1
|
Sakurai T, Fujita H, Iwase T, Sasaki K, Katayama N, Otsuka H. Multi-center study of use of the Exeter stem in Japan: a 10-year follow-up report. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04001-w. [PMID: 38822154 DOI: 10.1007/s00590-024-04001-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/09/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE Since the introduction of the Exeter stem for clinical use in Japan in 1996, the number of stems used has continued to rise owing to its favorable results. We investigated the outcomes of patients who had previously undergone total hip arthroplasty with the Exeter stem in Japan with a 10-year + follow-up period. METHODS This retrospective cohort study used clinical and radiographic data of 682 cases of primary total hip arthroplasty performed using the Exeter stem. RESULTS The mean postoperative follow-up period was 13.3 years. Femoral-side revision was required in 14 hips, with no cases of aseptic stem loosening-associated revision observed. Kaplan-Meier survival analysis predicted 97.3% 15-year survival when revision for any reason was used as the endpoint. CONCLUSION The obtained findings suggested the excellent long-term stability of the Exeter stem for primary total hip arthroplasty in Japan.
Collapse
Affiliation(s)
- Tatsuro Sakurai
- Department of Orthopedic Surgery, Nagareyama Central Hospital, 2-243-3 Higashihatsuishi, Nagareyama-shi, Chiba, 270-0114, Japan.
| | - Hiroshi Fujita
- Center for Hip Arthroplasty, Senshunkai Hospital, Nagaokakyo-shi, Kyoto, 617-0826, Japan
| | - Toshiki Iwase
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, 432-8580, Japan
| | - Kan Sasaki
- Department of Orthopedic Surgery, Yamagata Saisei Hospital, Okimachi, Yamagata, 990-8545, Japan
| | - Naoyuki Katayama
- Department of Orthopedic Surgery, Hokkaido Orthopedic Memorial Hospital, Sapporo, Hokkaido, 062-0937, Japan
| | - Hiromi Otsuka
- Department of Orthopedic Surgery, School of Medicine, Aichi Medical University, Nagakute-shi, Aichi, 480-1195, Japan
| |
Collapse
|
2
|
Wakama H, Okamoto Y, Okayoshi T, Ikeda K, Matsuyama J, Otsuki S, Neo M. Unfavorable cortical hypertrophy potentially predisposes to periprosthetic "axe splitter" fracture in a collarless polished curved triple-tapered cemented stem: The time-dependent radiographic change in five SC-stem cases. J Orthop Sci 2024; 29:439-444. [PMID: 36182639 DOI: 10.1016/j.jos.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/20/2022] [Accepted: 09/02/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The periprosthetic fracture of cemented polished tapered stems is occasionally called a "unique" or "axe splitter" fracture. However, there has been insufficient evidence regarding the association between the radiographic findings prior to incidence and this cumbersome fracture. To determine if there are any radiographic interpretations associated with this fracture pattern, we report the five SC-stem cases with total hip arthroplasty. METHODS We investigate the patient characteristics and serial radiographs of five fracture cases and evaluate the time-dependent specific radiographical changes around the stem between pre-arthroplasty and fracture. RESULTS Fractures developed at 3.5-6.4 years after surgery with low-grade injury or with no particular incentive. Femoral cortical hypertrophy at the distal medial side around the stem was observed in all cases before the development of fractures, at 2-6 years after primary surgery. The duration between cortical hypertrophy appearance to the development of fracture was 0.4-3.1 years. CONCLUSIONS The appearance of this zone-specific cortical hypertrophy might play a key role in the occurrence of periprosthetic fractures. Further studies with larger sample sizes should be conducted to elucidate this eccentric periprosthetic fracture.
Collapse
Affiliation(s)
- Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan.
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| |
Collapse
|
3
|
Messner M, Jacob R, Hagewood J, Broadfoot J, Chandler K, Medawar N, Prahad S, Naranje S. Bone remodeling and cortical thinning distal to the femoral stem: a retrospective review. Arch Orthop Trauma Surg 2023; 143:6461-6467. [PMID: 37055631 DOI: 10.1007/s00402-023-04860-8] [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: 01/26/2023] [Accepted: 03/25/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION There is a paucity of information on the bone remodeling that occurs distal to the femoral stem following total hip arthroplasty as most previous studies have focused on proximal changes. In this study, we report the cortical thinning that occur distal to the femoral stem after primary total hip arthroplasty. METHODS A retrospective review was performed at one institution over a 5-year period. 156 primary total hip arthroplasty procedures were included. The Cortical Thickness Index (CTI) was measured on both operative and non-operative hips at 1 cm, 3 cm and 5 cm below the prosthetic stem tip on anteroposterior radiographic images pre-operatively as well as at 6 months, 12 months and 24 months post-operatively. The difference in average CTI was measured using paired t-tests. RESULTS There were statistically significant decreases in CTI distal to the femoral stem at 12 months and 24 months (-1.3% and -2.8%, respectively). Greater losses were seen in female patients, patients older than 75, and patients with BMI less than 35 at 6 months postoperative. There were no differences in CTI at any time point on the non-operative side. CONCLUSION The current study demonstrates that patients undergo bone loss as measured by CTI distal to the stem in the first 2 years following total hip arthroplasty. Comparison to the contralateral non-operative side confirms that this change is greater than expected for the natural aging process. A greater understanding of these changes will help optimize post-operative management and direct future innovations in implant design.
Collapse
Affiliation(s)
- Mitchell Messner
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roshan Jacob
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jacob Hagewood
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jackson Broadfoot
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly Chandler
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nick Medawar
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sri Prahad
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sameer Naranje
- Departmentof Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| |
Collapse
|
4
|
Miyamoto S, Iida S, Suzuki C, Kawamoto T, Shinada Y, Ohtori S. Minimum 10-Year Follow-Up of Total Hip Arthroplasty With a Collarless Triple-Tapered Polished Cemented Stem With Line-to-Line Implantation Using a Direct Anterior Approach. J Arthroplasty 2022; 37:2214-2224. [PMID: 35588903 DOI: 10.1016/j.arth.2022.05.022] [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: 03/22/2022] [Revised: 05/01/2022] [Accepted: 05/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Trilliance stem (B. Braun-Aesculap, Tuttlingen, Germany), a novel collarless triple-tapered polished stem, was introduced in 2009. The aim of this study is to evaluate the long-term clinical and radiological results of the Trilliance stem with line-to-line implantation in primary total hip arthroplasty using a direct anterior approach. METHODS A consecutive retrospective series of 130 patients (151 hips) who underwent total hip arthroplasty between February 2009 and August 2011 were evaluated for a minimum of 10 years. Of these, 87.4% had a diagnosis of secondary osteoarthritis based on developmental hip dysplasia. Clinical and radiological results, complications were evaluated and survival analysis was performed. RESULTS The mean follow-up was 10.7 years (range, 10.0-12.1). Thirteen hips (13 patients, 6.8%) were lost to follow-up. Adequate cementation (Barrack grade A) was achieved in 136 hips (93.8%) 1 week post-operatively. Nearly all (144 hips, 99.3%) had been inserted within the range of 3°. No significant differences were identified between high- (≥30 procedures/year) and low- (<30 procedures/year) volume surgeons. The Kaplan-Meier survival analysis with revision of the femoral component for aseptic loosening, revision of the femoral component for any reason and revision of either component for any reason as the end points, cumulative survivorship was 100.0%, 97.6% (95% confidence interval (CI) 95.4-100.0) and 96.5% (95% CI 93.8-99.3) at 10 years, respectively. CONCLUSION The Trilliance stem with line-to-line implantation using a direct anterior approach has an excellent clinical and radiological outcome at a minimum of 10 years' follow-up. LEVEL OF EVIDENCE Level IV, Retrospective cohort study.
Collapse
Affiliation(s)
- Shuichi Miyamoto
- Department of Orthopedic Surgery, Matsudo City General Hospital, Chiba, Japan
| | - Satoshi Iida
- Department of Orthopedic Surgery, Matsudo City General Hospital, Chiba, Japan
| | - Chiho Suzuki
- Department of Orthopedic Surgery, Matsudo City General Hospital, Chiba, Japan
| | - Taisei Kawamoto
- Department of Orthopedic Surgery, Matsudo City General Hospital, Chiba, Japan
| | - Yoshiyuki Shinada
- Department of Orthopedic Surgery, Matsudo City General Hospital, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
5
|
Baryeh K, Mendis J, Sochart DH. Temporal subsidence patterns of cemented polished taper-slip stems: a systematic review. EFORT Open Rev 2021; 6:331-342. [PMID: 34150327 PMCID: PMC8183154 DOI: 10.1302/2058-5241.6.200086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The literature was reviewed to establish the levels of stem subsidence for both double and triple-tapered implants in order to determine whether there were any differences in subsidence levels with regard to the methods of measurement, the magnitude and rate of subsidence and clinical outcomes. All studies reporting subsidence of polished taper-slip stems were identified. Patient demographics, implant design, radiological findings, details of surgical technique, methods of measurement and levels of subsidence were collected to investigate which factors were related to increased subsidence. Following application of inclusion and exclusion criteria, 28 papers of relevance were identified. The studies initially recruited 3090 hips with 2099 being available for radiological analysis at final follow-up. Patient age averaged 68 years (42–70), 60.4% were female and the average body mass index (BMI) was 27.4 kg/m2 (24.1–29.2). Mean subsidence at one, two, five and 10 years was 0.97 mm, 1.07 mm, 1.47 mm and 1.61 mm respectively. Although double-tapered stems subsided more than triple-tapered stems at all time points this was not statistically significant (p > 0.05), nor was the method of measurement used (p > 0.05). We report the levels of subsidence at which clinical outcomes and survivorship remain excellent, but based on the literature it was not possible to determine a threshold of subsidence beyond which failure was more likely. There were relatively few studies of triple-tapered stems, but given that there were no statistically significant differences, the levels presented in this review can be applied to both double and triple-tapered designs.
Cite this article: EFORT Open Rev 2021;6:331-342. DOI: 10.1302/2058-5241.6.200086
Collapse
Affiliation(s)
- Kwaku Baryeh
- The Academic Surgical Unit, South West London Elective Orthopaedic Centre, UK
| | | | - David H Sochart
- The Academic Surgical Unit, South West London Elective Orthopaedic Centre, UK
| |
Collapse
|
6
|
Kataoka M, Fujita H, Hara H, Harada H, Okutani Y, Murotani Y. Influence of the knot position on the union of the greater trochanter after bipolar hip arthroplasty via the modified Dall approach: a prospective non-randomized study. BMC Musculoskelet Disord 2021; 22:162. [PMID: 33568142 PMCID: PMC7877116 DOI: 10.1186/s12891-021-04005-1] [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: 07/09/2020] [Accepted: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background In our institute, all elderly patients with displaced femoral neck fracture were treated with cemented bipolar hemiarthroplasty (BHA) using the modified Dall approach. To our knowledge, there are no reports on the knot position of the greater trochanter reattachment. The aim of this study was to determine influence of two knot positions (anterior or posterior) on the complications of the greater trochanter. Methods This is a prospective non-randomized study conducted on 95 elderly patients (95 hips) from September 2013 to December 2017. The knot position was changed from anterior to posterior alternately. The X-ray images obtained immediately after the operation were compared with those obtained at 3 months postoperatively; thereafter, the status of the greater trochanter was classified into three types: type A, no apparent shifting and fracture; type C, over 1-mm shifting of the fragment; and type F, fracture of the greater trochanter. Results Regarding age at operation, sex, BMI, size of the greater trochanteric fragment, stem type, and surgeon, there was no significant difference between two groups. In the anterior group, 34 hips (72.3%), 5 hips (10.6%), and 8 hips (17.0%) were classified under type A, C, and F, respectively. In the posterior group, 44 hips (91.7%), 1 hip (2.1%), and 3 hips (6.3%) were classified under type A, C, and F, respectively. There were significantly fewer greater trochanteric complications in the posterior group. Conclusions The posterior knot position improved the union of the greater trochanter after BHA compared with the anterior knot position. Trial registration We had approved IRB at our hospital clinical research review committee. Retrospectively registered.
Collapse
Affiliation(s)
- Masanao Kataoka
- Institute for Joint Replacement, Department of Orthopedic Surgery, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Hiroshi Fujita
- Institute for Joint Replacement, Department of Orthopedic Surgery, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan.
| | - Hiroaki Hara
- Department of Rehabilitation, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Hideto Harada
- Institute for Joint Replacement, Department of Orthopedic Surgery, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Yuki Okutani
- Institute for Joint Replacement, Department of Orthopedic Surgery, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Yoshiki Murotani
- Institute for Joint Replacement, Department of Orthopedic Surgery, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan
| |
Collapse
|