in primary total hip arthroplasty (THA). Methods From March 2012 to May 2014, we retrospectively reviewed 84 patients (104 hips) who received Tri‐Lock (BPS) and 84 patients (115 hips) who received conventional standard Corail stem in THA. Their mean ages were 53.12 ± 2.32 years and 52.00 ± 2.11 years, respectively. The clinical outcomes were assessed by Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Pain Visual Analogue Scale (VAS) and Harris Hip Score (HHS). The radiological outcomes were evaluated by the radiological examination. Accordingly, Intraoperative and postoperative complications were observed as well. Results The mean follow‐up time was 48.23 ± 2.91 months in the Tri‐Lock (BPS) group and 49.11 ± 2.11 months in the Corail group, respectively. The bleeding volumes in two groups were comparable (169.22 ± 58.11 mL vs 179.30 ± 59.14 mL, P = 0.003), with more bleeding volume in Corail group patients, while no statistically significance with respect to operation time was observed (65.41 ± 6.24 min vs 63.99 ± 6.33 min, P = 0.567). The rates of intraoperative fracture was 8% for the Corail group while 1% for the Tri‐Lock (BPS) group (8% vs 1%, P = 0.030). At final follow‐up, no statistical differences in regard to HHS, WOMAC, and Pain VAS were revealed between the two groups (P > 0.05). The rate of thigh pain was higher in Corail group than in Tri‐lock (BPS) group (5% vs 0%, P = 0.043). However, incidence of stress shielding in grade 1 was higher in Tri‐Lock (BPS) than in the Corail group (76% vs 23%, P < 0.01), while those in grade 2 and 3 were lower compared to the Corail stem (15% vs 28%, P < 0.01; 9% vs 16%, P = 0.008, respectively). Intriguingly, other assessments in relation to radiographic outcomes and postoperative complications were not comparable between the two groups. The Kaplan–Meier survival rate (revision surgery performed for any reason was defined as the end point) was similar between the two groups (P = 0.57), with 98.8% (95% confidence interval, 92.3%–100%) in Tri‐lock (BPS) group and 97.6% (95% confidence interval, 94.6%–100%) in Corail group. Conclusions The Tri‐Lock (BPS) has similar clinic performances compared to the Corail stem. Furthermore, the Tri‐lock (BPS) stem has some advantages in achieving lower incidence of thigh pain, stress shielding and intra‐operative fracture. Therefore, we recommend the Tri‐lock (BPS) stem as a good alternative in primary total hip arthroplasty, especially taking into account patient factors, including bone deficiency and convenience of extraction of the stem in hip revision.
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Affiliation(s)
- Jiang Guo
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.,Department of Orthopaedics, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Tan
- Department of Orthopaedic Surgery & Orthopeadic Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Peng
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.,Department of Orthopaedics, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Song
- Department of Osteology, Tianjin Hospital, Tianjin, China
| | - Hao-Ran Kong
- Department of Orthopaedics, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peng Wang
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.,Department of Orthopaedics, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui-Yong Shen
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.,Department of Orthopaedics, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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22
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Vu-Han T, Hardt S, Ascherl R, Gwinner C, Perka C. Recommendations for return to sports after total hip arthroplasty are becoming less restrictive as implants improve. Arch Orthop Trauma Surg 2021; 141:497-507. [PMID: 33258998 PMCID: PMC7899958 DOI: 10.1007/s00402-020-03691-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/11/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Total hip arthroplasty (THA) surgeries are expected to exponentially increase in the upcoming years, likely because of the overall broader indication of THAs. With these developments, an increasing number of younger (< 50 years) and active patients will receive surgical interventions, and expectations for an active lifestyle will accordingly increase. In addition, surgeons now have a growing array of techniques and implant materials to choose from. Despite these developments, evidence to provide the best standard-of-care to patients with high expectations for return to sports (RTS) is scarce and urgently needed. What recommendations do arthroplasty surgeons currently make to patients with high return to sports expectations, what factors may influence their recommendations and what surgical techniques and implant specifications are considered favorable in the treatment of patients with a more active lifestyle? This study was conducted to analyze the current recommendations, patient assessment, and patient counseling after THA to identify trends and relevant factors for surgical decision-making in patients with high-RTS expectations. MATERIAL AND METHODS We designed a questionnaire comprising five general items and 19 specific items that included 46 sub-items for hip arthroplasty and conducted a survey among 300 German surgeons specialized in arthroplasty at the German Arthroplasty Society (AE) to assess expert opinions, recommendations, surgical decision-making, and patient counseling for patients with high expectations for RTS after THA. RESULTS The majority of surgeons (81.9%) were in favor of RTS after THA. Risks associated with sports after THA were considered minimal (1%), with periprosthetic fractures ranking highest, followed by hip dislocation and polyethylene wear. Some surgical decision-making was influenced by high-RTS expectations in regard to implant fixation, stem type, femoral head diameter, and bearing-surface tribology. We observed an increasingly liberal counseling of patients for high-impact sports. CONCLUSION With the improvement of implants and surgical techniques, surgeons are more willing to encourage patients to adopt a more active lifestyle. However, the true long-term limitations need further investigation in future studies. LEVEL OF EVIDENCE 5 Expert opinions.
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Affiliation(s)
- T. Vu-Han
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - S. Hardt
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - R. Ascherl
- Department of Orthopaedic Surgery and Arthroplasty Nordoberpfalz AG, Krankenhaus Tirschenreuth, St.-Peter-Str. 31, 95643 Tirschenreuth, Germany
| | - C. Gwinner
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - C. Perka
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin University Hospital, Chariteplatz 1, 10117 Berlin, Germany
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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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