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Carnovale M, De Meo D, Guarascio G, Martini P, Cera G, Persiani P, Candela V, Gumina S, Villani C. Mid-Term Outcomes of a Short Modular Neck-Preserving Cementless Hip Stem: A Retrospective Study With a 6-Year Minimum Follow-Up. Arthroplast Today 2024; 27:101387. [PMID: 38707589 PMCID: PMC11068503 DOI: 10.1016/j.artd.2024.101387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/18/2024] [Accepted: 03/24/2024] [Indexed: 05/07/2024] Open
Abstract
Background The neck-preserving cementless short stem represents a valid therapeutic option for total hip replacement in high-functional-demand patients, but few studies are available about the use of modularity in the last-generation short stem. The aim of the study was to evaluate the mid-term survival of a specific implant design that combines partial collum short hip stem with neck modularity; assessing the functional status was the second endpoint. Methods A retrospective single-center cohort study was conducted on 75 patients aged 35 to 80 years, with a minimum 6-year follow-up. Patients with neurological/rheumatic pathologies and previous hip surgeries were excluded. All the patients underwent total hip replacement with a short modular neck-preserving cementless hip stem. Clinical outcomes, complications, revisions, and the Western Ontario and McMaster Universities Osteoarthritis Index, Harris hip score, and Short Form 12-Item Health Survey (SF-12) questionnaires were evaluated. The results were compared with healthy population's data extracted from the literature, stratified by age. Results The Kaplan-Meier analysis revealed a 10-year implant survival rate of 96.7%, coupled with a revision rate of 1.3%. Results showed a Harris hip score and physical SF-12 significantly lower and a mental SF-12 higher when compared to healthy population. No statistically significant differences emerged when comparing groups based on neck modularity. Conclusions The short modular neck-preserving cementless hip stem emerged as a reasonable choice for patients with elevated functional demands, ensuring good clinical outcomes while preserving bone integrity. The use of a modular neck in short stems didn't show any mechanical problems in the mid-term.
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Affiliation(s)
- Michele Carnovale
- Emergency Department, Policlinico Umberto I University Hospital, Rome, Italy
| | - Daniele De Meo
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Plastic Surgery and Orthopaedics, Policlinico Umberto I University Hospital, Rome, Italy
| | - Giovanni Guarascio
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Plastic Surgery and Orthopaedics, Policlinico Umberto I University Hospital, Rome, Italy
| | - Paolo Martini
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Plastic Surgery and Orthopaedics, Policlinico Umberto I University Hospital, Rome, Italy
| | - Gianluca Cera
- Emergency Department, Policlinico Umberto I University Hospital, Rome, Italy
| | - Pietro Persiani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Plastic Surgery and Orthopaedics, Policlinico Umberto I University Hospital, Rome, Italy
| | - Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Plastic Surgery and Orthopaedics, Policlinico Umberto I University Hospital, Rome, Italy
| | - Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy
- Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Ciro Villani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Plastic Surgery and Orthopaedics, Policlinico Umberto I University Hospital, Rome, Italy
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Ciatti C, Maniscalco P, Bosio S, Puma Pagliarello C, Bianchi G, Quattrini F. Pseudotumor from ceramic-on-ceramic total hip arthroplasty. Int J Surg Case Rep 2024; 116:109374. [PMID: 38401324 PMCID: PMC10943669 DOI: 10.1016/j.ijscr.2024.109374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Total hip arthroplasty is one of the most performed surgical interventions in the world. Adverse local tissue reactions and pseudotumors are infrequent but dangerous eventualities, which are often related with metal-on-metal or metal-on-polyethylene implants. This study wants to highlight how adverse local tissue reactions and pseudotumors must be taken into consideration during the diagnostic process. CASE PRESENTATION We report the case of a patient with ceramic-on-ceramic modular total hip arthroplasty with titanium neck. 12 years after surgery, he complained of pain and swelling on the hip. Diagnostic tests revealed the presence of a bulky pseudotumor. During the revision surgery biopsy samples were taken and microscopical analysis revealed the presence of fibrous tissue, fibrin hemorrhagic collections, histiocytes and chronic inflammation due to foreign body, with dark refractive material of an exogenous nature. CLINICAL DISCUSSION The possible formation of pseudotumor and metallosis reactions in hip prostheses with metal-on-metal coupling or in couplings with polyethylene is known. Many cases of pseudotumor are reported after revision of prostheses due to the breakage of ceramic components, but we did not observe any damage or corrosion of the prosthetic elements; on the other hand, we noticed an excessive retroversion of the femoral neck. It may be possible that an accurate microscopic analysis could clarify the failure of this implant. CONCLUSION To date ceramic-ceramic coupling remains the gold standard in terms of resistance and durability for hip arthroplasty but there is still a gap of knowledge in the field of tribology and individual immune response mechanisms.
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Affiliation(s)
- Corrado Ciatti
- U.O.C. Orthopedics and Traumatology, Guglielmo Da Saliceto Hospital, AUSL Piacenza, Italy; University of Parma
| | - Pietro Maniscalco
- U.O.C. Orthopedics and Traumatology, Guglielmo Da Saliceto Hospital, AUSL Piacenza, Italy; University of Parma.
| | - Silvia Bosio
- Pathology Unit, Onco-Hematologic Department, Guglielmo Da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy
| | | | - Giuseppe Bianchi
- Clinica Ortopedica III, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Fabrizio Quattrini
- U.O.C. Orthopedics and Traumatology, Guglielmo Da Saliceto Hospital, AUSL Piacenza, Italy; University of Parma
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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López RE, Pelayo de Tomás JM, Morales Suárez Varela M, Rodrigo Pérez JL. Comparison of chromium and cobalt serum levels between a modular neck stem and its monoblock counterpart in primary total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3403-3409. [PMID: 37140672 DOI: 10.1007/s00590-023-03567-1] [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: 02/06/2023] [Accepted: 04/27/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND The addition of junctions in modular stems implies a greater susceptibility to corrosion. PURPOSE The aim of this study is to compare serum chromium and cobalt levels after using a bimodular stem and its monoblock counterpart in primary total hip arthroplasty. Postoperative clinical scores were also compared. PATIENTS AND METHODS A prospective cohort study between 2012 and 2015 was designed. One arm of the cohort included patients with the cementless modular neck stem H-Max M® and the other with the cementless monoblock stem counterpart H-Max S®. RESULTS No statistically significant difference was found in chromium value between groups (p = 0.621) at two years postoperative. Cobalt value was higher in the modular group (p = < 0.001). No statistically significant difference was found in clinical postoperative scores except for the Harris Hip Score, with better results at six months in modular group (p = 0.007). CONCLUSIONS Higher serum cobalt level in the modular group has limited the use of modular stems in our daily practice. Advantages of modular stem were not found. LEVEL OF EVIDENCE II.
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Affiliation(s)
- R E López
- Doctor Peset University Hospital, Av. Gaspar Aguilar 90, 46017, Valencia, Spain.
| | - J M Pelayo de Tomás
- Doctor Peset University Hospital, Av. Gaspar Aguilar 90, 46017, Valencia, Spain
- School of Medicine, Valencia University, Av. Blasco Ibañez, 15, 46010, Valencia, Spain
| | - M Morales Suárez Varela
- Unit of Public Health, Hygiene and Enviromental Health, Departament of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, School of Pharmacy, Av. Vicente Andrés Estellés, Burjassot, Valencia, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Av. Monforte De Lemos 3-5, Pavillon 11, Floor 0, 28029, Madrid, Spain
| | - J L Rodrigo Pérez
- Doctor Peset University Hospital, Av. Gaspar Aguilar 90, 46017, Valencia, Spain
- School of Medicine, Valencia University, Av. Blasco Ibañez, 15, 46010, Valencia, Spain
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Castagnini F, Bordini B, Cosentino M, Tassinari E, Guizzardi G, Traina F. Comparison of single taper and dual taper versions of the same stem design in total hip arthroplasty for primary osteoarthritis. J Orthop Traumatol 2023; 24:5. [PMID: 36725766 PMCID: PMC9892395 DOI: 10.1186/s10195-023-00687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/21/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In total hip arthroplasty (THA), the outcomes of single taper (ST) and dual taper (DT) versions of the same stem design have been scarcely studied. A registry study comparing ST and DT versions of the same stem design was designed, aiming to assess: (1) the survival rates and the hazard ratios for failure; (2) the survival rates and the hazard ratios for failure using stem-focused endpoints. MATERIAL AND METHODS A regional arthroplasty registry was interrogated about stem designs with ST and DT versions in cementless THAs performed for primary osteoarthritis. Only the same cup and ceramic-on-ceramic bearings were included: the DT stems had a titanium-on-titanium modularity. Demographic and implant features were recorded. Survival rates and hazard ratios were evaluated and compared. Stem-focused endpoints were also investigated. RESULTS A total of 5359 THAs were included, with three stem designs. The two versions of every stem showed different demographics and implant-related features: ST versions were preferentially implanted in heavier young men. For each stem, the two versions had similar survival rates at 5 years (p = 0.076; p = 0.319; p = 0.616) and similar adjusted hazard ratios for failures (p = 0.084; p = 0.308; p = 0.729). When stem-focused endpoints were adopted, the ST and DT versions of the three stems achieved similar survival rates (p = 0.710; p = 0.784; p = 0.983) and similar adjusted hazard ratios (p = 0.647; p = 0.858; p = 0.787). Three neck breakages occurred (0.0007% of all the modular implants). CONCLUSIONS ST and DT versions of the same stem design did not show any differences in terms of survival rates and hazard ratios for failures at 5 years. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Francesco Castagnini
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Barbara Bordini
- grid.419038.70000 0001 2154 6641Laboratorio Di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136 Bologna, Italy
| | - Monica Cosentino
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Enrico Tassinari
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Giulia Guizzardi
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Francesco Traina
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy ,grid.6292.f0000 0004 1757 1758DIBINEM, Università Di Bologna, Bologna, Italy
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Castagnini F, Cosentino M, Bordini B, Montalti M, Biondi F, Faldini C, Traina F. Titanium modular stems in total hip arthroplasty due to developmental dysplasia: a registry comparison with single-taper implants. Hip Int 2023; 33:916-924. [PMID: 36127850 PMCID: PMC10486160 DOI: 10.1177/11207000221124115] [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: 09/04/2021] [Accepted: 06/28/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The routine use of proximal femoral modularity was discouraged in total hip arthroplasties (THAs). However, titanium dual-taper (DT) implants may provide some advantages over single-taper (ST) stems in cases of complex deformity. A registry study comparing ST and DT stems in dysplasia was designed, aiming to assess: (1) survival rates at long-term; (2) reasons for revision; (3) the profile of failed implants. METHODS The arthroplasty registry RIPO was investigated for cementless THAs performed for dysplasia since 2000. ST implants were compared to titanium-on-titanium DT stems. Demographics and implant features were collected. Survival rates and reasons for revision were compared. The profile of DT stem failures in dysplasia was defined. RESULTS 6429 implants were included in the study, 3642 ST and 2787 DT. The demographic and implant features of the 2 cohorts were not comparable. The DT cohort achieved higher survival rates at long-term (93.9% vs. 91.6%, p = 0.018). DT implants showed a higher rate of implant breakage (0.6%, p = 0.011) and a lower rate of aseptic loosening (p = 0.005). There were no differences in terms of revisions for dislocation. No metallosis occurred. There were more revisions in DT implants in males <65 years, with a 28-mm head size or smaller. CONCLUSIONS Modularity did not result in lower survival rates in dysplastic patients and may even reduce the rate of aseptic loosening in comparison to ST stems. The rate of implant breakage is not negligible. Younger males are not good candidates for titanium DT stems.
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Affiliation(s)
- Francesco Castagnini
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Monica Cosentino
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Montalti
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Biondi
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- First Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- University of Bologna, Italy
| | - Francesco Traina
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- University of Bologna, Italy
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Castagnini F, Bordini B, Lucchini S, Cosentino M, Tassinari E, Traina F. Mid-term outcomes of revision hip arthroplasty due to titanium modular neck failure. Arch Orthop Trauma Surg 2023; 143:5909-5918. [PMID: 36764965 DOI: 10.1007/s00402-023-04805-1] [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: 12/01/2022] [Accepted: 01/29/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION The current strategy for modular neck failures in total hip arthroplasty (THA) is calibrated on CrCo neck failures. Stem revision is usually required, but the procedure is challenging and achieves modest outcomes (up to 20% of re-revisions at short-term). No study reports revision strategies and outcomes after Ti neck failures. Aims of the study were to evaluate: (1) demographic and implant features of the cohort to be revised, (2) intra-operative findings and surgical revision strategies and (3) clinical and radiological post-revision outcomes. MATERIALS AND METHODS Hospital database was enquired about revisions due to Ti neck failures in primary THAs. Sixty-five revisions were enrolled (all with the same modular system). Neck exchange was attempted as the first-line treatment. Patients were clinically and radiographically evaluated after revision. RESULTS The revision cohort encompassed fatigue neck fractures occurred 4.4 ± 2.6 years after THA: patients < 65 years and/or > 80 kg (98.5%) were predominant. Fifty-three neck exchanges were performed (81.5%). Eleven failures required stem revisions (16.9%), generally due to demanding neck extraction. Six complications occurred after neck exchange (11.3%), among them 2 acute infections requiring surgery (3.8%). Among stem revisions, one aseptic loosening and one neck re-fracture (18.5%) required re-revisions. At a mean follow-up of 7.1 ± 4 years, the neck exchange cohort achieved a mean HHS of 89.1 ± 6.3 (stem revisions: 84.1 ± 10.9). CONCLUSIONS Revisions for Ti neck failures were predominantly performed due to fatigue fractures. In case of failures, neck exchange is a feasible procedure in most of the cases, with good outcomes at 7 years. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Stefano Lucchini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Enrico Tassinari
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- Orthopaedics and Traumatology, DIBINEM University of Bologna, Bologna, Italy
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Cook SD, Patron LP, Lavernia CJ, Gibian J, Hong T, Bendich I. Fracture of Contemporary Femoral Stems: Common Trends in This Rare Occurrence. J Arthroplasty 2023:S0883-5403(23)00364-9. [PMID: 37086930 DOI: 10.1016/j.arth.2023.04.025] [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: 11/20/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Fracture of contemporary femoral stems is a rare occurrence in total hip arthroplasty (THA). A knowledge gap remains regarding manufacturing, patient, and surgeon factors that may contribute to the increased risk of this complication. METHODS We analyzed 13 contemporary fractured porous coated femoral stems of various designs to determine cause and contributing factors of mechanical failure. Cases included 12 men and one woman who had an average age at index surgery of 53 years (range, 34 to 76). There were ten of 13 patients who had a body mass index (BMI) greater than 30 (obese); 3 of the 10 had a BMI greater than 40. The mean time to fracture was 7.6 years (range, 7 months to 12 years). RESULTS There were four titanium alloy stems that fractured an average of 3.6 years post-revision surgery for head/cup exchange, and had associated iatrogenic mechanical and electrocautery damage to the femoral neck at fracture initiation sites. There were six modular stems that failed at the stem-sleeve or stem-neck interfaces with evidence of fretting corrosion. For two stem-neck fractures, mis-matched head/stem combinations from different manufacturers resulted in untested mechanical offsets and loading. There were two proximal neck fractures and one mid-shaft fracture of coated cobalt-chromium alloy stems that occurred in three obese men. The neck fractures (10 to 12 years) were well-fixed stems. Lack of proximal fixation contributed to the mid-shaft fracture (7 months). CONCLUSION While rare, femoral stem fractures pose catastrophic outcomes in primary and revision THA. Manufacturing, patient, and surgical factors contributing to stem failures were identified, including patient obesity, heat-treatment reduction of mechanical properties, iatrogenic implant damage, and mixing of different vendor stems and heads.
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Affiliation(s)
- Stephen D Cook
- Fellowship of Orthopaedic Researchers, 320 Metairie-Hammond Hwy, Suite 406, Metairie, LA 70005.
| | - Laura P Patron
- Fellowship of Orthopaedic Researchers, 320 Metairie-Hammond Hwy, Suite 406, Metairie, LA 70005
| | | | - Joseph Gibian
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
| | - Thomas Hong
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
| | - Ilya Bendich
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
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Shabbir Tamboli S, Butta R, Sharad Jadhav T, Bhatt A. Optimized active contor segmentation model for medical image compression. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Pisanu F, Andreozzi M, Fiori E, Altamore F, Bartoli M, Caggiari G, Ortu S, Rios M, Manunta AF, Doria C. Surgical management of hip prosthetic failure in metallosis: A case series and literature review. J Orthop 2021; 28:10-20. [PMID: 34707335 DOI: 10.1016/j.jor.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/21/2021] [Accepted: 10/10/2021] [Indexed: 12/24/2022] Open
Abstract
Local and remote complications can be observed in hip prosthesis failures associated with metallosis. Structural changes in the periprosthetic bone and soft tissues may not always be precisely assessed preoperatively due to metal artifacts. The unpredictability of the damage extension, potentially leading to complex and insidious surgeries, requires the availability of alternative surgical plan(s) for the reconstruction of the joint. The aim of the study is to present and analyze, with the literature data support, practical tips for the revision of the prosthetic components, the management of ARMD and of intraoperative complications in the unusual scenario of metallosis.
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Affiliation(s)
- Francesco Pisanu
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Matteo Andreozzi
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Enrico Fiori
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Fabiana Altamore
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Marco Bartoli
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Gianfilippo Caggiari
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Sebastiano Ortu
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Mario Rios
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Andrea Fabio Manunta
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Carlo Doria
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
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Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches. MATERIALS 2021; 14:ma14113078. [PMID: 34199983 PMCID: PMC8200202 DOI: 10.3390/ma14113078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 12/13/2022]
Abstract
Titanium (Ti) alloys have been proven to be one of the most suitable materials for orthopaedic implants. Dual modular stems have been introduced to primary total hip arthroplasty (THA) to enable better control of the femoral offset, leg length, and hip stability. This systematic review highlights information acquired for dual modular Ti stem complications published in the last 12 years and offers a conclusive discussion of the gathered knowledge. Articles referring to dual modular stem usage, survivorship, and complications in English were searched from 2009 to the present day. A qualitative synthesis of literature was carried out, excluding articles referring solely to other types of junctions or problems with cobalt-chromium alloys in detail. In total, 515 records were identified through database searching and 78 journal articles or conference proceedings were found. The reasons for a modular neck fracture of a Ti alloy are multifactorial. Even though dual modular stems have not shown any clinical benefits for patients and have been associated with worse results regarding durability than monolithic stems, some designs are still marketed worldwide. Orthopaedic surgeons should use Ti6Al4V dual modular stem designs for primary THA in special cases only.
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12
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Maniscalco P, Quattrini F, Ciatti C, Gattoni S, Puma Pagliarello C, Burgio V, Di Stefano G, Cauteruccio M, Giovanelli M, Magro A, Capelli P. The Italian Covid-19 Phase 2 in Piacenza: results of the first semester of 2020 and future prospective of new orthopedics surgical procedures. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020159. [PMID: 33525208 PMCID: PMC7927514 DOI: 10.23750/abm.v91i4.10377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 12/23/2022]
Abstract
Introduction: During the pandemic, Piacenza’s Orthopedic and Traumatology Department firstly dealt with the emergency with the complete closure of all the elective surgical and outpatient activities. As general population, also healthcare workers were affected by Coronavirus, increasing difficulties of epidemic management. The aim of our study is to evaluate the activity trend of the first six months of 2020 in our hospital. Data will be compared to the two semesters of 2019, in order to have two objective samples. Materials and Methods: We retrospectively analyzed all the orthopedics surgical procedures performed at Guglielmo da Saliceto Hospital (Piacenza, Emilia Romagna, Northern Italy) between January 1st and June 30th 2020. 2019 semesters (January 1st - June 30th 2020 and July 1st - December 31st 2020) have been used as control group to evaluate the activity trend of the first six months of 2020, compared to the two semesters of 2019. Results: We noticed a significant increase of domestic and retirement houses accidents, a consistent increase in one-month mortality rate of 2020 first semester and a decrease of mean hospitalization time. About surgical procedures, we detect a drop in the total number: in the first semester of 2020 we performed 499 (-39.9%) surgeries less than the first semester of 2019 and 337 (-30.9%) then the second one. Traumatology recorded a decrease of 27.6% than the first semester of 2019 (-204 surgeries) and of 26.3% than the second one (-191 surgeries). Concerning orthopedic procedures, in comparison to the first semester of 2019 we registered a reduction of 57.6% (-295 surgeries) and of 40.2% to the second semester (-146 surgeries) Discussion and conclusion: Covid-19 forced a reorganization of the Italian Health System that led to a clear reduction of surgical procedures performed in the orthopedic and traumatology department. The “Phase 2” can’t be consider the last step of the emergency. We surely will have to get used to live with this enemy, at least until we will find an effective cure or a vaccine. (www.actabiomedica.it)
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Affiliation(s)
- Pietro Maniscalco
- Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
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