Primary total hip arthroplasty with a proximally HA-coated titanium femoral component: results at 10–15-year follow-up

Proximal radiolucent lines around fully hydroxyapatite-coated tapered femoral stems: should we be concerned?

INTRODUCTION

Radiolucent lines occasionally develop around the proximal aspect of fully hydroxyapatite (HA)-coated tapered femoral stems after total hip arthroplasty (THA). It was hypothesised that distal wedging of stems may predispose to proximal radiolucent line formation, which may negatively impact clinical outcome.

METHODS

All primary THA performed with a collarless fully HA-coated stem that had a minimum of 1 year of radiographic follow-up were identified in a surgical database (n = 244). Radiographic measures of proximal femoral morphology and femoral canal fill at the middle and distal thirds of the stem were analysed for association with the presence of proximal radiolucent lines. Linear regression was used to explore any association between radiolucent lines and patient reported outcome measures (PROMs), available in 61% of patients.

RESULTS

Proximal radiolucent lines developed in 31 cases (12.7%) at final follow-up. Dorr A femoral morphology and increased canal-fill at the distal ⅓ of the stem correlated with the development of radiolucent lines (p < 0.001). No correlation was observed between pain or PROMs and the presence of proximal radiolucent lines.

DISCUSSION

We observed an unexpectedly high incidence of proximal femoral radiolucent lines about collarless fully HA coated stems. Distal-only implant wedging in Dorr A bone may compromise proximal fixation. Although this finding did not correlate with short-term outcomes, the long-term clinical impact requires further study.

Differences in peri-hip articular pain after total hip arthroplasty between taper wedge stem and fit-and-fill stem

Background

Total hip arthroplasty (THA) for hip disorders helps to alleviate pain and improve active daily life. When determining the effects of medical therapy and the subsequent clinical results, patient quality of life (QOL) also needs to be assessed. Recently, patient-reported outcomes (PRO) have become important as evaluation criteria. This study aimed to evaluate patient QOL and various PRO between different types of cementless stems and to clarify the relationship between PRO and stem-cortical bone contact.

Methods

The study comprised 138 consecutive patients undergoing cementless THA for hip osteoarthritis. We assessed three different types of PRO: the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), patient's joint perception, and peri-hip articular joint pain (PHAP). We measured the state of contact between femur and implant by density mapping.

Results

No significant difference was noted in PRO between stem types based on the JHEQ and patient's joint perception. PHAP occurred more frequently in the patients with a taper wedge stem versus a fit-and-fill stem. In both groups, distal contact was associated with PHAP but not with JHEQ results and patient's joint perception.

Conclusion

The difference in PHAP between the two stem types groups was significant, with postoperative PHAP being higher with the taper wedge stem because of the more distal contact between the taper wedge stem and femur cortical bone.

Preoperative Canal Bone Ratio is Related to High-Degree Stress Shielding: A Minimum 5-Year Follow-Up Study of a Proximally Hydroxyapatite-Coated Straight Tapered Titanium Femoral Component

BACKGROUND

Few studies have reported risk factors for stress shielding. We sought to evaluate clinical and radiographic outcomes of a proximally hydroxyapatite-coated straight tapered titanium femoral component stem during a minimum 5-year follow-up and identify factors associated with high-degree stress shielding.

METHODS

A total of 156 total hip arthroplasties (n = 124; 98 women and 26 men; mean age, 56.5 years) with a minimum follow-up period of 5 years were included in the study. Clinical and radiologic measurements at follow-up (range, 5-16.3 years; mean, 10.2 years) were analyzed.

RESULTS

The mean preoperative Harris Hip Score (HHS) was 56.6, and the mean HHS at the latest follow-up was considerably improved at 86.8. Stress shielding at the latest follow-up was low degree in 136 (87%) hips and high degree in 20 (13%) hips. On average, high-degree stress shielding occurred 9.9 years (5-14 years) after surgery. The results of Cox proportional hazard analysis showed that a canal bone ratio ≥ 0.49 was an independent risk factor for high-degree stress shielding (P = .0075; hazard ratio, 3.981). HHS at the latest follow-up was significantly lower in high-degree stress shielding than in low-degree stress shielding (80.7 and 87.7, respectively; P = .0030).

CONCLUSION

Preoperative canal bone ratio ≥ 0.49 is independently associated with high-degree stress shielding. In addition, the number of cases with high-degree stress shielding significantly increased over time during a mean 10-year follow-up.

No decline in high patient satisfaction after total hip arthroplasty at long-term follow-up

INTRODUCTION

Patient satisfaction is gaining popularity as an important outcome parameter in today's healthcare system and in particular in evaluating the outcome of joint arthroplasty. Total hip arthroplasty (THA) is a very successful procedure with reports on high patient satisfaction at short-term follow-up. Commonly used clinical outcome parameters remain good at long-term follow-up; however, whether this also accounts for patient satisfaction remains unclear. This study presents a prospective follow-up of patient satisfaction after THA, and a possible correlation with common outcome parameters was established.

METHODS

This study entails a concise follow-up of an earlier study on patient satisfaction 2.5 years after THA. Patient satisfaction was repeatedly measured with a visual analogue scale (VAS) after a mean follow-up of 13.5 (12.6-14.2) years in a prospective cohort of 147 patients (153 THAs). In addition, VAS pain and common clinical outcome parameters (WOMAC, OHS and SF-36) were also reassessed and were compared with short-term results after a mean follow-up of 2.5 (1.3-3.0) years.

RESULTS

At a follow-up of 13.5 (12.6-14.2) years, the median VAS for satisfaction was 95 (26-100) compared to a median VAS satisfaction of 98 (0-100) at earlier follow-up (p = 0.781). Overall, the clinical outcome parameters also remained good at long-term follow-up without significant changes. However, a rather low correlation with VAS satisfaction was encountered. Pain during activity showed the highest correlation (- 0.686) with VAS satisfaction.

CONCLUSION

Patient satisfaction after THA remains high after prolonged follow-up. Apparently patients do not get used to the successful results of their THA. A rather low correlation with common clinical outcome parameters suggests that patient satisfaction is a separate entity. Since patient satisfaction correlated best with pain during activity, this is probably the most important aspect in patient satisfaction. Measurement of patient satisfaction has additional value and may even replace some of the more commonly used questionnaires.