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Loha T, Bhattacharya R, Pal B, Amis AA. A novel design of hip-stem with reduced strain-shielding. Proc Inst Mech Eng H 2024; 238:471-482. [PMID: 38644528 DOI: 10.1177/09544119241244537] [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] [Indexed: 04/23/2024]
Abstract
The use of uncemented stems in hip arthroplasty has been increasing, even in osteoporotic patients. The major concerns of uncemented hip-stems, however, are peri-prosthetic fracture, thigh pain, and proximal femoral stress-/strain-shielding. In this study, a novel design of uncemented hip-stem is proposed that will reduce such concerns, improve osseointegration, and benefit both osteoporotic and arthritic patients. The stem has a central titanium alloy core surrounded by a set of radial buttresses that are partly porous titanium, as is the stem tip. The aim of the study was to investigate the mechanical behaviour of the proposed partly-porous design, examining load transfer in the short-term, and comparing its strain-shielding behaviour with a solid metal implant. The long-term effect of implant-induced bone remodelling was also simulated. Computed tomography based three-dimensional finite element models of an intact proximal femur, and the same femur implanted with the proposed design, were developed. Peak hip contact and major muscle forces corresponding to level-walking and stair climbing were applied. The proposed partly-porous design had approximately 50% lower strain-shielding than the solid-metal counterpart. Results of bone remodelling simulation indicated that only 16% of the total bone volume is subjected to reduction of bone density. Strain concentrations were observed in the bone around the stem-tip for both solid and porous implants; however, it was less prominent for the porous design. Lower strain-shielding and reduced bone resorption are advantageous for long-term fixation, and the reduced strain concentration around the stem-tip indicates a lower risk of peri-prosthetic fracture.
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Affiliation(s)
- Tanmoy Loha
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, India
| | - Rounak Bhattacharya
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, India
| | - Bidyut Pal
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, India
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, London, UK
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Teh HL, Abounouh M, Haibock P, Selvaratnam V, Ganapathy SS, Graichen H. A comprehensive analysis on contributing factors for varus or valgus malposition of femoral stems in uncemented total hip arthroplasty via DAA. J Orthop 2024; 50:42-48. [PMID: 38162260 PMCID: PMC10755486 DOI: 10.1016/j.jor.2023.11.068] [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: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024] Open
Abstract
Background Varus or valgus malposition of uncemented femoral stems have been described to have detrimental effects for long term implant survival. Various pre- and intra-OP factors have been suggested to be relevant, one of them being the approach to the hip. The aim was to investigate several pre- and intra-OP factors associated with femoral stem malpositioning in a large series of DAA hips. Methods A series of 400 consecutive patients (416 hips) who underwent navigated (Brainlab) cementless Total Hip Arthroplasty (THA) in 2022 (Corail or Actis stem DePuy Synthes) via a direct anterior approach (DAA) was analyzed. Preoperative data were collected based on patients' demographics, radiographic information [critical trochanteric angle (CTA), centrum collum diaphyseal (CCD) angle, greater trochanter overhang, femoral neck resection angle, femoral neck resection height and Door classification], and these were correlated with the postoperative stem position. Univariable and multivariable linear regression were carried out to determine significant factors that contribute to varus and valgus stem malalignment. Results With the DAA approach, 56.5 % of stems were placed in an optimal neutral position, 38.4 % were in acceptable position of 0.1°-2° varus/valgus and only 5 % had a deviation larger than 2° varus/valgus. The critical trochanteric angle (CTA) was statistically significant in determining varus stem placement whereas centrum collum diaphyseal angle (CCD) was found to affect valgus stem malpositioning. All other factors have shown no relevant effect on stem placement using stepwise regression method. Conclusion In DAA, 95 % of stems were found in a varus/valgus position of 2° or less. In pre-operative measurement, only femoral morphology (e.g. CTA & CCD) were found to be relevant, affecting varus/valgus stem malposition. All other tested modifiable and non-modifiable factors had no significant effect. Therefore, pre-OP templating including measurement of CTA and CCD, intra-operative assessment as well as proper operative techniques are paramount to prevent excessive varus/valgus mal-position of femoral stem in DAA.
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Affiliation(s)
- Hak Lian Teh
- Department of Arthroplasty, General Orthopaedics and Sports Medicine, Asklepios Orthopaedic Hospital Lindenlohe, 92421, Schwandorf, Germany
| | - Mostafa Abounouh
- Department of Arthroplasty, General Orthopaedics and Sports Medicine, Asklepios Orthopaedic Hospital Lindenlohe, 92421, Schwandorf, Germany
| | - Philip Haibock
- Department of Arthroplasty, General Orthopaedics and Sports Medicine, Asklepios Orthopaedic Hospital Lindenlohe, 92421, Schwandorf, Germany
| | - Veenesh Selvaratnam
- Joint Reconstruction Unit, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Heiko Graichen
- Department of Arthroplasty, General Orthopaedics and Sports Medicine, Asklepios Orthopaedic Hospital Lindenlohe, 92421, Schwandorf, Germany
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van Dooren B, Peters RM, Visser D, van Steenbergen LN, Bos PK, Zijlstra WP. Femoral Neck Design Does Not Impact Revision Risk After Primary Total Hip Arthroplasty Using a Dual Mobility Cup. Arthroplast Today 2024; 25:101281. [PMID: 38292143 PMCID: PMC10826135 DOI: 10.1016/j.artd.2023.101281] [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: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024] Open
Abstract
Background The use of dual mobility (DM) cups has increased quickly. It is hypothesized that femoral neck taper geometry may be involved in the risk of prosthetic impingement and DM cup revision. We aim to (1) explore the reasons for revision of DM cups or head/liners and (2) explore whether certain femoral neck characteristics are associated with a higher risk of revision of DM cups. Methods Primary total hip arthroplasties with a DM cup registered in the Dutch Arthroplasty Register between 2007 and 2021 were identified (n = 7603). Competing risk survival analyses were performed, with acetabular component and head/liner revision as the primary endpoint. Reasons for revision were categorized in cup-/liner-related revisions (dislocation, liner wear, acetabular loosening). Femoral neck characteristics were studied to assess whether there is an association between femoral neck design and the risk of DM cup/liner revision. Multivariable Cox proportional hazard analyses were performed. Results The 5- and 10-year crude cumulative incidence of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was 0.5% (CI 0.4-0.8) and 1.9% (CI 1.3-2.8), respectively. After adjusting for confounders, we found no association between the examined femoral neck characteristics (alloy used, neck geometry, CCD angle, and surface roughness) and the risk for revision for dislocation, wear, and acetabular loosening. Conclusions The risk of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was low. We found no evidence that there is an association between femoral neck design and the risk of cup or head/liner revision.
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Affiliation(s)
- Bart van Dooren
- Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Rinne M. Peters
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- Department of Orthopedic surgery, Martini Hospital, Groningen, The Netherlands
| | - David Visser
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - P Koen Bos
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wierd P. Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Stadler C, Feldler S, Stevoska S, Schopper C, Gotterbarm T, Luger M. Gender differences in cementless short stem total hip arthroplasty: significantly higher femoral lengthening in female patients. Sci Rep 2024; 14:1154. [PMID: 38212361 PMCID: PMC10784556 DOI: 10.1038/s41598-024-51621-7] [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: 05/17/2023] [Accepted: 01/08/2024] [Indexed: 01/13/2024] Open
Abstract
Modern cementless short stems in total hip arthroplasty (THA) enable a precise reconstruction of the native pre-arthritic hip geometry. While gender differences have been reported for older generation straight hip stems, there are hardly reports regarding modern cementless short hip stems. Therefore, we aimed to evaluate the influence of gender differences in hip anatomy in cementless short stem THA. A total of 207 patients (109 females, 98 males) with unilateral THA and absence of contralateral joint space narrowing (Kellgren-Lawrence grade ≤ 2) were included. Acetabular height and offset as well as femoral height and offset were measured on pre- and 3-months-postoperative anteroposterior X-rays of the pelvis and compared to the contralateral hip. Additionally, implant position was evaluated on the postoperative radiograph. In male patients, the loss of acetabular offset was significantly greater than in females (p = 0.012), leading to a compensatory increase in femoral offset (p = 0.041). Femoral height discrepancy was significantly higher in females (p < 0.001), accounting for an increased global hip height discrepancy (p < 0.001). The mean acetabular anteversion was significantly greater in female patients (p < 0.001). Female patients are at higher risk of femoral lengthening in THA with a cementless short stem potentially caused by a further proximally conducted femoral neck osteotomy and show significantly higher cup anteversion angles. Therefore, surgeons should take special care to the level of neck resection and implant positioning in female patients.
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Affiliation(s)
- Christian Stadler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria.
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria.
| | - Sandra Feldler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Stella Stevoska
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Clemens Schopper
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
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Hennicke NS, Kluess D, Sander M. Influence of stem design parameters on periprosthetic femoral fractures examined by subject specific finite element analyses. Med Eng Phys 2023; 119:104032. [PMID: 37634909 DOI: 10.1016/j.medengphy.2023.104032] [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: 08/11/2022] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023]
Abstract
Due to the increasing number of periprosthetic femoral fractures (PFF), the optimisation of implant design gains importance. For the presented research a validated, subject specific finite element model of a human femur with an inlying total hip stem was used to compare the influence of different geometrical implant parameters on the development of PFF. The heterogeneous bone tissue was modelled on the basis of computed tomography scans. A ductile damage model with element deletion was applied to simulate bone fracture in a load case re-enacting a stumbling scenario. The results were compared in terms of fracture load, subsidence and fracture pattern to analyse the influence of friction at the implant-bone interface, implant size and stem length. The results showed that higher friction coefficients lead to an increase of fracture load. Also, the usage of an oversized implant has a negligible effect while an undersized implant reduces the fracture load by 48.9% for the investigated femur. Lastly, a higher fracture load was reached with an elongated stem, but the bending and change in fracture path indicate a more distal force transmission and subsequent stress shielding in the proximal femur.
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Affiliation(s)
- N S Hennicke
- Institute of Structural Mechanics, University of Rostock, Albert-Einstein-Str. 2, Rostock 18059, Germany.
| | - D Kluess
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - M Sander
- Institute of Structural Mechanics, University of Rostock, Albert-Einstein-Str. 2, Rostock 18059, Germany
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Luger M, Feldler S, Pisecky L, Allerstorfer J, Gotterbarm T, Klasan A. The 'critical trochanter angle' does not show superiority over the CCD angle in predicting varus stem alignment in cementless short-stem total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:529-537. [PMID: 35020039 PMCID: PMC9886626 DOI: 10.1007/s00402-022-04340-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/03/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Varus positioning of the femoral stem can affect the hip offset (HO). The critical trochanter angle (CTA) was introduced in 2019 as a novel geometric angle, to predict varus stem alignment in cementless straight stem THA. The aim of this study was to evaluate the applicability of the CTA as a predictor for stem alignment in THA with a cementless neck resecting short stem. PATIENTS AND METHODS In this retrospective study, 106 patients (index surgery 2014-2019) with unilateral THA and a morphologically healthy contralateral hip as a reference (Kellgren-Lawrence ≤ 1) were included. A cementless short stem with meta-diaphyseal fixation and press-fit cup was implanted in all cases. Stem alignment, CCD angle, CTA and offset reconstruction were measured on preoperative and 3 months postoperative AP radiographs of the pelvis. RESULTS Preoperative lower CTA and lower CCD angle were positively correlated (r = 0.472; p < 0.001). Higher varus stem alignment is correlated with lower CTA (r = - 0.384; p < 0.001) and lower CCD angle (r = - 0.474; p < 0.001). A CTA of 23.1° or lower showed a sensitivity of 59.1% and a specificity of 87.1% (AUC: 0.733) and a CCD angle of 132.75° or lower a sensitivity of 68.2% and a specificity of 80.6% (AUC: 0.77) for a varus stem alignment > 3°. CONCLUSION The CTA is also applicable in cementless THA with a neck resecting short stem to evaluate risk of intraoperative varus stem positioning. The CCD angle shows higher sensitivity with marginally lower specificity. Therefore, the CTA is not superior in predicting varus stem alignment in short-stem THA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthias Luger
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Sandra Feldler
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Lorenz Pisecky
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Jakob Allerstorfer
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Tobias Gotterbarm
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Antonio Klasan
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
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Kang JS, Nam YC, Kwon DG, Ryu DJ. Results of Hip Arthroplasty Using a COREN Stem at a Minimum of Ten Years. Hip Pelvis 2022; 34:211-218. [PMID: 36601611 PMCID: PMC9763833 DOI: 10.5371/hp.2022.34.4.211] [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: 08/10/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose We report on the 10-year clinical hip function and radiologic outcomes of patients who underwent hip arthroplasty using a COREN stem. Materials and Methods A consecutive series of 224 primary cementless hip arthroplasty implantations were performed using a COREN stem between 2009 and 2011; among these, evaluation of 128 hips was performed during a minimum follow-up period of 10 years. The mean age of patients was 65.4 years (range, 40-82 years) and the mean duration of follow-up was 10.8 years (range, 10-12 years). Evaluation of clinical hip function and radiologic implant outcomes was performed according to clinical score, thigh pain, and radiologic analysis. Results Dramatic improvement of the mean Harris hip score (HHS) from 59.4 preoperatively to 93.5 was observed at the final follow-up (P≤0.01). Stable fixation was demonstrated for all implants with no change in position except for one case of Vancouver type B2 periprosthetic femur fracture. A radiolucent line (RLL) was observed in 16 hips (12.5%). Thigh pain was observed in only two hips (1.6%) at the final follow-up. There were no cases of osteolysis around the stem. The survival rate for the COREN stem was 97.7%. Conclusion Good long-term survival with excellent clinical and radiological outcomes can be achieved using the COREN femoral stem regardless of Dorr type.
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Affiliation(s)
- Joon Soon Kang
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Yoon Cheol Nam
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Dae Gyu Kwon
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Dong Jin Ryu
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
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McConnell JS, Syed FA, Saunders P, Kattimani R, Ugwuoke A, Magra M, Young SK. Definition and validation of a system for classifying the undersized Corail femoral stem in total hip arthroplasty. Hip Int 2022; 32:737-746. [PMID: 33721509 DOI: 10.1177/1120700021996001] [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] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The uncemented total hip arthroplasty relies on a secure initial fixation of the femoral stem to achieve osseointegration. Undersizing of the femoral implant compromises this. Surgeons routinely review postoperative radiographs to assess appropriate sizing, but existing methods of assessment lack standardisation. We present a system of accurately and reliably classifying radiological undersizing, which will help us better understand the factors that might have led to undersizing. AIM To describe and evaluate a classification system for assessing radiological undersizing of the uncemented stem in hip arthroplasty. METHOD We conducted a retrospective review of 1,337 consecutive hip arthroplasties using the Corail stem. Two independent investigators reviewed post-operative radiographs and classified them as either appropriately sized or undersized. Undersized stems were sub-categorised into four subtypes: uniformly undersized, varus undersized, valgus undersized or 'cocktail-glass' undersized. Inter- and intra-observer agreement was determined. The accuracy of our classification system was validated by comparison with digital re-templating. We further assessed patient demographics and stem size in relation to sizing. RESULTS 1 in 5 cases (19.75%) were deemed radiologically undersized. The commonest subtypes of undersizing were uniformly (47%) and varus (39%) undersized. When assessing sizing and subtype categorisation, inter-observer agreement was 89-92% and intra-observer agreement 86%. Classification decisions showed 92% and 97% accuracy for uniformly undersizing and varus undersizing respectively when validated against digital re-templating. Age, gender and smaller stem size were significantly associated with radiological undersizing. The Corail KLA model (125° neck) was found to have a higher incidence of stems undersized in varus. CONCLUSIONS This study describes and validates a classification system for the analysis of radiological undersizing.
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Affiliation(s)
| | | | | | | | | | - Merzesh Magra
- University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK
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Luger M, Stiftinger J, Allerstorfer J, Hochgatterer R, Gotterbarm T, Pisecky L. High varus stem alignment in short-stem total hip arthroplasty: a risk for reconstruction of femoro-acetabular offset, leg length discrepancy and stem undersizing? Arch Orthop Trauma Surg 2022; 142:2935-2944. [PMID: 34554313 PMCID: PMC9474344 DOI: 10.1007/s00402-021-04176-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/09/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE Short stems are increasingly used in in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Short stems can be inserted in a more varus position compared to conventional straight stems. This poses the risk of final varus misplacement of the femoral component, which is not intended in all femoral short stems. METHODS We wanted to evaluate the effect of a high varus stem positioning in MIS THA on hip offset, leg length and femoral canal fill index. A series of 1052 consecutive THAs with a singular cementless femoral short stem and press-fit cup was retrospectively screened for inclusion. One hundred six patients with unilateral THA and a contralateral healthy hip met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior-posterior postoperative radiographs. Patients were divided into Group A (varus stem alignment ≤ 3°) and Group B (varus stem alignment > 3°). RESULTS Hip offset (HO) increased significantly in Group B by 4 mm (p = 0.013). No influence on leg length difference was detected in both groups. Preoperative CCD angle was significantly lower in Group B (p < 0.001). Canal Fill Indices (CFI) were significantly lower in Group B (CFI I: p < 0.001; CFI II p = 0.003; CF III p = 0.002). CONCLUSION High varus stem alignment > 3° leads to a statistically significant but minor increase in HO and poses the risk of stem undersizing. A preoperatively low genuine CCD angle pose a risk for varus stem positioning.
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Affiliation(s)
- Matthias Luger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria. .,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria. .,Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria.
| | - Julian Stiftinger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Jakob Allerstorfer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Rainer Hochgatterer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Lorenz Pisecky
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
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Li M, Zeng Y, Wu Y, Liu Y, Wu L, Shen B. Cementless femoral stems with lower canal fill ratio have similar mid-term to long-term outcomes to those with adequate fill ratio in Dorr type C femurs. Arch Orthop Trauma Surg 2022; 142:1265-1273. [PMID: 34117900 DOI: 10.1007/s00402-021-03916-x] [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: 12/15/2020] [Accepted: 04/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lower canal fill ratio was reported to correlate with aseptic loosening in many studies. However, the most widely used standard of fill ratio seemed inapplicable to Dorr type C femurs. We aimed to adapt the method of measuring the fill ratio in Dorr type C femurs and compare the outcomes among patients with different fill ratios. METHODS Twenty patients with Corail stems implanted in their Dorr type C femurs received spectrum CT to evaluate the whole-stem's fill ratio. Pearson Correlation Coefficient was calculated to assess the correlation between the fill ratio in X-ray film and spectrum CT. Then 87 THAs were involved in this study, divided into the fill ratio ≤ 80% group and the fill ratio > 80% group. Clinical and radiological outcomes were evaluated with a mean follow-up of 8.2 years. RESULTS Fill ratio at 2 cm below the lesser trochanter in anterior-posterior X-ray film correlated with the whole-stem's fill ratio (r = 0.50, P = 0.02). Survival rate of stem, function scores, and radiological outcomes between the two groups showed no significant difference. In the fill ratio > 80% group, intraoperative fracture was significantly higher (19% VS 5%, P < 0.05). CONCLUSION Patients with lower fill ratios at 2 cm below the lesser trochanter did not have poorer functional scores or more subsidence, but had a lower intraoperative fracture rate. The revision rates of the two groups presented no significant difference, but this result need to be confirmed in larger cohort in the future. In Dorr type C femurs, risk of fracture and the special morphology of the femur should be noted, and high fill ratio is not the most decisive factor for stem size selecting.
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Affiliation(s)
- Mingyang Li
- Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Yuan Liu
- Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Limin Wu
- Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.
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Dhillon MS, Jindal K, Kumar P, Rajnish RK, Neradi D. Long-term survival of CLS Spotorno femoral stem: a systematic review of literature. Arch Orthop Trauma Surg 2022; 142:1239-1251. [PMID: 34091733 DOI: 10.1007/s00402-021-03975-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND CLS Spotorno is a time-tested femoral stem design with excellent early results; the present review was designed to assess the published evidence on CLS Spotorno stem in the literature to evaluate its long-term outcomes and compare it to two other popular stem designs the uncemented Corail™ and the cemented Exeter™ stems. RESEARCH QUESTION Do CLS Spotorno stems provide adequate long-term rates of survival in terms of revisions and functional outcomes? METHODOLOGY Medline, EMBASE and SCOPUS databases were searched for relevant articles and a total number of 670 hits were obtained, out of which 14 relevant studies were included in this review. Pooled analysis of revisions rates, subsidence and Harris Hip scores (HHS) were done. RESULTS All the 14 studies were retrospective in design but had sufficiently large follow-up periods (12.3-27 years, mean 17.1 years). Of the 2459 hips reviewed, the documented revision rate was only 6.2%, with aseptic loosening reported in 3.1% and subsidence > 2 mm in 2.6% cases. The overall survival was similar to reported smaller cohorts of Corail (95% at 12 years) and Exeter stems (100% at 17 years). Varus malposition was seen in 10.6% cases, but it did not show any influence on implant survival or revision rates. Distal pedestal formation was seen in 172 of 805 hips across seven studies, while distal cortical hypertrophy was seen in 70 cases out of 398 hips; these were not related with stem malposition. The overall functional outcome was good, with mean HHS of 88.65 (95% CI = 86.08-91.23, p < 0.01). The improvement in scores from preoperative values (of 43.9 points) were comparable to Corail (43.8) and Exeter (45) stems. Thigh pain was seen in only 41 cases out of 1097 hips. CONCLUSION Despite the limitations due to high heterogeneity of the cumulative data, the review suggests that CLS Spotorno femoral stems provides excellent long-term survival and good hip function. These outcomes are comparable to other commonly utilized femoral stems like the Corail and Exeter. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Karan Jindal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prasoon Kumar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | | | - Deepak Neradi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Luger M, Hochgatterer R, Klotz MC, Allerstorfer J, Gotterbarm T, Schauer B. A single-surgeon experience in reconstruction of femoro-acetabular offset and implant positioning in direct anterior approach and anterolateral MIS approach with a curved short stem. Arch Orthop Trauma Surg 2022; 142:871-878. [PMID: 34076711 PMCID: PMC8994713 DOI: 10.1007/s00402-021-03977-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/26/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE Minimally invasive surgery using short stems in total hip arthroplasty gained more popularity. The differences in change of hip offset and implant positioning in minimally invasive approaches are not fully known. Therefore, this study was conducted to evaluate the difference in reconstruction of hip offset and implant positioning in direct anterior approach (DAA) and minimally invasive anterolateral approach (AL MIS). METHODS A single surgeon series of 117 hips (117 patients; mean age 65.54 years ± 11.47; index surgery 2014-2018) were included and allocated into two groups: group A (DAA) with 70 hips and Group B (AL MIS) with 47 patients operated. In both groups the same type of cementless curved short hip stem and press fit cup was used. RESULTS Both groups showed an equal statistically significant increase of femoral (p < 0.001) and decrease of acetabular offset (p < 0.001). Between both groups no statistically significant difference in offset reconstruction, leg length difference or implant positioning could be found. Leg length increased in both groups significantly and leg length discrepancy showed no difference (group A: - 0.06 mm; group B: 1.11 mm; p < 0.001). A comparable number of cups were positioned outside the target zone regarding cup anteversion. CONCLUSION The usage of a curved short stem shows an equal reconstruction of femoro-acetabular offset, leg length and implant positioning in both MIS approaches. The results of this study show comparable results to the existing literature regarding change of offset and restoration of leg length. Malposition of the acetabular component regarding anteversion poses a risk.
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Affiliation(s)
- Matthias Luger
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Rainer Hochgatterer
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Matthias C. Klotz
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Jakob Allerstorfer
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Tobias Gotterbarm
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Bernhard Schauer
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
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13
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The morphology of the proximal femur in cementless short-stem total hip arthroplasty: No negative effect on offset reconstruction, leg length difference and implant positioning. J Orthop Surg Res 2021; 16:730. [PMID: 34930358 PMCID: PMC8686665 DOI: 10.1186/s13018-021-02876-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Correct reconstruction of hip offset (HO) and leg length are important for clinical–functional outcome and patient satisfaction in total hip arthroplasty (THA). The morphology of the proximal femur can pose a risk for increased leg length difference (LLD) in cementless straight-stem THA. We therefore wanted to evaluate, if this is also applicable in THA with a cementless meta-diaphyseal short stem. Methods In a retrospective study, 106 patients (index surgery 2014–2019) with unilateral THA and a morphologically healthy hip as a reference (Kellgren–Lawrence ≤ 1) were included. The same cementless short stem with meta-diaphyseal fixation and cementless press-fit cup was implanted. The proximal femur was rated by Dorr’s classification, and subgroups were formed afterward. Measurements were carried out on preoperative and 3 months postoperative anterior–posterior radiographs of the pelvis. Kruskal–Wallis test, Fisher’s exact test and binary logistic regression were performed to evaluate the influence of the anatomical shape on postoperative leg length difference and offset reconstruction. Results The Dorr type did not show any significance influence on LLD (p = 0.532), or postoperative difference in femoral offset (p = 0.243), acetabular offset (p = 0.106) and hip offset (p = 0.698). Stem alignment (p = 0.705) and canal fill indices (CFI I: p = 0.321; CFI II: p = 0.411; CFI III: p = 0.478) were also without significant differences. Logistic regression did not show any significant increased risk for a LLD ≥ 5 mm or ≥ 10 mm as well as HO ≥ 5 mm or ≥ 10 mm. Conclusion Reconstruction of hip offset and postoperative leg length difference is not negatively influenced by Dorr type, canal flare index, cortical index and canal-to-calcar ratio in cementless short-stem THA. Implant positioning and canal fill are also not negatively affected by the anatomical shape of the proximal femur. Level of evidence: Level IV.
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García-Rey E. The fate of sagittal alignment in tapered uncemented femoral components in total hip arthroplasty: 889 hips followed for a minimum of 10 years. Hip Int 2021; 31:472-481. [PMID: 31908180 DOI: 10.1177/1120700019895983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Aseptic loosening is rare after primary total hip arthroplasty (THA) with mostly uncemented tapered stems; however, different factors can modify the results. We question whether 3 different current femoral components and/or the surgical technique affect the clinical and radiological outcome after a minimum follow-up of 10 years. METHODS 889 uncemented tapered stems implanted from 1999 to 2007 were evaluated for a minimum follow-up of 10 years. Group 1 (273 hips) shared a conical shape and a porous-coated surface, group 2 (286 hips) a conical splined shape and group 3 (330 hips) a rectangular grit-blasted stem. Groups 1 and 2 were implanted through a posterolateral approach and group 3 using an anterolateral approach. Clinical outcomes and anteroposterior and sagittal radiographic analyses were compared. RESULTS No thigh pain was reported in unrevised patients. Mean Harris Hip score was lower for patients in group 3 for pain and function at all intervals. 14-year implant survival for aseptic loosening was 98.2% (95% confidence interval [CI] 96.2-100) in group 3. No revision for aseptic loosening was found with the other designs. A stem position outside neutral limits in the sagittal alignment (p = 0.001, hazard ratio: 6.17, 95% CI, 2.05-18.61) was associated with aseptic loosening in group 3. CONCLUSIONS Most current uncemented straight tapered femoral components can provide adequate bone fixation in primary THA after 10 years. Conical stems inserted through a posterolateral approach are more reliable than rectangular ones inserted through an anterolateral approach.
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Affiliation(s)
- Eduardo García-Rey
- Orthopaedic Surgery Department, Hospital La Paz-Idi Paz, Madrid, Spain.,Biomedical Research Centre in Bioengineering, Biomaterials and Nanomedicine Network, CIBER-BBN, Spain
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15
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Ferreño Márquez DM, Dauder Gallego C, Bebea Zamorano FNG, Sebastián Pérez V, Montejo Sancho J, Martínez Martín J. Long-Term Outcomes of 496 Anatomical Cementless Modular Femoral Stems: Eleven to Twenty Years of Follow-Up. J Arthroplasty 2021; 36:2087-2099. [PMID: 33610406 DOI: 10.1016/j.arth.2021.01.057] [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: 10/02/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of the study is to assess the long-term outcomes of this specific stem (anatomical cementless modular stem ESOP), to review the survivorship, complication rate, and radiographic and clinical outcomes. METHODS Descriptive and analytical retrospective longitudinal observational study of patients was operated on total hip arthroplasty between 1998 and 2007. Four hundred ninety-six prostheses corresponding to 447 patients were reviewed, mean age was 65.8 years (standard deviation [SD] ±11.6 years), and median follow-up time was 13.4 years (range 1-20). The most used cups were cementless (75.8%). The most frequent friction pairs were metal-polyethylene (53.1%) and ceramic-polyethylene (24.2%). Main variables analyzed were stem survival, subsidence, coronal orientation, osteolysis, reintervention, and Oxford Hip Score. RESULTS From 496 implants, there were 22 lost to follow-up (4.4%). Stem revision was performed in 51 patients: 26 periprosthetic joint infections (2-stage revision), 16 periprosthetic fractures, and 8 one-stage revisions (6 real aseptic loosening with negative culture after revision). The stem survivorship at more than 15 years for any reason was 89.2% and for aseptic loosening 97.97%. No specific complications were found due to modularity. The mean subsidence and orientation was 2.06 mm (SD ±5.11 mm) and 0.41° varus (SD ±2.20°) respectively. Subsidence >5 mm or varus >5° was associated with a higher revision rate. Osteolysis was found in 110 patients (zone I = 79, VII = 57), associated with zirconium-polyethylene, without relationship to the stem revision rate or Oxford Hip Score. CONCLUSION To our knowledge, this study represents the largest series of this stem, revealing an excellent survival rate and long-term clinical outcomes similar to the best results of classical cementless stems published in the literature.
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Affiliation(s)
| | | | | | | | - Jorge Montejo Sancho
- Department of Orthopaedic Surgery, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Javier Martínez Martín
- Department of Orthopaedic Surgery, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Jahnke A, Ghandourah S, Fonseca Ulloa CA, Seeger JB, Rickert M, Ishaque BA, Ahmed GA. Comparison of Short Stems Versus Straight Hip Stems: A Biomechanical Analysis of the Primary Torsional Stability. J Biomech Eng 2020; 142:1084892. [PMID: 32601705 DOI: 10.1115/1.4047659] [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: 11/25/2019] [Indexed: 11/08/2022]
Abstract
Cementless straight stems show very good survival rates. However, the more distal force application of straight stems may lead to release-related proximal stress-shielding. Nevertheless, this technical brief had the objective of conducting a biomechanical in vitro analysis comparing short stems with established straight stems with respect to their primary torsional stability. Two cementless short hip stems and three cementless straight hip stems were implanted in n = 5 synthetic femora each. Torsional torques were applied into the hip stems at a continuous interval of ±7 Nm. Micromotions were measured by six inductive extensometers on four different measurement levels. At the proximal measuring point, significantly smaller relative micromotions of the CLS® prosthesis could be detected compared to all other stem models (p < 0.05). In all stem models, smallest relative micromotions were found at the metaphyseal/diaphyseal measuring point. Only at the measuring point of the distal tips of the straight stems, statistically significantly lower relative micromotion of the CLS® stem compared to the Trendhip® stem could be found (p < 0.01). All the investigated stems generally display a rather comparable anchoring pattern and an almost physiological force application. Since the comparatively long straight stems present an anchoring pattern nearly identical to that of the examined short stems, a shortening of the established straight stems could be taken into consideration. This would offer the advantage of minimally invasive surgery and bone-saving resection as well as preservation of cancellous bone in case a revision would become necessary.
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Affiliation(s)
- Alexander Jahnke
- Laboratory of Biomechanics, Justus-Liebig-University, Klinikstrasse 29, Giessen 35392, Germany
| | - Suleiman Ghandourah
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen, Klinikstrasse 33, Giessen 35392, Germany
| | - Carlos A Fonseca Ulloa
- Laboratory of Biomechanics, Justus-Liebig-University, Klinikstrasse 29, Giessen 35392, Germany
| | - Jörn Bengt Seeger
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen, Klinikstrasse 33, Giessen 35392, Germany
| | - Markus Rickert
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen, Klinikstrasse 33, Giessen 35392, Germany
| | - Bernd Alexander Ishaque
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen, Klinikstrasse 33, Giessen 35392, Germany
| | - Gafar Adam Ahmed
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen, Klinikstrasse 33, Giessen 35392, Germany
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Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Niikura T, Kuroda R. Risk factors of thigh pain following total hip arthroplasty with short, tapered-wedge stem. INTERNATIONAL ORTHOPAEDICS 2020; 44:2553-2558. [PMID: 32767085 DOI: 10.1007/s00264-020-04762-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The occurrence of thigh pain following cementless total hip arthroplasty (THA) may be dependent on multiple factors, which may differ with design of the prosthesis. Thus, this study aimed to investigate the frequency of thigh pain following cementless THA using a short, tapered-wedge stem to identify risk factors for thigh pain. METHODS This retrospective cohort study analysed 222 joints of patients who underwent THA with a short, tapered-wedge stem. Thigh pain was evaluated using a questionnaire during each follow-up visit, and the clinical and radiographic assessments were compared. RESULTS Thigh pain occurred in 37 patients (16.7%) during the follow-up period. The pain started two to 24 months after THA. Multivariate analysis demonstrated that higher University of California, Los Angeles, activity rating (odds ratio 7.2; 95% confidence interval (CI) 3.0-17.2); Dorr type C femoral bone shape (odds ratio 1.5; 95% CI 1.1-2.0); and stem tip-cortical bone contact (odds ratio 8.2; 95% CI 2.3-29.4) were significant risk factors of thigh pain following THA. Post-operatively, cortical hypertrophy at Gruen zone 4 was significantly found in patients with thigh pain (p value = 0.032). CONCLUSION Risk factors of pain following THA with short, tapered-wedge stem were high activity level, Dorr type C femoral bone shape, and stem tip contacting the distal bone surface. Moreover, post-operative cortical hypertrophy at the distal stem tip significantly increased the incidence of thigh pain. Therefore, we must pay attention to the aforementioned factors to avoid post-operative thigh pain when using a short, tapered-wedge stem.
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Affiliation(s)
- Shinya Hayashi
- 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
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- 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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18
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Zampelis V, Flivik G, Kesteris U. No effect of femoral canal jet-lavage on the stability of cementless stems in primary hip arthroplasty: a randomised RSA study with 6 years follow-up. Hip Int 2020; 30:417-422. [PMID: 31006262 DOI: 10.1177/1120700019843123] [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: 02/04/2023]
Abstract
INTRODUCTION In contrast to cemented hip prostheses, the effect of washing the bone bed with jet-lavage prior to insertion of cementless stem components in primary hip arthroplasty (THA) is unclear. Jet-lavage potentially decreases the risk of fat embolisation during rasping and stem insertion and might help in avoiding bacterial contamination. An earlier animal study has shown less debris and better-organised trabecular structure of new bone when jet-lavage was used. We hypothesised that the primary stability of cementless femoral stems implanted after jet-lavage of the femoral canal prior to stem insertion would improve with earlier stabilisation, as measured with Radiostereometry (RSA), compared with insertion without prior jet-lavage. METHODS 40 patients with primary osteoarthritis operated on with a cementless titanium grit blasted stem are included in the study. The patients were randomised to either jet-lavage or control without any lavage of the femoral canal prior to insertion of the prosthesis. The stem migration pattern was measured with RSA at 0, 3, 12, 24 and 72 months. RESULTS At 6 years, 19 patients remained for analysis in the jet-lavage and 18 in the control group. We found no difference in extent or pattern of migration as measured with RSA. Both groups seemed to have stabilised within 3 months after a slight subsidence and retroversion. No stem was revised or considered loose as measured with RSA. CONCLUSIONS Washing the bone bed with jet-lavage prior to insertion of cementless stems does not affect the stability of cementless femoral components. No adverse effects were observed.
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Affiliation(s)
- Vasileios Zampelis
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Gunnar Flivik
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Uldis Kesteris
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
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Busch A, Stöckle U, Schreiner A, de Zwaart P, Schäffler A, Ochs BG. Total hip arthroplasty following acetabular fracture: a clinical and radiographic outcome analysis of 67 patients. Arch Orthop Trauma Surg 2020; 140:331-341. [PMID: 31501930 DOI: 10.1007/s00402-019-03272-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) is a challenging option for the treatment of posttraumatic arthritis due to acetabular fractures. METHODS The study aimed to determine the short- and mid-term clinical and radiographic results of THA following acetabular fracture. The fracture pattern, the extent of injury and the initial fracture treatment were considered to evaluate the influence of these factors on the clinical-radiographic outcome. RESULTS 67 patients who received THA for the treatment of posttraumatic osteoarthritis after acetabular fracture between January 2007 and December 2012 were analyzed consecutively. The group consisted of 13 female (19%) and 54 male (81%) patients with a mean age of 59 (25-87) years at the time of THA. The time between acetabular injury and arthroplasty was 107 (1-504) months on average. The all-cause 8-year survival rate was 0.87% (0.76-0.93) and there were 8 revisions, half of them were due to aseptic loosening of the cup. The Harris Hip Score achieved was 75.7 ± 21.3 (26.9-100) points. Prior to THA, heterotopic ossifications were detected in 28% and after THA implantation in 42%. CONCLUSION The decrease of the interval between injury and arthroplasty was associated with increasing patient age (p = 0.001) and surgical treatment of the acetabular fracture (p = 0.04). Complex fracture patterns were accompanied by acetabular bone defects more often than simple patterns (p = 0.03). Overall, arthroplasty due to posttraumatic osteoarthritis after acetabular fracture resulted in decreased overall survival rates and poorer clinical outcome as compared to primary arthroplasty.
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Affiliation(s)
- André Busch
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany. .,BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany.
| | - Ulrich Stöckle
- BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany
| | - Anna Schreiner
- BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany
| | - Peter de Zwaart
- BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany
| | - Aljoscha Schäffler
- BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany.,Krankenhaus Freudenstadt, Karl-von-Hahn-Straße 120, 72250, Freudenstadt, Germany
| | - Björn Gunnar Ochs
- BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany
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20
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Klug A, Gramlich Y, Hoffmann R, Pfeil J, Drees P, Kutzner KP. Trends in Total Hip Arthroplasty in Germany from 2007 to 2016: What Has Changed and Where Are We Now? ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 159:173-180. [PMID: 31711254 DOI: 10.1055/a-1028-7822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The number of total hip arthroplasties (THA) is rising in many industrialized nations. At the same time, the evidence regarding different types of prostheses and fixation techniques is constantly evolving. Therefore, this study aimed to analyze changes in THA by these advancements during the last decade. METHODS A retrospective analysis of data provided by the Federal Statistical Office of Germany from 2007 to 2016 was conducted using codes from the German procedure classification system and associated International Statistical Classification of Diseases and Related Health Problems codes. THA procedures were evaluated according to diagnoses, sex, and age of patients, along with the distribution of different prosthesis types. Additionally, changes in these parameters over time were analyzed. RESULTS From 2007 to 2016 a total of 2 157 041 primary THA procedures were performed in Germany, with an increase of 14.4% over this period. Overall, cementless standard THA (STHA) was used most frequently (50.0%), followed by hybrid variants (18.8%), hemiarthroplasties (15.9%), cemented standard THA (cSTHA; 9.2%), cementless short-stem THA (ssTHA; 4.8%), and hip resurfacing (HR; 0.9%) techniques. During the study period, the number of cSTHA and HR decreased significantly, whereas the use of STHA and ssTHA rose substantially, with a significantly higher application of these procedures in the elderly population. While osteoarthritis of the hip joint was the main indication for THA, several procedure-specific differences were identified. CONCLUSION The present data clearly demonstrate an increase in the use of cementless fixation for THA in Germany during the last decade and document a rise in ssTHA in recent years with, in contrast, the use of HR decreasing to a minimum.
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Affiliation(s)
- Alexander Klug
- Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main
| | - Yves Gramlich
- Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main
| | - Reinhard Hoffmann
- Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main
| | - Joachim Pfeil
- Klinik für Orthopädie und Unfallchirurgie, St. Josefs Hospital Wiesbaden
| | - Philipp Drees
- Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin Mainz
| | - Karl Philipp Kutzner
- Klinik für Orthopädie und Unfallchirurgie, St. Josefs Hospital Wiesbaden.,Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin Mainz
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21
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Zang J, Uchiyama K, Moriya M, Li Z, Fukushima K, Yamamoto T, Takahira N, Takaso M, Liu J, Feng W. Long-term clinical and radiographic results of the cementless Spotorno stem in Japanese patients: A more than 15-year follow-up. J Orthop Surg (Hong Kong) 2019; 26:2309499017750310. [PMID: 29320963 DOI: 10.1177/2309499017750310] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Although previous studies have reported encouraging results of cementless Spotorno (CLS) stem, studies with more than 15 years of follow-up are rare. The objective of this study is to investigate the long-term results of CLS stem and the factors potentially influencing the outcomes. METHODS The clinical and radiographic data of 79 hips (64 patients) were reviewed. Clinical outcome was determined using the Japanese Orthopedic Association's hip scoring system (JOA hip score). Survival rate was assessed by Kaplan-Meier survival analysis. The main end point for survival analysis was revision of stem. The correlations between patient demographics, radiographic factors, and stem survival rates were analyzed. RESULTS At a mean follow-up period of 20.1 years, the mean JOA hip score at final follow-up was 84.7 points. Stem survival rate for all revisions was 97.5% at 20 years, and stem survival for aseptic loosening was 98.9%. Varus alignment had a significant negative influence on the survival of the femoral stem. CONCLUSION This study demonstrates acceptable long-term clinical and radiographic results of the CLS stem in Japanese patients. Caution should be exercised to avoid varus stem alignment.
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Affiliation(s)
- Junting Zang
- 1 Department of Orthopedic Surgery, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Katsufumi Uchiyama
- 2 Department of Orthopedic Surgery, School of Medicine, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Mitsutoshi Moriya
- 2 Department of Orthopedic Surgery, School of Medicine, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Zhengwei Li
- 3 Department of Orthopedic Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Kensuke Fukushima
- 2 Department of Orthopedic Surgery, School of Medicine, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Takeaki Yamamoto
- 2 Department of Orthopedic Surgery, School of Medicine, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Naonobu Takahira
- 4 Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Masashi Takaso
- 2 Department of Orthopedic Surgery, School of Medicine, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Jianguo Liu
- 1 Department of Orthopedic Surgery, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Wei Feng
- 1 Department of Orthopedic Surgery, the First Hospital of Jilin University, Changchun, Jilin Province, China
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22
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Diesel CV, Ribeiro TA, Macedo CADS, Galia CR. Results of Medium-Term Survival of the Non-Cemented Logical Femoral Stem. Rev Bras Ortop 2019; 54:453-458. [PMID: 31435114 PMCID: PMC6701964 DOI: 10.1055/s-0039-1688755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 07/10/2018] [Indexed: 12/03/2022] Open
Abstract
Objective
The main objective of the present study was to evaluate the clinical and radiographic results of the Logical (Baumer, Mogi Mirim, SP, Brasil) cementless femoral stem in primary total hip arthroplasties (THAs).
Methods
A retrospective cohort study of 632 patients submitted to primary THA with the Logical cementless femoral stem. The study period was between January 2004 and January 2015. The outcome defined to evaluate the survival of the stem was the clinical and radiographic indication of the revision hip arthroplasty or the actual revision of the femoral stem for any cause.
Results
Kaplan-Meier survival curves were estimated at > 95%, with a follow-up ranging from 2 to 13 years. There was a low incidence of transoperative periprosthetic fractures (0.02%). No axial migration or cortical bone atrophy was observed in the radiographic sample evaluated.
Conclusions
In the intermediate follow-up, there was excellent survival of the Logical cementless femoral stem. Although long-term studies are still awaited, this implant appears to be safe and promising to be used for primary THAs.
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Affiliation(s)
- Cristiano Valter Diesel
- Programa de Pós-Graduação em Medicina, Ciências Cirúrgicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.,Serviço de Ortopedia e Traumatologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brasil.,Departamento de Cirurgia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Tiango Aguiar Ribeiro
- Programa de Pós-Graduação em Medicina, Ciências Cirúrgicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.,Departamento de Cirurgia, Curso de Medicina, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brasil.,Serviço de Ortopedia e Traumatologia, Hospital Universitário de Santa Maria (SOT-HUSM), Santa Maria, RS, Brasil
| | - Carlos Alberto de Souza Macedo
- Serviço de Ortopedia e Traumatologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brasil.,Departamento de Cirurgia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Carlos Roberto Galia
- Programa de Pós-Graduação em Medicina, Ciências Cirúrgicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.,Serviço de Ortopedia e Traumatologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brasil.,Departamento de Cirurgia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
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23
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García-Rey E, Carbonell-Escobar R, Cordero-Ampuero J, García-Cimbrelo E. Outcome of a hemispherical porous-coated acetabular component with a proximally hydroxyapatite-coated anatomical femoral component. Bone Joint J 2019; 101-B:378-385. [DOI: 10.1302/0301-620x.101b4.bjj-2018-1223.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims We previously reported the long-term results of the cementless Duraloc-Profile total hip arthroplasty (THA) system in a 12- to 15-year follow-up study. In this paper, we provide an update on the clinical and radiological results of a previously reported cohort of patients at 23 to 26 years´ follow-up. Patients and Methods Of the 99 original patients (111 hips), 73 patients (82 hips) with a mean age of 56.8 years (21 to 70) were available for clinical and radiological study at a minimum follow-up of 23 years. There were 40 female patients (44 hips) and 33 male patients (38 hips). Results All acetabular and femoral components were well fixed and showed signs of bone ingrowth. Nine acetabular components were revised due to wear-osteolysis-related problems and four due to late dislocation. The probability of not having component revision at 25 years was 83.2% (95% confidence interval (CI) 74.5 to 91.8; number at risk 41). Acetabular osteolysis was observed in ten hips. The mean femoral head penetration was 1.52 mm (sd 0.8) at 15 years and 1.92 mm (sd 1.2) at 25 years. Receiver operating characteristic (ROC) analysis revealed that mean femoral penetration with a value of 0.11 mm/year or more was associated with the appearance of osteolysis. The 25-year Kaplan–Meier survival with different endpoints was 89.9% for acetabular osteolysis (95% CI 83.3 to 96.5), 92.1% for proximal femoral osteolysis (95% CI 86.1 to 98.2), and 75.5% for femoral osteopenia (95% CI 66.5 to 84.5). Conclusion The Duraloc-Profile THA system showed excellent long-term bone fixation. Nevertheless, monitoring is recommended in order to detect wear and late dislocations in this population that was relatively young at the time of surgery. Cite this article: Bone Joint J 2019;101-B:378–385.
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Affiliation(s)
- E. García-Rey
- Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | | | - J. Cordero-Ampuero
- Orthopaedics Department, Hospital Universitario La Princesa, Madrid, Spain
| | - E. García-Cimbrelo
- Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
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24
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Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet 2019; 393:647-654. [PMID: 30782340 PMCID: PMC6376618 DOI: 10.1016/s0140-6736(18)31665-9] [Citation(s) in RCA: 292] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Total hip replacement is a common and highly effective operation. All hip replacements would eventually fail if in situ long enough and it is important that patients understand when this might happen. We aimed to answer the question: how long does a hip replacement last? METHODS We did a systematic review and meta-analysis with a search of MEDLINE and Embase from the start of records to Sept 12, 2017. We included articles reporting 15-year survival of primary, conventional total hip replacement constructs in patients with osteoarthritis. We extracted survival and implant data and used all-cause construct survival as the primary outcome. We also reviewed reports of national joint replacement registries, and extracted data for a separate analysis. In the meta-analyses, we weighted each series and calculated a pooled survival estimate for each source of data. This study was registered with PROSPERO (CRD42018085642). FINDINGS We identified 140 eligible articles reporting 150 series, and included 44 of these series (13 212 total hip placements). National joint replacement registries from Australia and Finland provided data for 92 series (215 676 total hip replacements). The 25-year pooled survival of hip replacements from case series was 77·6% (95% CI 76·0-79·2) and from joint replacement registries was 57·9% (95% CI 57·1-58·7). INTERPRETATION Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients. FUNDING National Institute for Health Research, National Joint Registry for England, Wales, Northern Ireland and Isle of Man, and The Royal College of Surgeons of England.
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Affiliation(s)
- Jonathan T Evans
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK.
| | - Jonathan P Evans
- Health and Policy Research Group, University of Exeter, Exeter, UK
| | - Robert W Walker
- Department of Trauma and Orthopaedics, Derriford Hospital, Plymouth, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals, Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals, Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
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25
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Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet 2019. [PMID: 30782340 DOI: 10.1016/s0140-6736(18)31665-9/attachment/14b424e0-004d-4903-8960-c00543bdca68/mmc2.mp4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Total hip replacement is a common and highly effective operation. All hip replacements would eventually fail if in situ long enough and it is important that patients understand when this might happen. We aimed to answer the question: how long does a hip replacement last? METHODS We did a systematic review and meta-analysis with a search of MEDLINE and Embase from the start of records to Sept 12, 2017. We included articles reporting 15-year survival of primary, conventional total hip replacement constructs in patients with osteoarthritis. We extracted survival and implant data and used all-cause construct survival as the primary outcome. We also reviewed reports of national joint replacement registries, and extracted data for a separate analysis. In the meta-analyses, we weighted each series and calculated a pooled survival estimate for each source of data. This study was registered with PROSPERO (CRD42018085642). FINDINGS We identified 140 eligible articles reporting 150 series, and included 44 of these series (13 212 total hip placements). National joint replacement registries from Australia and Finland provided data for 92 series (215 676 total hip replacements). The 25-year pooled survival of hip replacements from case series was 77·6% (95% CI 76·0-79·2) and from joint replacement registries was 57·9% (95% CI 57·1-58·7). INTERPRETATION Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients. FUNDING National Institute for Health Research, National Joint Registry for England, Wales, Northern Ireland and Isle of Man, and The Royal College of Surgeons of England.
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Affiliation(s)
- Jonathan T Evans
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK.
| | - Jonathan P Evans
- Health and Policy Research Group, University of Exeter, Exeter, UK
| | - Robert W Walker
- Department of Trauma and Orthopaedics, Derriford Hospital, Plymouth, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals, Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals, Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
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26
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Heyland M, Checa S, Kendoff D, Duda GN. Anatomic grooved stem mitigates strain shielding compared to established total hip arthroplasty stem designs in finite-element models. Sci Rep 2019; 9:482. [PMID: 30679467 PMCID: PMC6345751 DOI: 10.1038/s41598-018-36503-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/19/2018] [Indexed: 01/30/2023] Open
Abstract
Aseptic loosening remains a major problem for uncemented femoral components in primary total hip arthroplasty (THA). Ideally, bone adaptation after THA manifests minimally and local bone density reduction is widely avoided. Different design features may help to approximate initial, post-THA bone strain to levels pre-THA. Strain-shielding effects of different SP-CL stem design features are systematically analyzed and compared to CLS Spotorno and CORAIL using finite element models and physiological musculoskeletal loading conditions. All designs show substantial proximal strain-shielding: 50% reduced medial surface strain, 40–50% reduction at lateral surface, >120 µm/m root mean square error (RMSE) compared to intact bone in Gruen zone 1 and >60 µm/m RMSE in Gruen zones 2, 6, and 7. Geometrical changes (ribs, grooves, cross sections, stem length, anatomic curvature) have a considerable effect on strain-shielding; up to 20%. Combinations of reduced stem stiffness with larger proximal contact area (anatomically curved, grooves) lead to less strain-shielding compared to clinically established implant designs. We found that only the combination of a structurally flexible stem with anatomical curvature and grooves improves strain-shielding compared to other designs. The clinical implications in vivo of this initial strain-shielding difference are currently under evaluation in an ongoing clinical analysis.
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Affiliation(s)
- Mark Heyland
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Sara Checa
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Georg N Duda
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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27
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Vijayvargiya M, Shetty V, Makwana K, Suri HS. Mid-term results of an uncemented tapered femoral stem and various factors affecting survivorship. J Clin Orthop Trauma 2019; 10:368-373. [PMID: 30828210 PMCID: PMC6383067 DOI: 10.1016/j.jcot.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/03/2018] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE CLS stem is commonly used today in primary hip arthroplasty, but only a few studies have evaluated their outcome in young high demanding patients. In Indian scenario, many patients require squatting and sitting cross-legged as part of their daily activities placing excessive load on the joint. We evaluated (I) Mid-long term functional and radiological results (II) Influence of age, gender, diagnosis, stem alignment, Canal fill index (CFI) on the outcome (III) Kaplan-Meier survivorship using revision for any reason or for aseptic loosening as an endpoint. METHODS Retrospective evaluation of 64 THA in 54 patients operated between July 2000 to July 2011 using CLS stem was done. Mean follow-up was 10.3 years (5-14.9 years) with 5 patients lost to follow-up and 4 patients died. Mean age at surgery was 46.8 years (18-78 years). RESULTS Mean Harris hip score was 89.4 (72-100). Thigh pain was present in 4 hips which were not associated with the sizing of the stem (p = .489). Stable fixation by bony ingrowth was seen in 53 hips (96.4%) and by fibrous ingrowth in 2 cases (3.6%) with no case of loosening seen. Stress shielding was seen as Grade II in 17 hips (30.9%), Grade III in 3 hips (5.4%). Pedestal formation was seen in 9 hips (16.4%) which were statistically associated with varus alignment and CFI < 80. No stem revision was performed with stem survivorship of 100%. CONCLUSION The mid-term survival rates and good clinical-radiological outcomes of CLS stem in high demanding Indian population were excellent.
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Affiliation(s)
| | - Vivek Shetty
- Corresponding author at: Hinduja Clinic Building, 1st floor Wing 4, P.D. Hinduja National Hospital, Veer Savarkar Marg, Mahim (W), Mumbai-16, India.
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28
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Peitgen DS, Innmann MM, Merle C, Gotterbarm T, Moradi B, Streit MR. Cumulative Long-Term Incidence of Postoperative Periprosthetic Femoral Fractures Using an Uncemented Tapered Titanium Hip Stem: 26- to 32-Year Results. J Arthroplasty 2019; 34:77-81. [PMID: 30274947 DOI: 10.1016/j.arth.2018.08.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/12/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although falling is becoming a major problem in the elderly, little is known about the long-term incidence of postoperative periprosthetic femoral fractures (PFF) after total hip arthroplasty (THA) using uncemented stems with a minimum follow-up of 26 years postoperatively. METHODS In a consecutive series, the cumulative incidence of PFF after uncemented THA using a straight, collarless, tapered titanium stem was retrospectively reviewed in 354 hips (326 patients). After a mean follow-up of 28 (26-32) years postoperatively, 179 hips had died and 5 hips had been lost to follow-up. Kaplan-Meier survival analysis was used to estimate cumulative percentage probability of PFF. RESULTS At final follow-up, a total of 27 fractures in 27 patients had occurred. In 15 hips, the stem had to be revised, and in 10 the fracture was treated by open reduction and internal fixation. Two patients declined further surgery. The cumulative percentage probability of PFF was 1.6% (95% confidence interval, 0.7 to 3.8) at 10 years and 13.2% (95% confidence interval, 8.5 to 20.2) at 29 years after primary THA. There was no association between the occurrence of fracture and gender, age at primary THA, cup revision, or canal fill index. CONCLUSION Our findings indicate that PFF is the major mode of failure in the long term after uncemented THA using a tapered titanium stem. More research is needed to evaluate the reasons and risk factors for PFF after THA, thus providing better prophylaxis for those at risk and to compare the long-term incidence using different fixation methods and implants. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- David S Peitgen
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Moritz M Innmann
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Christian Merle
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Tobias Gotterbarm
- Department of Orthopedics, Kepler University Hospital, Linz, Austria
| | - Babak Moradi
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Marcus R Streit
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
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29
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Peitgen DS, Innmann MM, Merle C, Gotterbarm T, Moradi B, Streit MR. Periprosthetic Bone Mineral Density Around Uncemented Titanium Stems in the Second and Third Decade After Total Hip Arthroplasty: A DXA Study After 12, 17 and 21 Years. Calcif Tissue Int 2018; 103:372-379. [PMID: 29858615 DOI: 10.1007/s00223-018-0438-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
Implant failure and periprosthetic fractures because of periprosthetic bone loss are a major concern in total hip arthroplasty (THA). Hardly any clinical data exist on the long-term evolution of bone mineral density (BMD) around uncemented femoral implants. The question to address is whether relevant bone loss continues into third decade around well-fixed uncemented femoral implants. BMD around stable uncemented straight titanium femoral implants was assessed in a longitudinal cohort study. We included 142 hips of 128 patients and measured the development of the periprosthetic BMD using dual-energy X-ray absorptiometry. The baseline measurement was 12 years (t1) after the implantation of an uncemented femoral stem. Follow-up-measurements were performed at 17 (t2) and at 21 years (t3) after primary THA. The regions of interest (ROI) were selected conforming to Gruen et al. We acquired complete data including three consecutive measurements (t1, t2, t3) for 42 patients (49 hips). Performing radiographic evaluation at t1, t2 and t3, we found a regular bone-implant interface present in all cases. Significant decrease in BMD could be shown in ROI 1 (p = 0.0001; - 7.8%), 4 (p = 0.024; - 2.4%), 6 (p = 0.001; - 5.5%) and 7 (p < 0.0001; - 11.7%) between t1 and t3 and in ROI 1 (p = 0.002; - 3.7%), 2 (p = 0.046; - 3.6%), 4 (p = 0.002; - 2.7%) and 7 (p < 0.0001; - 8.0%) between t2 and t3. There were significant differences in overall bone density (netavg) between t1 and t3 (p = 0.001; - 3.6%) and between t2 and t3 (p = 0.020; - 2.1%). The data indicate clinically relevant changes of BMD especially in the proximal Gruen zones in the long-term after uncemented THA. Loss of periprosthetic BMD might be a risk factor for periprosthetic fractures.
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Affiliation(s)
- David S Peitgen
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Moritz M Innmann
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Christian Merle
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Gotterbarm
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Babak Moradi
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Marcus R Streit
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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30
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Valkering LJJ, Biemond JE, van Hellemondt GG. A Wedge-Shaped Uncemented Femoral Component: Survivorship in Patients Younger Than 50 Years at a Mean Follow-Up of 22 Years. J Arthroplasty 2018; 33:3226-3230. [PMID: 30232016 DOI: 10.1016/j.arth.2018.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study presents the results of the long-term survival of a wedge-shaped uncemented femoral component in a cohort of young patients with a follow-up of 20-25 years. METHODS In a consecutive series of 85 patients (100 hips), aged less than 50 years at the time of primary total hip arthroplasty, the long-term survival of the Cementless Spotorno femoral component was analyzed by performing a Kaplan-Meier survival analysis (95% confidence interval [CI]). RESULTS The mean follow-up was 22 years (range, 19.7-25.5). The clinical and radiographic outcomes were satisfactory. The overall survival rate of the femoral component was 93.4% after 23.8 years (95% CI, 85.9%-97.0%). Survival with revision for aseptic loosening as the end point was 94.4% (95% CI, 87.0%-97.6%) after 23.8 years. CONCLUSION This study shows an excellent long-term survival of this specific wedge-shaped uncemented femoral component after 20 to 25 years in patients younger than 50 years.
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Affiliation(s)
- Lucia J J Valkering
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - J Elizabeth Biemond
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
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31
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Varus malalignment of cementless hip stems provides sufficient primary stability but highly increases distal strain distribution. Clin Biomech (Bristol, Avon) 2018; 58:14-20. [PMID: 30005422 DOI: 10.1016/j.clinbiomech.2018.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/24/2018] [Accepted: 07/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Varus position of cementless stems is a common malalignment in total hip arthroplasty. Clinical studies have reported a low rate of aseptic loosening but an increased risk for thigh pain. This in vitro study aimed to evaluate these clinical observations from a biomechanical perspective. METHODS A conventional cementless stem (CLS Spotorno) was implanted in a regular, straight (size 13.75) as well as in a varus position (size 11.25) in 6 composite femora (Sawbones), respectively. Primary stability was assessed by recording 3-dimensional micromotions under dynamic load bearing conditions and stress shielding was evaluated by registering the surface strain before and after stem insertion. FINDINGS Primary stability for stems in varus malposition revealed significantly lower micromotions (p < 0.05) for most regions compared to stems in neutral position. The greatest difference was observed at the tip of the stem where the straight aligned implants exceeded the critical upper limit for osseous integration of 150 μm. The surface strains for the varus aligned stems revealed a higher load transmission to the femur, resulting in a clearly altered strain distribution. INTERPRETATION This biomechanical study confirms the clinical findings of a good primary stability of cementless stems in a varus malposition, but impressively demonstrates the altered load transmission with the risk for postoperative thigh pain.
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Fernández-Fernández R, Martínez-Miranda JM, Gil-Garay E. Comparison of an Uncemented Tapered Stem Design in Cobalt-Chrome vs Titanium at 15-Year Follow-Up. J Arthroplasty 2018; 33:1139-1143. [PMID: 29221842 DOI: 10.1016/j.arth.2017.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/29/2017] [Accepted: 11/12/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cobalt-chromium (Co-Cr) and titanium (Ti) have been the most popular materials employed for cementless implants. The purpose of this study was to compare clinical and radiological results of a single stem design with both alloys at long-term follow-up. METHODS Two hundred consecutive uncemented stems implanted in 171 patients (100 Co-Cr and 100 Ti implants) between 1999 and 2002 were studied. Mean age of the patients was 60.9 years (range, 20-84). Clinical results were evaluated using the Harris hip score. The presence of thigh pain was also analyzed. Stem fixation was graded according to Engh criteria. Radiolucent lines, osteolysis, and stem subsidence were also analyzed. RESULTS At 15-year follow-up, no stems had been revised. Both groups showed similar clinical results with mean Harris hip score of 93.4 (Co-Cr) vs 93.9 (Ti). There was no difference in the rate of thigh pain (11 vs 8.3, respectively, P = .507). Radiolucent lines were more frequent in the Co-Cr group (63.6% vs 35.6%, P < .001). CONCLUSION Ti stems showed better osteointegration than Co-Cr stems, with a significantly lower incidence of radiolucent lines. However, this did not affect the clinical results or the appearance of thigh pain.
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Affiliation(s)
| | | | - Enrique Gil-Garay
- Department of Orthopaedic Surgery, University Hospital La Paz, Madrid, Spain
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Ugland TO, Haugeberg G, Svenningsen S, Ugland SH, Berg ØH, Hugo Pripp A, Nordsletten L. Less periprosthetic bone loss following the anterolateral approach to the hip compared with the direct lateral approach. Acta Orthop 2018; 89:23-28. [PMID: 29037093 PMCID: PMC5810828 DOI: 10.1080/17453674.2017.1387730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The loss of bone mineral in the proximal femur following hip arthroplasty may increase the fracture risk around uncemented stems. We hypothesized that the surgical approach to the hip might influence bone mineral changes around the femoral stem in patients with a femoral neck fracture (FNF). Patients and methods - This was a pre-specified subgroup analysis (n = 51) of an ongoing randomized trial (n = 120) in patients with FNF. Participants were allocated to an uncemented hemiarthroplasty inserted through a direct lateral (Hardinge) approach or an anterolateral (modified Watson-Jones) approach. The 51 patients (mean age 83 (70-90) years, 33 women) were measured by dual-energy X-ray absorptiometry (DXA) to assess changes in periprosthetic bone mineral density (BMD). Results - The mean change in total BMD differed between groups at 12 months in favor of the anterolateral group (4.8%, 95% CI 0.0-9.6; p = 0.05). DXA at 3 months displayed BMD loss in the proximal Gruen zones in the lateral group compared with the anterolateral group. Zone 1 (-5.0% vs. 2.7%), zone 2 (-4.3% vs. 4.1%), zone 6 (-6.5% vs. 0.0%) and zone 7 (-11% vs. -2.4%, all p < 0.05). Interpretation - DXA measurements in this study indicate that surgical approach to the hip influences periprosthetic BMD. Clinical implications remain uncertain. Our conclusions should be interpreted with caution as we did not perform adjustments for multiple tests, possibly leading to inflation of false-positive findings.
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Affiliation(s)
- Terje O Ugland
- Department of Orthopaedics, Sorlandet Hospital Kristiansand, Norway,University of Oslo, Oslo, Norway,Correspondence:
| | - Glenn Haugeberg
- Department of Orthopaedics, Sorlandet Hospital Kristiansand, Norway,Martina Hansens Hospital, Gjettum, Norway,Department of Neurosciences, Rheumatology Division, INM, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Stein H Ugland
- Department of Orthopaedics, Sorlandet Hospital Kristiansand, Norway
| | - Øystein H Berg
- Department of Orthopaedics, Sorlandet Hospital Kristiansand, Norway
| | | | - Lars Nordsletten
- Department of Orthopaedics, Oslo University Hospital, Ullevål,University of Oslo, Oslo, Norway
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Cruz-Pardos A, García-Rey E, García-Cimbrelo E. Total Hip Arthroplasty with Use of the Cementless Zweymüller Alloclassic System: A Concise Follow-up, at a Minimum of 25 Years, of a Previous Report. J Bone Joint Surg Am 2017; 99:1927-1931. [PMID: 29135666 DOI: 10.2106/jbjs.16.01109] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED We previously reported the 10 to 13-year follow-up results for 104 total hip replacements with the Zweymüller Alloclassic stem and a threaded cup in 94 patients. The present study is a clinical and radiographic outcome update after a minimum follow-up of 25 years. Four patients (4 hips) were lost and 46 patients (50 hips) died, leaving 44 patients (50 hips) available for follow-up. Since our previous report, 7 cups and 2 stems were revised. At 20 years, the probability of survival of any component was 84.1% (95% confidence interval [CI], 73.91% to 94.29%) and the cumulative probability of not having stem loosening was 95.9% (95% CI, 95.51% to 96.29%). We observed proximal femoral osteolysis in 15 hips (30%), cortical hypertrophy in 21 hips (42%), and proximal femoral osteopenia in 30 hips (60%). The Zweymüller Alloclassic stem continues to provide excellent results after extended follow-up. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Godoy-Monzon D, Buttaro M, Comba F, Zanotti G, Piccaluga F, Neira-Borrajo I. Outcomes using wedge stem with full hydroxiapatite coverage with a minimum of 5 years’ follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Fottner A, Woiczinski M, Kistler M, Schröder C, Schmidutz TF, Jansson V, Schmidutz F. Influence of undersized cementless hip stems on primary stability and strain distribution. Arch Orthop Trauma Surg 2017; 137:1435-1441. [PMID: 28865042 DOI: 10.1007/s00402-017-2784-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Undersizing of cementless hip stems is a risk factor for aseptic loosening and early subsidence. The purpose of this study was to evaluate the effects of undersized stems and determine whether a biomechanical study can predict the clinical results. MATERIALS AND METHODS Three consecutive sizes of a clinically proven stem (CLS Spotorno) were implanted into six composite femora (size large, Sawbones®), respectively. According to the Canal Fill Index (CFI), two stems (size 11.25 and 12.5) were undersized (CFI < 80%) and one stem (size 13.75) had an appropriate size (CFI > 80%). The primary stability was evaluated by measurement of 3-dimensional (3D)-micromotions under physiological adapted load and surface strains were recorded before and after implantation to detect stress-shielding processes. RESULTS Both undersized stems revealed significantly higher micromotions in all regions compared to the appropriate stem. The highest micromotions were registered at the distal tip of the three stem sizes. The changes in surface strain did not show a significant difference between the three stem sizes, but the highest strain reduction was observed proximally indicating a tendency for stress shielding. CONCLUSIONS This study confirms the clinical assumption that undersized stem result in a significantly reduced primary stability. Furthermore, in vitro studies allow to determine the effects of undersizing and stress shielding processes.
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Affiliation(s)
- Andreas Fottner
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany.
| | - Matthias Woiczinski
- Laboratory for Biomechanics and Experimental Orthopedics, Grosshadern Medical Center, University of Munich (LMU), Munich, Germany
| | - Manuel Kistler
- Laboratory for Biomechanics and Experimental Orthopedics, Grosshadern Medical Center, University of Munich (LMU), Munich, Germany
| | - Christian Schröder
- Laboratory for Biomechanics and Experimental Orthopedics, Grosshadern Medical Center, University of Munich (LMU), Munich, Germany
| | - Tobias F Schmidutz
- Cavendish Laboratory, University of Cambridge, J. J. Thomson Avenue, Cambridge, CB3 0HE, UK
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany
| | - Florian Schmidutz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistraße 15, 81377, Munich, Germany.,BG Trauma Center, Eberhard Karls University Tübingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
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Godoy-Monzon D, Buttaro M, Comba F, Zanotti G, Piccaluga F, Neira-Borrajo I. Outcomes using wedge stem with full hydroxiapatite coverage with a minimum of 5 years' follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:390-396. [PMID: 28917605 DOI: 10.1016/j.recot.2017.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 04/28/2017] [Accepted: 06/27/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Total Hip Arthroplsty (THA) using uncemented stems is a popular practice in the last decades. The implant survivorship is crtitical and a less than 10% revision at 10 years is been propesed for commercialization and use. OBJECTIVE To analyse the clinicoradiological results of an uncemented hydroxiapatite covered wedge stem with a 5 years minimum follow up. MATERIAL AND METHODS Prospective study, patients aged from 21-75years were included. All patients received an Element stem (Exactech) and uncemented cup with crosslink poly and 32 mm metal head, and posterior approach with piriformis retention was used. Scheduled clinical and radiographic evaluation at 3 weeks, 3-6 month, year and subsequent years using Harris Hip Score and Merle d'Aubigné Postel. Intraoperative and during follow up complications were recorded. RESULTS One hundred and fourteen total hip replacements in 104 patients: 54 females and 50 males (52%/48%). Follow-up of 5.7 years (range, 5-6.2years). Average age 56.8years (range, 42-75years). Clinical evaluation the Merle d'Aubigné score improved 6.8 points and from the initianl Harris Hip Score 47.3 to 93.1 points at last follow up. Radiographic evaluation shows osteointegration in all stems. And in 6 cases (5.3% at 3 months subsidence was detected, average 1.4 mm (range 0-2.6 mm) with no clinical manifestation, 3 cases of subsidence were associated to intraoperative fractures (1 greater trochanter and 2 in the calcar area, all resolved with wire cerclaje). Subjective evaluation: 86 cases (82.6%) excellent, 9 patients (8.6%) good, 6 cases (5.9%) satisfactory and 3 cases (2.9%) poor. All poor results linked to the intraoperative complications. No patient lost during follow up period. No femoral pain dislocation or aseptic or loosening detected. All implants were in situ at last follow up. CONCLUSIONS The radiological results confirm the benefits of this type of stem with good osteointegration. The clinical and subjective results are promising. With good surgical technical and without complications the risk of aseptic loosening should be absent or minimal.
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Affiliation(s)
- D Godoy-Monzon
- Centro de Cadera Sir John Charnley, Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M Buttaro
- Centro de Cadera Sir John Charnley, Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F Comba
- Centro de Cadera Sir John Charnley, Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G Zanotti
- Centro de Cadera Sir John Charnley, Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F Piccaluga
- Centro de Cadera Sir John Charnley, Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Hayashi S, Nishiyama T, Hashimoto S, Matsumoto T, Takayama K, Ishida K, Nishida K, Kuroda R. Risk factors for failure of revision total hip arthroplasty using a Kerboull-type acetabular reinforcement device. BMC Musculoskelet Disord 2017; 18:382. [PMID: 28865420 PMCID: PMC5581424 DOI: 10.1186/s12891-017-1741-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/28/2017] [Indexed: 11/27/2022] Open
Abstract
Background The present study aimed to identify the risk factors associated with revision total hip arthroplasty (THA) failure using a Kerboull-type (KT) plate. Methods We analyzed 77 revision THAs using cemented acetabular components with a KT plate for aseptic loosening between May 2000 and March 2012. We examined the association of bone graft type, acetabular bone defects, age at the time of surgery, preoperative Japanese Orthopaedic Association (JOA) score, postoperative JOA hip score, and body mass index, with radiographic failure as the outcome. Results The 7.4-year radiographic failure survival rate was 81.6%. The survival rate was significantly different between the beta-tricalcium phosphate (β-TCP) group and the bulk allograft group (p = 0.019). The survival curves were also significantly different between the β-TCP group and bulk allograft group (p = 0.036). American Academy of Orthopaedic Surgeons type IV was significantly associated with radiographic failure (odds ratio [OR]: 15.5, 95% confidence interval [CI]: 1.4–175.4; p = 0.032). Conclusions The midterm outcomes of revision THA indicate that type of bone graft and bone defect size may affect radiographic survival rate when using a KT plate.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Takayuki Nishiyama
- Department of Orthopaedic Surgery, Kakogawa City Hospital, Kakogawa, Japan
| | - Shingo Hashimoto
- 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
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Kotaro Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- 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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Can the metaphyseal anchored Metha short stem safely be revised with a standard CLS stem? A biomechanical analysis. INTERNATIONAL ORTHOPAEDICS 2017; 41:2471-2477. [DOI: 10.1007/s00264-017-3497-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023]
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De Martino I, De Santis V, D'Apolito R, Sculco PK, Cross MB, Gasparini G. The Synergy cementless femoral stem in primary total hip arthroplasty at a minimum follow-up of 15 years. Bone Joint J 2017; 99-B:29-36. [PMID: 28053254 DOI: 10.1302/0301-620x.99b1.bjj-2016-0231.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/05/2016] [Indexed: 11/05/2022]
Abstract
AIMS We report on the outcome of the Synergy cementless femoral stem with a minimum follow-up of 15 years (15 to 17). PATIENTS AND METHODS A retrospective review was undertaken of a consecutive series of 112 routine primary cementless total hip arthroplasties (THAs) in 102 patients (112 hips). There were 60 female and 42 male patients with a mean age of 61 years (18 to 82) at the time of surgery. A total of 78 hips in the 69 patients remain in situ; nine hips in eight patients died before 15 years, and 16 hips in 16 patients were revised. Clinical outcome scores and radiographs were available for 94 hips in 85 patients. RESULTS In all, four stems were revised. One stem was revised for aseptic loosening; two stems because of deep infection; and one because of periprosthetic femoral fracture. There was a significant improvement in all components of the Western Ontario and McMaster Universities Osteoarthritis Index score at the final follow-up (total: p < 0.001, pain: p < 0.001, stiffness: p < 0.001, function: p < 0.001). The mean Harris Hip Scores improved from 47 points (27 to 59) pre-operatively to 89 points (65 to 100) at the latest follow-up (p < 0.001). Kaplan-Meier survivorship, with stem revision for aseptic loosening as the endpoint, was 98.9% at 15 years (95% confidence interval (CI) 96.9 to 100, number at risk at 15 years: 90) and with stem revision for any reason was 95.7% (95% CI 91.7 to 99.8, number at risk at 15 years: 90). CONCLUSION The Synergy cementless femoral stem demonstrates excellent survivorship and functional outcomes at 15 years. Cite this article: Bone Joint J 2017;99-B:29-36.
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Affiliation(s)
- I De Martino
- Hospital for Special Surgery, Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - V De Santis
- Catholic University of the Sacred Heart, Agostino Gemelli University Hospital, Orthopaedic Surgery Division, Department of Geriatrics, Neurosciences and Orthopaedics, Largo Agostino Gemelli 8, Rome, 00168, Italy
| | - R D'Apolito
- Catholic University of the Sacred Heart, Agostino Gemelli University Hospital, Orthopaedic Surgery Division, Department of Geriatrics, Neurosciences and Orthopaedics, Largo Agostino Gemelli 8, Rome, 00168, Italy
| | - P K Sculco
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - M B Cross
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - G Gasparini
- University of Catanzaro Magna Græcia, Orthopaedic Surgery Division, Department of Medical and Surgical Sciences, Viale Europa, Localitá Germaneto, Catanzaro, 88100, Italy
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Influence of different sizes of composite femora on the biomechanical behavior of cementless hip prosthesis. Clin Biomech (Bristol, Avon) 2017; 41:60-65. [PMID: 27960138 DOI: 10.1016/j.clinbiomech.2016.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 11/12/2016] [Accepted: 12/07/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND For the biomechanical evaluation of cementless stems different sizes of composite femurs have been used in the literature. However, the impact of different specimen sizes on test results is unknown. METHODS To determine the potential effect of femur size the biomechanical properties of a conventional stem (CLS Spotorno) were examined in 3 different sizes (small, medium and large composite Sawbones®). Primary stability was tested under physiologically adapted dynamic loading conditions measuring 3-dimensional micromotions. For the small composite femur the dynamic load needed to be adapted since fractures occurred when reaching 1700N. Additionally, surface strain distribution was recorded before and after implantation to draw conclusions about the tendency for stress shielding. FINDINGS All tested sizes revealed similar micromotions only reaching a significant different level at one measurement point. The highest micromotions were observed at the tip of the stems exceeding the limit for osseous integration of 150μm. Regarding strain distribution the highest strain reduction after implantation was registered in all sizes at the level of the lesser trochanter. INTERPRETATION Specimen size seems to be a minor influence factor for biomechanical evaluation of cementless stems. However, the small composite femur is less suitable for biomechanical testing since this size failed under physiological adapted loads. For the CLS Spotorno osseous integration is unlikely at the tip of the stem and the tendency for stress shielding is the highest at the level of the lesser trochanter.
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Carlson SW, Goetz DD, Liu SS, Greiner JJ, Callaghan JJ. Minimum 10-Year Follow-Up of Cementless Total Hip Arthroplasty Using a Contemporary Triple-Tapered Titanium Stem. J Arthroplasty 2016; 31:2231-6. [PMID: 27339824 DOI: 10.1016/j.arth.2016.04.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is extensive variation in design and insertion technique of cementless tapered femoral stems. The purpose of our study was to evaluate a consecutive series of contemporary tapered cementless femoral stems inserted with a ream-and-broach technique at a minimum 10-year follow-up in patients undergoing total hip arthroplasty (THA). METHODS One hundred consecutive THAs (88 patients) performed by a single surgeon were followed for a minimum of 10 years. Hips were evaluated clinically for revision status, Western Ontario and McMaster Universities Osteoarthritis Index, 36-item Short Form Health Survey, Harris Hip Score, and University of California, Los Angeles, and Tegner Activity Scores. Radiographic evaluation included assessment for loosening, osteolysis, and stress shielding. Kaplan-Meier survivorship analysis included end points for revision and radiographic evidence of femoral component loosening. RESULTS At minimum 10-year follow-up, 66 patients (74 hips) were living, 20 patients (24 hips) were deceased, and 2 patients (2 hips) were lost to follow-up. Four hips required reoperation, but no femoral components were revised for aseptic loosening. One femoral component (1%) was revised due to a postoperative periprosthetic fracture. Radiographic evaluation demonstrated bone ingrowth of all stems without evidence of component loosening and 1 case of severe stress shielding. Kaplan-Meier survivorship at 10 years was 100% for the end points of femoral revision for loosening or femoral radiographic loosening. CONCLUSION This contemporary, cementless titanium-tapered femoral component inserted with ream-and-broach technique demonstrated excellent results in terms of outcomes and clinical durability as well as osteointegration on radiographs at minimum 10-year follow-up. This study corroborates, with level 2 and level 3 data, level 1 data reported in national registries.
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Affiliation(s)
- Samuel W Carlson
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Devon D Goetz
- Des Moines Orthopaedic Surgeons, West Des Moines, Iowa
| | - Steve S Liu
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Justin J Greiner
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - John J Callaghan
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Maier MW, Streit MR, Innmann MM, Krüger M, Nadorf J, Kretzer JP, Ewerbeck V, Gotterbarm T. Cortical hypertrophy with a short, curved uncemented hip stem does not have any clinical impact during early follow-up. BMC Musculoskelet Disord 2015; 16:371. [PMID: 26627999 PMCID: PMC4667403 DOI: 10.1186/s12891-015-0830-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 11/25/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Short stems have become more and more popular for cementless total hip arthroplasty in the past few years. While conventional, uncemented straight stems for primary total hip arthroplasty (THA) have shown high survival rates in the long term, it is not known whether uncemented short stems represent a reasonable alternative. As cortical hypertrophy has been reported for short stems, the aim of this study was to determine the radiographic prevalence of cortical hypertrophy and to assess the clinical outcome of a frequently used short, curved hip stem. METHODS We retrospectively studied the clinical and radiographic results of our first 100 consecutive THAs (97 patients) using the Fitmore® hip stem. Mean age at the time of index arthroplasty was 59 years (range, 19 - 79 years). Clinical outcome and radiographic results were assessed with a minimum follow-up of 2 years, and Kaplan-Meier survivorship analysis was used to estimate survival for different endpoints. RESULTS After a mean follow-up of 3.3 years (range, 2.0 - 4.4 years), two patients (two hips) had died, and three patients (four hips) were lost to follow-up. Kaplan-Meier analysis estimated a survival rate of 100 % at 3.8 years, with revision for any reason as the endpoint. No femoral component showed radiographic signs of loosening. No osteolysis was detected. Cortical hypertrophy was found in 50 hips (63 %), predominantly in Gruen zone 3 and 5. In the cortical hypertrophy group, two patients (two hips; 4 %) reported some thigh pain in combination with pain over the greater trochanter region during physical exercise (UCLA Score 6 and 7). There was no significant difference concerning the clinical outcome between the cortical hypertrophy and no cortical hypertrophy group. CONCLUSIONS The survival rate and both clinical and the radiographic outcome confirm the encouraging results for short, curved uncemented stems. Postoperative radiographs frequently displayed cortical hypertrophy but it had no significant effect on the clinical outcome in the early follow-up. Further clinical and radiographic follow-up is necessary to detect possible adverse, long-term, clinical effects of cortical hypertrophy.
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Affiliation(s)
- Michael W Maier
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Marcus R Streit
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Moritz M Innmann
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Marlis Krüger
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Jan Nadorf
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - J Philippe Kretzer
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Volker Ewerbeck
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Tobias Gotterbarm
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Innmann MM, Streit MR, Kolb J, Heiland J, Parsch D, Aldinger PR, Königshausen M, Gotterbarm T, Merle C. Influence of surgical approach on component positioning in primary total hip arthroplasty. BMC Musculoskelet Disord 2015; 16:180. [PMID: 26242180 PMCID: PMC4523950 DOI: 10.1186/s12891-015-0623-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 07/08/2015] [Indexed: 11/18/2022] Open
Abstract
Background Minimal invasive surgery (MIS) has gained growing popularity in total hip arthroplasty (THA) but concerns exist regarding component malpositioning. The aim of the present study was to evaluate femoral and acetabular component positioning in primary cementless THA comparing a lateral to a MIS anterolateral approach. Methods We evaluated 6 week postoperative radiographs of 52 hips with a minimal invasive anterolateral approach compared to 54 hips with a standard lateral approach. All hips had received the same type of implant for primary cementless unilateral THA and had a healthy hip contralaterally. Results Hip offset was equally restored comparing both approaches. No influence of the approach was observed with regard to reconstruction of acetabular offset, femoral offset, vertical placement of the center of rotation, stem alignment and leg length discrepancy. However, with the MIS approach, a significantly higher percentage of cups (38.5 %) was malpositioned compared to the standard approach (16.7 %) (p = 0.022). Conclusions The MIS anterolateral approach allows for comparable reconstruction of stem position, offset and center of rotation compared to the lateral approach. However, surgeons must be aware of a higher risk of cup malpositioning for inclination and anteversion using the MIS anterolateral approach.
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Affiliation(s)
- Moritz M Innmann
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Marcus R Streit
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Jeanette Kolb
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Jochen Heiland
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Dominik Parsch
- Department of Orthopaedic and Trauma Surgery, Karl-Olga-Krankenhaus, Hackstraße 61, 70190, Stuttgart, Germany.
| | - Peter R Aldinger
- Department of Orthopaedic and Trauma Surgery, Paulinenhilfe, Diakonieklinikum, Rosenbergstrasse 38, 70192, Stuttgart, Germany.
| | - Matthias Königshausen
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Tobias Gotterbarm
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Christian Merle
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Wen-ming X, Ai-min W, Qi W, Chang-hua L, Jian-fei Z, Fang-fang X. An integrated CAD/CAM/robotic milling method for custom cementless femoral prostheses. Med Eng Phys 2015. [PMID: 26210779 DOI: 10.1016/j.medengphy.2015.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aseptic loosening is the primary cause of cementless femoral prosthesis failure and is related to the primary stability of the cementless femoral prosthesis in the femoral cavity. The primary stability affects both the osseointegration and the long-term stability of cementless femoral prostheses. A custom cementless femoral prosthesis can improve the fit and fill of the prosthesis in the femoral cavity and decrease the micromotion of the proximal prosthesis such that the primary stability of the custom prosthesis can be improved, and osseointegration of the proximal prosthesis is achieved. These results will help to achieve long-term stability in total hip arthroplasty (THA). In this paper, we introduce an integrated CAD/CAM/robotic method of milling custom cementless femoral prostheses. The 3D reconstruction model uses femoral CT images and 3D design software to design a CAD model of the custom prosthesis. After the transformation matrices between two units of the robotic system are calibrated, consistency between the CAM software and the robotic system can be achieved, and errors in the robotic milling can be limited. According to the CAD model of the custom prosthesis, the positions of the robotic tool points are produced by the CAM software of the CNC machine. The normal vector of the three adjacent robotic tool point positions determines the pose of the robotic tool point. In conclusion, the fit rate of custom pig femur stems in the femoral cavities was 90.84%. After custom femoral prostheses were inserted into the femoral cavities, the maximum gaps between the prostheses and the cavities measured less than 1 mm at the diaphysis and 1.3 mm at the metaphysis.
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Affiliation(s)
- Xi Wen-ming
- School of Physics and Mechanical Engineering, Xiamen University, Xiamen 361005, China
| | - Wang Ai-min
- School of Physics and Mechanical Engineering, Xiamen University, Xiamen 361005, China.
| | - Wu Qi
- The 82 Hospital of People's Liberation Army, Huai'an 223001, China
| | - Liu Chang-hua
- The 174 Hospital of People's Liberation Army, Xiamen 361001, China
| | - Zhu Jian-fei
- The 82 Hospital of People's Liberation Army, Huai'an 223001, China
| | - Xia Fang-fang
- School of Physics and Mechanical Engineering, Xiamen University, Xiamen 361005, China
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Busch V. The young osteoarthritic hip: Clinical outcome of total hip arthroplasty and a cost-effectiveness analysis. Acta Orthop 2015; 86:1-21. [PMID: 25898151 DOI: 10.3109/17453674.2015.1041354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Vincent Busch
- Sint Maartenskliniek Orthopaedic surgery P.O. Box 9011, 6500 GM Nijmegen The Netherlands
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Proximal femoral canal shape is more accurately assessed on AP hip radiographs than AP pelvis radiographs in primary hip osteoarthritis. Hip Int 2015; 23:484-91. [PMID: 23813170 DOI: 10.5301/hipint.5000040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2013] [Indexed: 02/04/2023]
Abstract
The objectives of the present study were to determine whether differences in the radiographic appearance of the of the proximal femoral canal exist on corresponding AP pelvis and AP hip radiographs, and whether radiographic assessment of canal shape is accurate with reference to computed tomography (CT). In a retrospective study, corresponding radiographs and CT scans of 100 consecutive patients with primary hip OA were evaluated. Active shape modelling (ASM) was performed to assess the variation in proximal femoral canal shape and to identify differences between AP hip and AP pelvis views. Differences in the medial cortical flare between radiographs and CT were quantified using least squares curve fitting. ASM identified significant differences in the assessment of canal shape on corresponding AP hip and AP pelvis views. Curve fitting demonstrated a good agreement between AP hip radiographs and CT. Agreement between AP pelvis radiographs and CT was less good. In contrast to AP pelvis radiographs, AP hip radiographs allow a more accurate and reliable assessment of proximal femoral canal shape in the frontal plane in primary hip OA. Our findings may improve stem fit in total hip arthroplasty without the routine use of CT.
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Biemond JE, Venkatesan S, van Hellemondt GG. Survivorship of the cementless Spotorno femoral component in patients under 50 years of age at a mean follow-up of 18.4 years. Bone Joint J 2015; 97-B:160-3. [PMID: 25628276 DOI: 10.1302/0301-620x.97b2.34926] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The long-term survival of the cementless Spotorno CLS femoral component in patients aged > 50 years at the time of arthroplasty was investigated. Survivorship analysis of a consecutive series of 85 patients (100 hips; under 50 years of age at a mean follow-up of 18.4 years (16.3 to 20.8)) was performed. The clinical and radiographic outcomes were satisfactory. The overall rate of survival of the femoral component was 93.5% (95% confidence interval (CI), 90.9 to 96.1) after 19 years. Survival with revision for aseptic loosening as the end point was 95.7% (95% CI 93.6 to 97.8%) at 19 years. This study demonstrates an excellent long-term survival of the Spotorno CLS femoral component after 16 to 20 years in young patients undergoing total hip arthroplasty.
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Affiliation(s)
- J E Biemond
- Sint Maartenskliniek, Postbus 9011, 6500 GM Nijmegen, The Netherlands
| | - S Venkatesan
- Sint Maartenskliniek, Postbus 9011, 6500 GM Nijmegen, The Netherlands
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Abstract
BACKGROUND The clinical results of total hip arthroplasty (THA) with a cementless prosthesis have been constantly improving due to progress in the area of stem design and surface finish. Cementless Spotorno stem (CLS stem; Zimmer, Warsaw, USA) is a double-tapered rectangular straight stem. The purpose of this study is to investigate the mean 10 year results of CLS stem and to evaluate the press-fit stability of CLS stem. METHODS One hundred and eighty-six consecutive patients (194 hips) were evaluated at more than five years after THA using CLS stems. The mean follow-up period was 111 months. The radiographic stability of the femoral stem was determined by Engh's criteria. The ascertained period of spot welds was noted by Gruen zones on the femoral side. The presence of stress shielding, and subsidence was also evaluated. RESULTS A stable stem with bony on growth was identified in all cases. The mean period of expression of spot welds was 10.8 months in zone 2, 9.9 months in zone 3, 8.5 months in zone 5, and 8.8 months in zone 6. Stress shielding of more than grade 2 was observed in only three hips, which was non-progressive at one year after surgery. Subsidence of more than 2 mm was not observed in any of the hips. CONCLUSIONS Excellent stability of CLS stem has been maintained without abnormal bone reaction at the proximal femur. CLS stem is considered to achieve not only press-fit stability at trochanteric and subtrochanteric level, but bony fixation by osseointegration within one year after THA.
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Long-term results using the straight tapered femoral cementless hip stem in total hip arthroplasty: a minimum of twenty-year follow-up. J Arthroplasty 2014; 29:1559-65. [PMID: 24656056 DOI: 10.1016/j.arth.2014.02.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/17/2014] [Accepted: 02/05/2014] [Indexed: 02/01/2023] Open
Abstract
We report the first long-term results of a prospective cohort study after total hip arthroplasty using the cementless Bicontact hip stem. Between 1987 and 1990, 250 total hip arthroplasties in 236 patients were performed using the cementless Bicontact hip stem. The average follow-up was 22.8 years (20.4-24.8) and average age at index surgery was 58.1 years. Eighty-one patients died and 9 were lost to follow-up. We noted 11 stem revisions revealing an overall Kaplan Meier survival rate of 95.0% (CI 95%: 91.1-97.2%). The average Harris Hip Score revealed 81 points (range 24-93). The Bicontact hip stem demonstrated high survival rates despite high ages and osteopenic changes, which are equivalent to other long-term reports of cementless stem fixation.
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