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Glismann K, Konow T, Lampe F, Ondruschka B, Huber G, Morlock MM. Small design modifications can improve the primary stability of a fully coated tapered wedge hip stem. PLoS One 2024; 19:e0300956. [PMID: 38630711 PMCID: PMC11023602 DOI: 10.1371/journal.pone.0300956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/07/2024] [Indexed: 04/19/2024] Open
Abstract
Increasing the stem size during surgery is associated with a higher incidence of intraoperative periprosthetic fractures in cementless total hip arthroplasty with fully coated tapered wedge stems, especially in femurs of Dorr type A. If in contrast a stem is implanted and sufficient primary stability is not achieved, such preventing successful osseointegration due to increased micromotions, it may also fail, especially if the stem is undersized. Stem loosening or periprosthetic fractures due to stem subsidence can be the consequence. The adaptation of an established stem design to femurs of Dorr type A by design modifications, which increase the stem width proximally combined with a smaller stem tip and an overall shorter stem, might reduce the risk of distal locking of a proximally inadequately fixed stem and provide increased stability. The aim of this study was to investigate whether such a modified stem design provides improved primary stability without increasing the periprosthetic fracture risk compared to the established stem design. The established (Corail, DePuy Synthes, Warsaw, IN, US) and modified stem designs (Emphasys, DePuy Synthes, Warsaw, IN, US) were implanted in cadaveric femur pairs (n = 6 pairs) using the respective instruments. Broaching and implantation forces were recorded and the contact areas between the prepared cavity and the stem determined. Implanted stems were subjected to two different cyclic loading conditions according to ISO 7206-4 using a material testing machine (1 Hz, 600 cycles @ 80 to 800 N, 600 cycles @ 80 to 1600 N). Translational and rotational relative motions between stem and femur were recorded using digital image correlation. Broaching and implantation forces for the modified stem were up to 40% higher (p = 0.024), achieving a 23% larger contact area between stem and bone (R2 = 0.694, p = 0.039) resulting in a four times lower subsidence during loading (p = 0.028). The slight design modifications showed the desired effect in this in-vitro study resulting in a higher primary stability suggesting a reduced risk of loosening. The higher forces required during the preparation of the cavity with the new broaches and during implantation of the stem could bare an increased risk for intraoperative periprosthetic fractures, which did not occur in this study.
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Affiliation(s)
- Katja Glismann
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Tobias Konow
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | | | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerd Huber
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Michael M. Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
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Ait-Si-Selmi T, Vidalain JP, Ramos-Pascual S, Kuratle T, Saffarini M, Dejour E, Bonnin MP. Outcomes of total hip arthroplasty using collared versus collarless uncemented HA-coated stems: a meta-analysis. EFORT Open Rev 2024; 9:264-275. [PMID: 38579748 PMCID: PMC11044085 DOI: 10.1530/eor-22-0091] [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] [Indexed: 04/07/2024] Open
Abstract
Purpose to systematically review comparative studies reporting revision rates, clinical outcomes, or radiographic outcomes of total hip arthroplasty (THA) using collared versus collarless conventional-length uncemented hydroxyapatite (HA)-coated stems. Methods In adherence with PRISMA guidelines, a literature search was performed on Medline, Embase, and Scopus. Comparative clinical studies were eligible if they reported outcomes of collared versus collarless uncemented HA-coated stems for primary THA. Two reviewers screened titles, abstracts, and full-texts to determine eligibility; then performed data extraction; and assessed the quality of studies according to Joanna Briggs Institute (JBI) checklist. Results The search returned 972 records, 486 were duplicates, and 479 were excluded after title/abstract/full-text screening. Three further studies were included from the references of eligible studies and from discussions with subject matter experts, resulting in 11 included studies. The JBI checklist indicated six studies scored ≥7 points and four studies ≥4 points. Pooled data revealed collared stems had significantly lower revision rates (OR = 0.45; 95% CI = 0.31-0.64) and subsidence (MD = -1 mm; 95% CI = -1.6--0.3), but no significant difference in intraoperative complication rates (OR = 0.94; 95% CI = 0.67-1.32) in the short term to mid-term. Unpooled data indicated that collared stems provide equivalent survival, equivalent or better outcomes, and equivalent or lower complication rates. Conclusion In comparative studies, collared stems have lower revision rates than collarless stems, as well as equivalent or better clinical and radiographic outcomes. Differences could be due to a protective effect that the collar offers against subsidence, particularly in undersized or misaligned stems. Further studies are warranted to confirm long-term results and better understand differences between registry data and clinical studies.
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Affiliation(s)
- Tarik Ait-Si-Selmi
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, 55 Avenue Jean Mermoz, Lyon, France
- Artro Institute, 8, rue du Pont de Thé, Annecy Le Vieux, France
| | | | | | | | | | | | - Michel P Bonnin
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, 55 Avenue Jean Mermoz, Lyon, France
- Artro Institute, 8, rue du Pont de Thé, Annecy Le Vieux, France
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Huang Z, Zhang Z, Wang W, Wang G, Lu X, Zhang H. Improved radiographic outcomes and decreased complications rate on the femoral side can be achieved by a novel designed whole-process robotic assisted hip system for total hip arthroplasty: a prospective randomized controlled trial. J Robot Surg 2024; 18:79. [PMID: 38365906 DOI: 10.1007/s11701-024-01835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/14/2024] [Indexed: 02/18/2024]
Abstract
Postoperative complications due to inaccurate prosthesis positioning are the main causes of early revision. The aim of this study was to (1) determine whether novel designed whole-process robotic assisted hip system allowed better radiographic outcomes and lower complications risk on the femoral side particularly stem subsidence compared to conventional THA, and to (2) identify the comparison of early clinical outcomes. 72 patients were initially enrolled and randomly divided into 2 groups. Finally, only 65 patients (31 RA-THAs, 34 C-THAs) were analyzed who had full 18-month follow-up data. Radiographic follow-up was performed at immediate and 6-month postoperatively, while clinical follow-up at 18-month postoperatively. Stem-related radiographic outcomes, femoral side complications and clinical scores were compared. The robotic arm allowed better radiographic outcomes of the femoral side, including a higher canal fill ratio (CFR) at B1 (P = 0.040), more neutral stem alignment (P = 0.029), lower subsidence (P = 0.023) and lower leg length discrepancy (LLD) (P = 0.010). In addition, low CFR at B1 (P = 0.001) was found the risk factor for subsidence. However, early clinical outcomes were consistent between both groups. The novel designed whole-process robotic assisted hip system covers both femoral and acetabular side operations. It allows accurate and safe manipulation of femoral side, including better stem-related radiographic outcomes and lower risk of subsidence and LLD. However, no advantage of robotic system in early clinical score was identified. Clinical trial registration number: ChiCTR2100044124.
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Affiliation(s)
- Zhenchao Huang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Zian Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Wenzhe Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Guanrong Wang
- Nursing Department of Operating Room, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xinzhe Lu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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Giovanoulis V, Kenanidis E, Aïm F, Gamie Z, Marmor S, Potoupnis M, Lustig S, Tsiridis E. Collared versus collarless hydroxyapatite-coated stems for primary cementless total hip arthroplasty; a systematic review of comparative studies. Is there any difference in survival, functional, and radiographic outcomes? SICOT J 2024; 10:8. [PMID: 38358293 PMCID: PMC10868518 DOI: 10.1051/sicotj/2024003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION This systematic review aims to critically assess the literature comparative studies investigating collared and collarless Corail stem in primary total hip arthroplasty (THA) to find differences in revision rates, radiographic and clinical outcomes, and postoperative complications between these two types of the same stem. METHODS Eligible studies were found by searching PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews from conception till May 2023. The PRISMA guidelines were followed. The investigation encompassed randomized controlled trials, case series, comparative, cohort, and observational studies that assessed at least one comparative outcome or complication between collared and collarless Corail stems. RESULTS Twelve comparative studies with 90,626 patients undergoing primary THA were included. There were 40,441 collared and 58,543 collarless stems. The follow-up ranged from 12 to 360 months. Our study demonstrated no significant difference in stem revision relative risk (RR = 0.68; 95% confidence interval (CI), 0.23, 2.02; p = 0.49), number of radiolucent lines (RR = 0.3; 95% CI, 0.06, 2.28; p = 0.29) and overall complication risk (RR = 0.62; 95% CI, 0.22, 1.76; p = 0.37) between collared and collarless stems. The collared stems demonstrated significantly lesser subsidence (mean difference: 1.01 mm; 95% CI, -1.77, -0.25; p = 0.009) and risk of periprosthetic fractures (RR = 0.52; 95% CI, 0.29, 0.92; p = 0.03). CONCLUSION The comparative studies between collared and collarless stem groups showed similar survival and overall complication rates and functional outcomes. The similar revision rates between groups make the impact of higher subsidence for collarless stems uncertain. The lower risk of periprosthetic fractures in the collared stems group must be clarified further but could be related to increased rotational stability.
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Affiliation(s)
- Vasileios Giovanoulis
- Orthopedic Surgery Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon 125 Rue d’Avron 75020 Paris France
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon 103 Grande Rue de La Croix Rousse 69004 Lyon France
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| | - Florence Aïm
- Orthopedic Surgery Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon 125 Rue d’Avron 75020 Paris France
| | - Zakareya Gamie
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| | - Simon Marmor
- Orthopedic Surgery Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon 125 Rue d’Avron 75020 Paris France
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon 103 Grande Rue de La Croix Rousse 69004 Lyon France
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
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Munir S, Suzuki L, Dixon M. Migration Characteristics of a Proximally Coated Collarless Femoral Stem: A Prospective 2-Year Radiostereometric Analysis Study. Arthroplast Today 2023; 22:101157. [PMID: 37521743 PMCID: PMC10374859 DOI: 10.1016/j.artd.2023.101157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/10/2023] [Accepted: 05/14/2023] [Indexed: 08/01/2023] Open
Abstract
Background Collared femoral stems have been considered to reduce the risk of early subsidence over collarless stems. However, with advances in material technology, new surface treatments have been introduced into cementless stem design to enhance primary fixation and long-term stability. This study aims to analyze the early migration behaviors of a proximally coated collarless femoral stem and cementless acetabular component and compare the outcomes with commercially available cementless stems and acetabular cups. Methods A total of 24 patients (25 hips) undergoing total hip arthroplasty were recruited and followed up for 2 years. All patients received a Masterloc femoral stem (Medacta International SA, Castel San Pietro, Switzerland) and an Mpact acetabular component (Medacta International SA, Castel San Pietro, Switzerland) with tantalum beads embedded during the operation. Radiographs for radiostereometric analysis were taken immediately postsurgery, 6-months, 1-year, and 2-years postoperatively. Results The median condition number for this study was 59. The median stem subsidence was -0.08 mm (-2.47 to 0.40) at 2 years. The median cup subsidence was -0.03 mm (-0.38 to 0.57) at 2 years. The migration of the Masterloc stem was less than that of other cementless collarless, as well as collared stems, as reported in literature. Conclusions This study has demonstrated the high stability and fixation provided with the use of a collarless cementless stem. The subsidence seen in both this cementless femoral stem and acetabular cup at 2 years postoperative was below the range reported in literature for cementless collarless and collared stems.
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Affiliation(s)
- Selin Munir
- Medical Affairs Department, Medacta Australia, Lane Cove, New South Wales, Australia
| | - Leina Suzuki
- Medical Affairs Department, Medacta Australia, Lane Cove, New South Wales, Australia
| | - Michael Dixon
- Orthopaedic Department, The Sutherland Hospital, Caringbah, New South Wales, Australia
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Blum P, Neugebauer J, Keiler A, Putzer D, Watrinet J, Biermeier S, Dammerer D. Mid-Term Migration Behavior of an Uncemented Proximally Anchored Straight Stem-A Retrospective EBRA Migration Analysis. J Clin Med 2023; 12:4335. [PMID: 37445370 DOI: 10.3390/jcm12134335] [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: 04/17/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Aseptic loosening is one of the most-common causes of the failure of cementless stems. Einzel Bild Röntgen Analyse-Femoral Component Analysis (EBRA-FCA) allows the diagnosis of stem migration, which can be considered a factor in predicting implant survival. The current study aimed to present the migration behavior of a tapered proximally anchored straight stem. METHODS This retrospective study reviewed all consecutive patients who received a cementless CBC straight stem (Mathys AG, Bettlach, Switzerland) between 2005 and 2019. We analyzed the migration pattern using the EBRA-FCA software and reviewed their medical histories. In addition, periprosthetic radiolucency was rated according to the Gruen zones and femoral configuration according to Dorr. RESULTS A total of 333 stems in 332 patients (female 191; male 141) met our inclusion criteria. The mean age at surgery was 63 (range 21-87) years. Migration analysis by EBRA-FCA showed a mean subsidence of 1.6 mm at final follow-up at 96 months with a maximum noted mean subsidence of 2.0 mm at 72 and 84 months. Dorr Type A showed a tendency of less subsidence than did Dorr Type B and was statistically significant at 6 (p = 0.0396) and 72 months (p = 0.0127). The body mass index (BMI) and increased subsidence were not found to correlate (p > 0.05). For this cohort, the overall femoral revision-free rate was 95.2% and the revision-free rate for aseptic loosening was 99.1%. CONCLUSIONS The results showed migration behavior in cementless stems with initial increased migration and subsequent secondary stabilization, suggesting an excellent long-term outcome. Stem migration of this tapered proximally anchored stem might be lower in Dorr Type A than in Dorr Type B femurs without being statistically significant at all time points.
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Affiliation(s)
- Philipp Blum
- Department of Trauma Surgery, BG Trauma Center Murnau, 82418 Murnau, Germany
| | - Johannes Neugebauer
- Department of Orthopaedics and Traumatology, Krems University Hospital, 3500 Krems, Austria
- Karl Landsteiner Private University for Health Sciences, 3500 Krems, Austria
| | - Alexander Keiler
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - David Putzer
- Department of Experimental Orthopaedics, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Julius Watrinet
- Department of Trauma Surgery, BG Trauma Center Murnau, 82418 Murnau, Germany
| | - Sebastian Biermeier
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Krems University Hospital, 3500 Krems, Austria
- Karl Landsteiner Private University for Health Sciences, 3500 Krems, Austria
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Muffly BT, Kluemper JC, Jacobs CA, Landy DC, Duncan ST. Penalty for Switching Implants? Assessing the Learning Curve With a Collarless, Tapered Wedge Cementless Femoral Component. Arthroplast Today 2023; 20:101119. [PMID: 36923057 PMCID: PMC10009679 DOI: 10.1016/j.artd.2023.101119] [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: 10/15/2022] [Revised: 01/01/2023] [Accepted: 01/28/2023] [Indexed: 03/18/2023] Open
Abstract
Background Surgeon learning curve associated with a tapered wedge femoral implant as measured by early femoral component subsidence and 90-day risk of reoperation was evaluated. Methods The first 451 patients undergoing primary, cementless total hip arthroplasty by a single, fellowship-trained arthroplasty surgeon with a tapered wedge stem design were retrospectively reviewed. Early radiographic femoral component subsidence during the first 6 weeks postoperatively and 90-day reoperations was recorded. Results When stratified by approach, there was no association between date of surgery and femoral component subsidence in the posterior approach (P-value for linear trend over time = 0.44). In the direct anterior approach, there was a significant association between date of surgery and early femoral component subsidence (P-value for linear trend over time = 0.01). For both approaches, there was an increase in implanted stem size relative to templated stem size over time (P < .01 and P = .03, respectively). There was no association between the date of surgery and risk of 90-day reoperation (P = .45). Conclusions In a single surgeon's initial use of a tapered cementless wedge stem, early femoral component subsidence was not impacted by the surgeon's learning curve when the posterior approach was utilized. Although subsidence was associated with date of surgery in the direct anterior cohort, this was not associated with increased risk of 90-day reoperation. Should a surgeon adopt a new tapered-wedge stem, these findings suggest that the stem is forgiving both in relation to subsidence and 90-day reoperation risk when appropriate surgical technique is utilized.
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Affiliation(s)
- Brian T Muffly
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Jude C Kluemper
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Cale A Jacobs
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - David C Landy
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Stephen T Duncan
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
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Jacquot L, Machenaud A, Bonnin MP, Chouteau J, Vidalain JP, Ramos-Pascual S, Saffarini M, Dubreuil S. Survival and Clinical Outcomes at 30 to 35 Years Following Primary Total Hip Arthroplasty With a Cementless Femoral Stem Fully Coated With Hydroxyapatite. J Arthroplasty 2022; 38:880-885. [PMID: 36496046 DOI: 10.1016/j.arth.2022.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/28/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of the present study was to update and report clinical outcomes and survival of primary total hip arthroplasty using a cementless double-tapered titanium fully hydroxyapatite-coated stem at a follow-up > 30 years. METHODS The outcomes of this series of 347 primary total hip arthroplasties were already published at a follow-up > 25 years, during which only 12 stems were revised. Since then, there were two additional stem revisions, bringing the total to 14 stem revisions (all of which also required cup revision). Patients still living with the original stem were assessed using the modified Harris Hip Score and patient satisfaction (very satisfied, satisfied, dissatisfied, and very dissatisfied). Revision incidence was calculated using the Kaplan-Meier (KM) method and Cumulative Incidence Function (CIF) at 35 years. RESULTS At a mean follow-up of 33 years (range, 31 to 35 years), 32 patients (34 hips) were still living with the original stem. Their mean modified Harris Hip Score was 86 points (range, 46 to 100) and all patients (100%) were very satisfied or satisfied with surgery. The revision incidence at 35 years considering (a) stem revision for any reason was 9.5% using KM and 4.5% using CIF; (b) stem revision for aseptic loosening was 3.1% using KM and 2.1% using CIF; and (c) reoperation or revision of any component for any reason was 45.3% using KM and 26.3% using CIF. CONCLUSION The present study has demonstrated excellent survival at 35 years for a cementless double-tapered titanium fully hydroxyapatite-coated stem. LEVEL OF EVIDENCE Level IV, Retrospective cohort study.
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Affiliation(s)
- Laurent Jacquot
- Artro Institute, Annecy Le Vieux, France; Clinique d'Argonay, Ramsay Santé, Annecy, France
| | - Alain Machenaud
- Artro Institute, Annecy Le Vieux, France; Clinique d'Argonay, Ramsay Santé, Annecy, France
| | - Michel P Bonnin
- Artro Institute, Annecy Le Vieux, France; Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Julien Chouteau
- Artro Institute, Annecy Le Vieux, France; Clinique d'Argonay, Ramsay Santé, Annecy, France
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- ReSurg SA, Nyon, Switzerland
| | - Jean-Pierre Vidalain
- Artro Institute, Annecy Le Vieux, France; Clinique d'Argonay, Ramsay Santé, Annecy, France
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Kuroda Y, Hashimoto S, Hayashi S, Nakano N, Fujishiro T, Hiranaka T, Kuroda R, Matsumoto T. Fully hydroxyapatite-coated compaction broached and triple-tapered stem may reduce the risk of stress shielding after primary total hip arthroplasty. Arch Orthop Trauma Surg 2022; 142:4087-4093. [PMID: 35066641 DOI: 10.1007/s00402-021-04308-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 12/04/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Changes in bone mineral density (BMD) around the fully hydroxyapatite (HA)-coated compaction broached and triple-tapered stem, namely, Polarstem, after total hip arthroplasty (THA) are currently unknown. Therefore, the aims of this study were to investigate clinical outcomes of Polarstem, mainly postoperative temporal changes in BMD around the stem for 2 years, and to compare them with those of HA-coated and non-HA-coated tapered-wedge stems. METHODS This retrospective cohort study enrolled 100 consecutive patients who underwent THA using Polarstem (n = 38), HA-coated Anthology (n = 31), and non-HA-coated Anthology (n = 31). BMD was evaluated using dual-energy X-ray absorptiometry in seven regions according to the Gruen zones. Postoperatively, BMD around the stem was assessed within 2 months (baseline BMD) and at 6, 12, and 24 months. A change in BMD was defined as the value calculated by dividing each postoperative BMD value at 6, 12, and 24 months by the baseline BMD value. Changes in BMD and radiographic parameters such as stress shielding and spot welds were compared among the three stems. RESULTS The incidence rate of stress shielding in the Polarstem group was significantly lower than those in the other two groups (p = 0.007). The change in BMD in Zone 7 of Polarstem was significantly more than that of the other two groups at 12 and 24 months postoperatively (p = 0.030 and p = 0.009, respectively). CONCLUSION Polarstem, a fully HA-coated compaction broached and triple-tapered stem, maintained BMD around the femoral calcar until 2 years postoperatively and could reduce the risk of stress shielding compared with tapered-wedge stems.
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Affiliation(s)
- Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shinya Hayashi
- 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
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Ryosuke Kuroda
- 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
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