1
|
Jahnke A, Köther-Herrmann J, Fonseca Ulloa CA, Harz T, Rickert M, Ishaque BA. Retrospective clinical and X-ray-based outcome analysis of a short-stem hip arthroplasty taking into account the operative learning curve over 7 years in the 3-year control course. Arch Orthop Trauma Surg 2023; 143:6589-6597. [PMID: 37418006 PMCID: PMC10542719 DOI: 10.1007/s00402-023-04977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Self-monitoring is crucial to work progressively with a high-quality standard. A retrospective analysis is a valuable tool for studying the postoperative outcome of a prosthesis and for evaluating the learning process for the surgeon. MATERIALS AND METHODS The learning process of one surgeon was analysed in 133 cases of hip arthroplasty. These were divided into seven groups representing the surgical years 2008-2014. Over the course of 3 postoperative years, a total of 655 radiographs were analysed at regarding three radiological quality parameters (centrum-collum-diaphyseal angle (CCD angle), intramedullary fit&fill ratio (FFR), and migration) and ancillary outcome parameters (Harris Hip Score (HHS), blood loss, operating time, and complications). This period was divided into five times: 1st-day post-op, 6 M, 12 M, 24 M, and 36 M. Bivariate Spearman's correlation analysis and pairwise comparisons were performed. RESULTS The total collective achieved a proximal FFR of over 0.8. The distal prosthesis tip migrated and was located on the lateral cortex within the first months. The CCD angle initially showed a variation with a subsequent constant course. The HHS showed a significant increase (p < 0.001) to over 90 points postoperatively. Over time, the operating time and blood loss decreased. Intraoperative complications existed only at the beginning of the learning phase. A learning curve effect can be determined for almost all parameters by comparing the subject groups. CONCLUSIONS Operative expertise was shown to gain through a learning curve, whereby postoperative results corresponded to the system philosophy of the short hip stem prosthesis. The distal FFR and the distal lateral distance could represent the principle of the prosthesis, which overall could be an interesting approach for verification of a new parameter.
Collapse
Affiliation(s)
- Alexander Jahnke
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany
| | - Jan Köther-Herrmann
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany
| | - Carlos A Fonseca Ulloa
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany
| | - Torben Harz
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany
| | - Markus Rickert
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstrasse 33, 35392, Giessen, Germany
| | - Bernd Alexander Ishaque
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany.
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstrasse 33, 35392, Giessen, Germany.
| |
Collapse
|
2
|
Montbarbon B, Letissier H, Di Francia R, Stindel E, Dubrana F, Williams T. Is a Total Hip Arthroplasty Stem in Varus a Risk Factor of Long-Term Mechanical Complication? J Arthroplasty 2022; 38:1104-1109. [PMID: 36535449 DOI: 10.1016/j.arth.2022.12.025] [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: 07/05/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The impact of implanting cementless femoral stems in varus alignment on long-term mechanical complications remains poorly defined in the literature. The aim of our study was to compare survivorship and functional and radiographic outcomes of stems in varus alignment to those in neutral alignment with and average follow-up of 10 years. METHODS This single-center, multisurgeon, retrospective case-control study compared a group of 105 total hip arthroplasty (THA) patients who had varus stem alignment (Varus Stem) to a matching group of 105 THA patients who had neutral stem alignment, operated on between January 2007 and December 2012. The primary outcome measure was implant survival. Secondary outcomes included functional (Harris Hip Score, Postel Merle d'Aubigné Score, thigh pain, dislocation and hip range of motion) and radiographic outcomes (radiolucency, osseointegration, heterotopic ossification, subsidence, and stress shielding). RESULTS There was no significant difference in implant survival between the 2 groups with 95.7% (±2.46) in the Varus Stem group versus 97.7% (±1.64) in the Neutral Stem group (P = .41) after an average follow-up of 10 years. There was no significant difference in clinical and radiographic outcomes between groups. CONCLUSION Cementless femoral stems in varus alignment were not the cause of mechanical complications with an average follow-up of 10 years. The comparison between groups in terms of implant survival, functional, and radiographic outcomes does not show any significant differences. Positioning a femoral stem in varus alignment may be an alternative for surgeons wishing to restore preoperative offset and to ensure satisfactory hip stability.
Collapse
Affiliation(s)
- Baptiste Montbarbon
- Centre hospitalier d'Aubagne, Edmond Garcin, Hôpital d'Aubagne, Aubagne, France
| | - Hoel Letissier
- Service de Chirurgie Orthopédique et Traumatologique, CHRU de Brest, Brest, France; Laboratoire de Traitement de l'Information Médicale, LaTIM UMR 1101 INSERM UBO, Brest, France; Université de Bretagne Occidentale, Faculté de Médecine, Brest, France
| | - Rémi Di Francia
- Service de Chirurgie Orthopédique et Traumatologique, CHRU de Brest, Brest, France
| | - Eric Stindel
- Service de Chirurgie Orthopédique et Traumatologique, CHRU de Brest, Brest, France; Laboratoire de Traitement de l'Information Médicale, LaTIM UMR 1101 INSERM UBO, Brest, France; Université de Bretagne Occidentale, Faculté de Médecine, Brest, France
| | - Frédéric Dubrana
- Service de Chirurgie Orthopédique et Traumatologique, CHRU de Brest, Brest, France; Université de Bretagne Occidentale, Faculté de Médecine, Brest, France
| | - Thomas Williams
- Service de Chirurgie Orthopédique et Traumatologique, CHRU de Brest, Brest, France
| |
Collapse
|
3
|
Nizam I, Dabirrahmani D, Alva A, Choudary D. Bikini anterior hip replacements in obese patients are not associated with an increased risk of complication. Arch Orthop Trauma Surg 2022; 142:2919-2926. [PMID: 34510240 DOI: 10.1007/s00402-021-04143-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 08/22/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Direct anterior approach (DAA) arthroplasty has generated great interest because of its minimally invasive and muscle sparing nature. Obese patients are reported to be associated with greater incidence of complications in primary joint replacement. The purpose of this study was to compare patient outcomes and complication rates between obese and non-obese patients undergoing primary total hip arthroplasty (THA) through a Bikini direct anterior incision. METHODS This retrospective, single surgeon study compared the outcome of 258 obese patients and 200 non-obese patients undergoing DAA THA using a Bikini incision, over a 5-year period. The average follow-up was 3.2 years (range 1.1-5.6 years). RESULTS There was no statistically significant differences in the complication rate between the two groups. The obese group recorded 2 major (venous thromboembolism and peri-prosthetic fracture) and 2 minor complications (superficial wound infection), compared with the non-obese group, which recorded 2 major (deep-wound infection and peri-prosthetic fracture) and 1 minor complication (superficial wound infection). Patient-reported outcomes (WOMAC and Harris Hip Scores) showed significant post-operative improvements (p < 0.001) and did not differ between the two groups. CONCLUSIONS Bikini DDA THA does not increase the complication rate in obese patients and offers similar clinical improvements compared to non-obese patients.
Collapse
Affiliation(s)
- I Nizam
- Ozorthopaedics, 1356 High Street, Malvern, VIC, 3144, Australia.
| | - D Dabirrahmani
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - A Alva
- Ozorthopaedics, 1356 High Street, Malvern, VIC, 3144, Australia
| | - D Choudary
- Ozorthopaedics, 1356 High Street, Malvern, VIC, 3144, Australia
| |
Collapse
|
4
|
Open reduction and internal fixation might be a valuable alternative to stem revision in Vancouver B2 periprosthetic femoral fractures, irrespective of the stem's design. Arch Orthop Trauma Surg 2021; 141:871-878. [PMID: 32778919 DOI: 10.1007/s00402-020-03568-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to compare the clinical and radiological outcomes following open reduction and internal fixation (ORIF) of Vancouver B2 periprosthetic femoral fractures versus stem revision (SR) surgery. METHODS Between 2004 and 2018, 39 patients were treated with SR and 31 with ORIF for a Vancouver type B2. Mean follow-up was 40.4 months for the ORIF group and 43.5 months for the SR group. 22 of 31 stems in the ORIF group were uncemented, of which 7 (23%) were short stems. Perioperative complications, intraoperative blood loss, revision rate, and mortality were recorded. Functional outcomes included Harris Hip Score, Parker Mobility Score and hip abductor strength. RESULTS Both groups did not differ in the American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, body mass index, age, and sex. Compared to SR, patients treated with ORIF had a decreased blood loss, transfusion rate, operation duration, and mortality. Total complication and re-operation rates were similar. The relative risk for complication and re-operation was 0.5 and 0.7, respectively, in favour of ORIF. CONCLUSIONS ORIF might be a valuable alternative to SR in the treatment of Vancouver type B2 periprosthetic fractures with shorter operation duration, lower blood loss and similar complication rate compared to SR. Moreover, re-stabilization seems possible irrespective of stem's design or fixation technique. LEVEL OF EVIDENCE Level III.
Collapse
|
5
|
Hasler J, Flury A, Dimitriou D, Holweg I, Helmy N, Finsterwald M. Mid-term subsidence and periprosthetic radiolucency of the AMIStem: a 5-year EBRA-FCA analysis. J Orthop Surg Res 2021; 16:19. [PMID: 33413463 PMCID: PMC7792117 DOI: 10.1186/s13018-020-02104-8] [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] [Received: 10/04/2020] [Accepted: 11/19/2020] [Indexed: 01/22/2023] Open
Abstract
Background There has been an evolution in cementless total hip arthroplasty (THA) with newer short stem designs aimed to preserve metaphyseal bone stock and facilitate implantation through minimally invasive approaches. While early subsidence has been correlated to aseptic loosening in conventional stems, there is a paucity of data regarding short stems. The current study aims to report on stem subsidence and mid-term clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, specifically designed for the direct anterior approach (DAA). Methods Ninety-four consecutive patients (100 hips) with a minimum follow-up of 5 years following cementless THA were included in this single-center retrospective study. Subsidence was evaluated using the “Ein-Bild-Roentgen-Analyse” (EBRA). Periprosthetic radiolucency allocated to the zones of Charnley and Gruen was assessed. Additionally, demographic and implant-related factors potentially associated with increased subsidence and clinical outcomes were evaluated. Results At the last follow-up, the average stem subsidence was 1.98 ± 1.20 mm, with 48% of the implants demonstrating subsidence of > 2 mm. Periprosthetic radiolucency of > 2 mm was found in 26% of the implants in zone 1 and in 9% in zone 7, respectively. Neither the amount of subsidence nor proximal periprosthetic radiolucency was associated with aseptic loosening or worse clinical outcomes. Conclusions Comparable to other proximally fixed short stem designs, the highest subsidence was observed within the first 3 months following implantation. No demographic or implant-related factors were found to have a statistically significant influence on stem subsidence. Periprosthetic radiolucency and subsidence of the AMISstem is not correlated with worse clinical outcomes at 5-year follow-up.
Collapse
Affiliation(s)
- Julian Hasler
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland.
| | - Andreas Flury
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Dimitris Dimitriou
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Iris Holweg
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Naeder Helmy
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Michael Finsterwald
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| |
Collapse
|
6
|
Alva A, Nizam I, Gogos S. Minimizing complications in bikini incision direct anterior approach total hip arthroplasty: A single surgeon series of 865 cases. J Exp Orthop 2021; 8:1. [PMID: 33394190 PMCID: PMC7782761 DOI: 10.1186/s40634-020-00318-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/03/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose The purpose of this study was to report all complications during the first consecutive 865 cases of bikini incision direct anterior approach (DAA) total hip arthroplasty (THA) performed by a single surgeon. The secondary aims of the study are to report our clinical outcomes and implant survivorship. We discuss our surgical technique to minimize complication rates during the procedure. Methods We undertook a retrospective analysis of our complications, clinical outcomes and implant survivorship of 865 DAA THA’s over a period of 6 years (mean = 3.9yrs from 0.9 to 6.8 years). Results The complication rates identified in this study were low. Medium term survival at minimum 2-year survival and revision as the end point, was 99.53% and 99.84% for the stem and acetabular components respectively. Womac score improved from 49 (range 40–58) preoperatively to 3.5(range 0–8.8) and similarly, HHS scores improved from 53(range 40–56) to 92.5(range 63–100) at final follow-up (mean = 3.9 yrs) when compared to preoperative scores. Conclusions These results suggest that bikini incision DAA technique can be safely utilised to perform THA.
Collapse
Affiliation(s)
- Avinash Alva
- Mulgrave Private Hospital, Cnr Police Rd and Gladstone Rd, Mulgrave, VIC, 3170, Australia
| | - Ikram Nizam
- Centre for Adult Joint Arthroplasty, 1356 High Street, Malvern, VIC, 3144, Australia.
| | - Sophia Gogos
- Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| |
Collapse
|
7
|
Biomechanical Evaluation of the Accuracy in Radiographic Assessment of Femoral Component Migration Measurement after Total Hip Arthroplasty. Kans J Med 2020; 13:65-70. [PMID: 32337002 PMCID: PMC7182061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/13/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Implant subsidence is one criteria utilized to monitor for prosthesis loosening after total hip arthroplasty (THA) with initial implant subsidence assessment often done utilizing plain radiographs. The specific aim of this study was to identify the most reliable references when using plain radiographs to establish an image magnification with the goals being easy to use, inexpensive, reliable, and accurate. METHODS Two femoral stem implants (stem lengths: 127 mm, 207 mm) were utilized to simulate hemiarthroplasty of the hip with composite femurs. Different combinations of femoral stem distances from the radiographic film (ODD), source-detector differences (SDD), hip rotation, and hip flexion were elected. Standardized anterior-posterior pelvis for each parameter combination setup were taken. Radiographic measurements (head diameter, stem length, stem seating length) were undertaken five times by three examiners. Radiographic image magnification factors were generated from two references (head diameter and stem length). Radiograph measurement reproducibility and stem seating length errors using these magnification factors were evaluated. RESULTS High level of repeated measurements reliability was found for head diameter (99 ± 0%) and stem length (90 ± 7%) measurements, whereas seating length measurements were less reliable (76 ± 6%). Stem length error using the femoral head magnification factor yielded 11% accuracy. Stem seating length error using both magnification factors were not reliable (< 7% accuracy). All parameters, except SDD, showed significant effect on calibrated measurement error. CONCLUSION Current methods of assessing the implant subsidence after THA are inaccurate and unreliable. Clinicians should recognize these limitations and be cautious when diagnosing implant stability using plain radiographs alone.
Collapse
|
8
|
Carli AV, Negus JJ, Haddad FS. Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture? Bone Joint J 2017; 99-B:50-59. [PMID: 28042119 DOI: 10.1302/0301-620x.99b1.bjj-2016-0220.r1] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/27/2016] [Indexed: 11/05/2022]
Abstract
AIMS Periprosthetic femoral fractures (PFF) following total hip arthroplasty (THA) are devastating complications that are associated with functional limitations and increased overall mortality. Although cementless implants have been associated with an increased risk of PFF, the precise contribution of implant geometry and design on the risk of both intra-operative and post-operative PFF remains poorly investigated. A systematic review was performed to aggregate all of the PFF literature with specific attention to the femoral implant used. PATIENTS AND METHODS A systematic search strategy of several journal databases and recent proceedings from the American Academy of Orthopaedic Surgeons was performed. Clinical articles were included for analysis if sufficient implant description was provided. All articles were reviewed by two reviewers. A review of fundamental investigations of implant load-to-failure was performed, with the intent of identifying similar conclusions from the clinical and fundamental literature. RESULTS In total 596 articles were initially identified, with 34 being eligible for analysis. Aggregate analysis of 1691 PFFs in 342 719 primary THAs revealed a significantly higher number of PFFs with cementless femoral implants (p < 0.001). Single-wedge and double-wedge (fit-and-fill) femoral implants were associated with a threefold increase in PFF rates (p < 0.001) compared with anatomical, fully coated and tapered/rounded stems. Within cemented stems, loaded-taper (Exeter) stems were associated with more PFFs than composite-beam (Charnley) stems (p = 0.004). Review of the fundamental literature revealed very few studies comparing cementless component designs. CONCLUSION Very few studies within the PFF literature provide detailed implant information. Cementless implants, specifically those of single-wedge and double-wedge, have the highest PFF rates in the literature, with most investigations recommending against their use in older patients with osteoporotic bone. This review illustrates the need for registries and future PFF studies to record implant name and information for future analysis. Furthermore, future biomechanical investigations comparing modern implants are needed to clarify the precise contribution of implant design to PFF risk. Cite this article: Bone Joint J 2017;99-B(1 Supple A):50-9.
Collapse
Affiliation(s)
- A V Carli
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - J J Negus
- University College London Hospitals, 235 Euston Road, London, NW1 2BU and NIHR University College London Hospitals Biomedical Research Centre, UK
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London, NW1 2BU and NIHR University College London Hospitals Biomedical Research Centre, UK
| |
Collapse
|
9
|
Radiographic alterations in short-stem total hip arthroplasty: a 2-year follow-up study of 216 cases. Hip Int 2016; 26:278-83. [PMID: 27102556 DOI: 10.5301/hipint.5000339] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In recent years a variety of short-stems have been introduced. Stable osteointegration is a key factor for a satisfactory long-term result. The purpose of this study was to evaluate postoperative radiological alterations and subsidence, as a result of using a newly developed device, over a 2-year follow-up. METHODS 216 short-stems were implanted in combination with a cementless cup. Patients were allowed full weight-bearing on the first day postoperatively. Pre- and postoperative x-rays were done using a standardised technique. Radiological alterations, such as bone resorption, radiolucency, osteolysis and cortical hypertrophy were detected and located using modified Gruen zones, and subsidence was measured via a conventional digital technique over a 2-year follow-up. In addition, Harris Hip Score (HHS), rest pain and load pain on the visual analogue scale (VAS) were assessed respectively. RESULTS At 2-year follow-up 6 stems (2.9%) showed nonprogressive radiolucent lines with a maximum width of 2 mm. Resorption of femoral bone stock was detected in a total of 8 cases (3.9%). Femoral cortical hypertrophy was seen in a total of 9 hips (4.4%). No patient showed osteolysis. A measureable subsidence of at least 2 mm was observed in a total of 15.7% (32 cases) after 6 weeks, corresponding to an initial settlement given full weight-bearing ambulation. Only 1.1% (2 cases) showed further progression at the 6-month follow-up, whereas at the 1- and 2-year follow-ups no further subsidence was observed. After 2 years HHS was 98.1 (65.0-100.0), rest pain on the VAS was 0.2 (0.0-7.0) while load pain was 0.4 (0.0-7.0). CONCLUSIONS The results of this radiographic analysis give support to the principle of using metaphyseal anchoring, calcar guided short-stems. The low incidence of bony alterations after a follow-up of 2 years indicates a physiological load distribution. After mild initial subsidence a stable osteointegration can be achieved over time.
Collapse
|
10
|
Bohler IRM, Velu VK, Husami Y, Campbell AC. TEMPORARY REMOVAL: Radiographic subsidence in Excia hip prostheses following elective uncemented total hip arthroplasty. J Orthop 2014. [DOI: 10.1016/j.jor.2014.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|