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Ishii S, Baba T, Shirogane Y, Hayashi K, Homma Y, Muto O, Kaneko K, Ishijima M. Callus formation after total hip arthroplasty using a short tapered-wedge stem. Skeletal Radiol 2024:10.1007/s00256-024-04756-7. [PMID: 39052073 DOI: 10.1007/s00256-024-04756-7] [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: 03/04/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE The incidence of periprosthetic fractures after total hip arthroplasty using a short tapered-wedge stem is high. Callus formation preceding this fracture, which indicates postoperative stress fracture around the stem, has been reported. However, previous studies on postoperative callus are limited. Hence, the current study aimed to evaluate the prevalence and risk factors of postoperative callus after total hip arthroplasty with a short tapered-wedge stem. MATERIALS AND METHODS This retrospective study included 127 patients who underwent total hip arthroplasty using a cementless short tapered-wedge stem. The depth of stem insertion was measured as the distance from the lateral corner of the stem to the most medial point of the lesser trochanter along the body axis. Postoperative callus was defined as a bridging callus on the lateral femoral cortex at the distal end of the porous coating of the stem. Plain radiography was performed before surgery and immediately and at 1, 3, and 6 months after surgery to assess postoperative callus. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PC. RESULTS In total, 60 (47.2%) of 127 patients presented with postoperative callus. Multivariate logistic regression analysis with postoperative callus as the dependent variable revealed that the stem depth at 1 month after total hip arthroplasty (odds ratio, 1.14; 95% confidence interval, 1.04-1.24, p = 0.002) was a significant and independent risk factor of postoperative callus. CONCLUSION Deep insertion of a short tapered-wedge stem is a risk factor for postoperative callus.
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Affiliation(s)
- Seiya Ishii
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan.
- Department of Orthopaedic Surgery, Yokohama Tsurugamine Hospital, Kanagawa, Japan.
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yuichi Shirogane
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Koju Hayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Osamu Muto
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
- Department of Orthopaedic Surgery, Yokohama Tsurugamine Hospital, Kanagawa, Japan
| | - Kazuo Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Freitag T, Fuchs M, Friedrich D, Bieger R, Reichel H, Oltmanns M. The Migration Pattern of a Short-Tapered Femoral Stem Correlates with the Occurrence of Cortical Hypertrophies: A 10-Year Longitudinal Study Using Ein Bild Röntgen Analyse-Femoral Component Analysis. J Clin Med 2024; 13:3616. [PMID: 38930145 PMCID: PMC11205188 DOI: 10.3390/jcm13123616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Shorter hip stems have shown promising mid-term results but lack long-term data. High rates of distal cortical hypertrophy (CH) have been described, suggesting a more diaphyseal load transmission. This study aimed to determine patient-specific and surgery-related factors influencing CH and their impact on 10-year outcomes. Methods: It included 100 consecutive total hip arthroplasties (THAs) using the Fitmore stem (Zimmer, Warsaw, Indiana), with clinical and radiographic follow-ups at 1, 2, 5, and at least 10 years post-surgery. Results: No revisions were performed due to aseptic loosening after a mean of 11.6 years (range: 10-13.5 years). CH was observed in 26% of hips, primarily in Gruen zones 3 and 5. There was no significant difference in the Harris Hip Score between patients with and without CH. Larger stem sizes and greater axial subsidence significantly correlated with CH occurrence (OD 1.80, (1.13-1.92), p = 0.004; OD 1.47, (1.04-2.08), p = 0.028). The Fitmore stem demonstrated excellent survival rates and favorable outcomes over 10 years. Conclusions: Despite a lower CH rate compared to other studies, significant correlations with stem size and subsidence were identified. This study underscores the importance of patient selection and achieving high primary stability to maintain the metaphyseal anchoring concept.
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Affiliation(s)
- Tobias Freitag
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
| | - Michael Fuchs
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
| | - David Friedrich
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
| | - Ralf Bieger
- Center for Knee, Hip and Shoulder Surgery, Schoen Clinic München Harlaching, Harlachinger Strasse 51, 81547 Munich, Germany;
| | - Heiko Reichel
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
| | - Moritz Oltmanns
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
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Ishii S, Homma Y, Matsukawa T, Baba T, Kaneko K, Ishijima M. Reply to letter to editor: Blood cobalt ion level in patients with different sizes of cobalt/chrome femoral head with Accolade TMZF stem. INTERNATIONAL ORTHOPAEDICS 2023; 47:97-98. [PMID: 36383224 DOI: 10.1007/s00264-022-05635-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Seiya Ishii
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Yasuhiro Homma
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Takehisa Matsukawa
- Department of Epidemiology and Environmental Health, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.,Department of Forensic Medicine, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Tomonori Baba
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Muneaki Ishijima
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
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