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Gaujac N, Sariali E, Grimal Q. Does the bone mineral density measured on a preoperative CT scan before total hip arthroplasty reflect the bone's mechanical properties? Orthop Traumatol Surg Res 2023; 109:103348. [PMID: 35688378 DOI: 10.1016/j.otsr.2022.103348] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION No method exists to quantify the bone quality and factors that will ensure osteointegration of total hip arthroplasty (THA) implants. A preoperative CT scan can be used to evaluate the bone mineral density (BMD) when planning a THA procedure. The aim of this study was to validate BMD measurement as a marker of bone quality based on a preoperative CT scan. HYPOTHESIS BMD reflects the bone's mechanical properties for the purposes of preoperative THA planning. METHODS Patients who underwent primary THA for hip osteoarthritis or dysplasia with cementless implants and 3D preoperative plan were enrolled prospectively. The cortical BMD was calculated on CT scans used in the preoperative planning process. During the surgical procedure, the femoral head and neck were collected. These bone samples were subsequently scanned with a calibrated micro-CT scanner. The BMD was derived from the micro-CT scan and used as input for a finite element model to determine the bone's mechanical properties. Correlations between BMD, apparent moduli of elasticity and porosity were calculated. RESULTS The values of cortical BMD measured on the micro-CT and CT scan were significantly correlated (cc=0.52). The mean angular cortical BMD measured with the micro-CT scan was 1472.33mg/cm3 (SD: 357.53mg/cm3, 980.64-2830.6mg/cm3). There was no significant correlation between cortical BMD and the various apparent moduli of elasticity, except for Eyy and Gzy. Cortical BMD and porosity were inversely correlated with a Spearman coefficient of -0.41 (CI95: [-0.71; -0.02], p=0.03). There was also an inverse correlation between the apparent moduli of elasticity (independent of their orientation) and porosity (p<0.01). DISCUSSION BMD provides information about porosity, which is a major factor when evaluating the bone's mechanical properties before THA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nicolas Gaujac
- Department of Orthopaedic Surgery, Hôpital La Pitié Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Elhadi Sariali
- Department of Orthopaedic Surgery, Hôpital La Pitié Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Quentin Grimal
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, 15, rue de l'Ecole de Médecine, 75006 Paris, France
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Sariali E, Pascal Moussellard H. Higher femoral anteversion restoration accuracy after total hip arthroplasty with a proximally fixed anatomic stem than with a generic straight double-tapered stem. Hip Int 2022:11207000221078920. [PMID: 35437058 DOI: 10.1177/11207000221078920] [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
BACKGROUND Femoral antetorsion in uncemented hip replacement hardly can be modified and the restoration of the anatomic anteversion might be difficult with standard stems. We compared femoral anteversion restoration of a generic straight stem with a proximally fixed anatomic stem that included a dual sagittal curvature and a proximal torsion. It was hypothesised that the restoration of the anteversion was more accurate with the anatomic stem. PATIENTS AND METHODS In this comparative study data were collected prospectively of 80 consecutive patients with total hip arthroplasty for primary osteoarthritis. In the first 40 patients (Group I) a cementless proximally fixed anatomic stem with 15° antetorsion of the shaft and a dual sagittal curvature was used. Its design was based on a database of 3D CT images of 600 hips. For comparison a cementless generic straight double-tapered stem was implanted in the next 40 patients (Group II). All operations were performed by one experienced surgeon. All patients had a preoperative 3D planning. A low-dose CT scan was performed at 3 months postoperatively to determine the postoperative stem anteversion. RESULTS The demographics were similar in both groups. In group I the mean postoperative femoral anteversion was similar to the preoperative one (22.1° ± 10.2° vs. 20.4° ± 9°; p = 0.2). In Group II, the mean postoperative femoral anteversion was lower (12.9° ± 10.8°, vs. 18.3° ± 12°; p = 0.02). CONCLUSIONS Uncemented standard femoral stems tend to reduce femoral anteversion. The used anatomic stem restored femoral anteversion better. The clinical impact of this finding has to be proven.
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Affiliation(s)
- Elhadi Sariali
- Orthopaedic Surgery, Pitié-Salpêtrière University Hospital, Paris, France
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Clinical Application and Biological Functionalization of Different Surface Coatings in Artificial Joint Prosthesis: A Comprehensive Research Review. COATINGS 2022. [DOI: 10.3390/coatings12020117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
With advances in materials science and biology, there have been continuing innovations in the field of artificial joint prostheses. Cementless prostheses have the advantages of long service life, easy revision, and good initial stability and are widely used in artificial joint replacement. Coatings are the key to cementless prostheses and are at the heart of their excellent functionality. This article mainly studies the clinical application of hydroxyapatite (HA) coating, standard porous coating represented by Porocoat coating, and new high-porosity coating represented by Gription coating. The clinical application and biological functionalization of different artificial joint prosthesis surface coatings are clarified, and it provides a reference for the clinical selection and development of different prosthesis surface coating materials.
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Almeida F, Gállego S, Argüelles F, Silvestre A. Long-term outcome of cementless total hip arthroplasty with threaded Tropic® acetabular cup and Corail® femoral stem. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study investigates the clinical and radiological results of a tapered femoral stem (Corail®) and uncemented threaded acetabular cups (Tropic®) and in addition an analysis of the complications and retrieved implants was conducted. Between January 1990 and September 1998, 301 total hips arthroplasties in 268 patients were implanted. 78 patients (87 hips) had died and 9 patients (12 hips) had been lost to follow-up, leaving at the time of the latest follow-up 180 patients (202 hips). The mean age at surgery was 56,1 (27-75) years. Of the 154 unrevised hips, the median Harris and Merle d´Aubigne and Postel hip scores were 83,3 points and 15,3 points respectively at the latest follow-up. The median follow-up time was 16.9 years (10,4-25). No femoral component was revised for aseptic loosening ; osteolysis was observed in the 9,5% of the implants (13 stems). 48 hips (23%) were revised and 27 cups (56,2%) needed revision surgery because of massive polyethylene wear. Pelvic osteolysis was found out in 80 cups (58,8%). 87 hips (63,9%) showed signs of a progressive wear of the liner, more than 2mm in 48 hips. Kaplan-Meier survivorship analysis at 15 years follow-up was 81.2% with revision for any reason (85.8% for mechanical or radiographic loosening). High rates of polyethylene wear and the high prevalence of pelvic osteolysis are serious matters in these types of implants with high rates of revision at 15 years follow-up so we decided to abandon the concept of a threaded cup design in favor of a press-fit acetabular cup.
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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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Kwak DK, Bang SH, Lee SJ, Park JH, Yoo JH. Effect of stem position and length on bone-stem constructs after cementless hip arthroplasty. Bone Joint Res 2021; 10:250-258. [PMID: 33820433 PMCID: PMC8076980 DOI: 10.1302/2046-3758.104.bjr-2020-0043.r3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims There are concerns regarding initial stability and early periprosthetic fractures in cementless hip arthroplasty using short stems. This study aimed to investigate stress on the cortical bone around the stem and micromotions between the stem and cortical bone according to femoral stem length and positioning. Methods In total, 12 femoral finite element models (FEMs) were constructed and tested in walking and stair-climbing. Femoral stems of three different lengths and two different positions were simulated, assuming press-fit fixation within each FEM. Stress on the cortical bone and micromotions between the stem and bone were measured in each condition. Results Stress concentration was observed on the medial and lateral interfaces between the cortical bone and stem. With neutral stem insertion, mean stress over a region of interest was greater at the medial than lateral interface regardless of stem length, which increased as the stem shortened. Mean stress increased in the varus-inserted stems compared to the stems inserted neutrally, especially at the lateral interface in contact with the stem tip. The maximum stress was observed at the lateral interface in a varus-inserted short stem. All mean stresses were greater in stair-climbing condition than walking. Each micromotion was also greater in shorter stems and varus-inserted stems, and in stair-climbing condition. Conclusion The stem should be inserted neutrally and stair-climbing movement should be avoided in the early postoperative period, in order to preserve early stability and reduce the possibility of thigh pain, especially when using a shorter stem. Cite this article: Bone Joint Res 2021;10(4):250–258.
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Affiliation(s)
- Dae-Kyung Kwak
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Sun-Hee Bang
- Department of Biomedical Engineering, Inje University, Gimhae, South Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, Inje University, Gimhae, South Korea
| | - Ji-Hun Park
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Je-Hyun Yoo
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, South Korea
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Rivera F, Bardelli A, Giolitti A. Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty. J Orthop Traumatol 2021; 22:8. [PMID: 33675436 PMCID: PMC7936996 DOI: 10.1186/s10195-021-00567-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In the last decade, the increase in the use of the direct anterior approach to the hip has contributed to the diffusion of the use of short stems in orthopedic surgery. The aim of the study is to verify the medium-term clinical and radiographic results of a cementless anatomic short stem in the anterior approach to the hip. We also want to verify whether the use of the standard operating room table or the leg positioner can affect the incidence of pre- and postoperative complications. MATERIALS AND METHODS All total hip arthroplasty patients with a 1-year minimum follow-up who were operated using the MiniMAX stem between January 2010 and December 2019 were included in this study. Clinical evaluation included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC) Score, and Short Form-36 (SF-36) questionnaires. Bone resorption and remodeling, radiolucency, osteolysis, and cortical hypertrophy were analyzed in the postoperative radiograph and were related to the final follow-up radiographic results. Complications due to the use of the standard operating room table or the leg positioner were evaluated. RESULTS A total of 227 patients (238 hips) were included in the study. Average age at time of surgery was 62 years (range 38-77 years). Mean follow-up time was 67.7 months (range 12-120 months). Kaplan-Meier survivorship analysis after 10 years revealed 98.2% survival rate with revision for loosening as endpoint. The mean preoperative and postoperative HHS were 38.35 and 94.2, respectively. The mean preoperative and postoperative WOMAC Scores were 82.4 and 16.8, respectively. SF-36 physical and mental scores averaged 36.8 and 42.4, respectively, before surgery and 72.4 and 76.2, respectively, at final follow-up. The radiographic change around the stem showed bone hypertrophy in 55 cases (23%) at zone 3. In total, 183 surgeries were performed via the direct anterior approach (DAA) on a standard operating room table, and 44 surgeries were performed on the AMIS mobile leg positioner. Comparison between the two patient groups did not reveal significant differences. CONCLUSION In conclusion, a short, anatomic, cementless femoral stem provided stable metaphyseal fixation in younger patients. Our clinical and radiographic results support the use of this short stem in the direct anterior approach. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Fabrizio Rivera
- Orthopedics and Trauma Department, SS Annunziata Hospital, ASL CN1, Savigliano (CN), Italy.
| | - Alessandro Bardelli
- Orthopedics and Trauma Department, SS Annunziata Hospital, ASL CN1, Savigliano (CN), Italy
| | - Andrea Giolitti
- Orthopeadics and Traumatology Department, Faculty of Medicine and Surgery, CTO Hospital, University of Turin, Turin, Italy
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Uemura K, Hamada H, Ando W, Takao M, Sugano N. Minimum 10 years clinical results of an anatomical short stem with a proximal hydroxyapatite coating. Mod Rheumatol 2021; 31:1066-1072. [PMID: 33428474 DOI: 10.1080/14397595.2020.1868129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The CentPillar stem (Stryker Orthopaedics), an anatomical short stem, was designed to match the proximal femoral canal shape in both patients with normal hips and those with developmental dysplasia of the hip (DDH). The long-term outcomes of the CentPillar stem was examined herein. METHODS In total, 222 hips that underwent total hip arthroplasty using the CentPillar stem were analyzed. DDH was the main reason for surgery (79.3%). Implant survivorship was assessed using Kaplan-Meier analysis. For radiographic evaluation, stress shielding was assessed using the Engh classification. For functional evaluation, patients' ability to perform deep hip bending activities (sit on the floor, squat, and sit straight) was assessed. RESULTS During a median follow-up of 13.1 years, 2 stem revisions were performed (aseptic loosening and late hematogenous periprosthetic infection), and the overall cumulative implant survival rate was 99.0% at 15 years. In the radiographic evaluation, grade >3 stress shielding was found in only one hip. More than 80% of the patients were able to perform each of the three deep hip bending activities. CONCLUSIONS Good fixation at the proximal part of the femur was obtained, and the implant survival rate of the CentPillar stem was excellent during a long-term follow-up.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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Pre-operative bone mineral density is a predictive factor for excellent early patient-reported outcome measures in cementless total hip arthroplasty using a proximally fixed anatomic stem. A prospective study at two year minimum follow-up. INTERNATIONAL ORTHOPAEDICS 2020; 44:2253-2259. [PMID: 32594225 DOI: 10.1007/s00264-020-04683-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The goal of the study was to analyze the impact of the pre-operative bone mineral density on the patients' reported outcomes at two year minimum follow-up of cementless THA using a proximally fixed anatomic stem. METHODS A prospective study included all patients who underwent a cementless THA using a specific proximally fixed anatomic stem and a 3D preoperative CT scan-based planning. The bone mineral density (BMD) of the metaphyseal cancellous bone was computed in a volume (of 1 mm thick and of 1 cm2 surface) at the level of the calcar 10 mm above the top of the lesser trochanter. Patients were assessed at two year follow-up using self-administered auto-questionnaires corresponding to the modified Harris (mHHS), the Oxford (OHS), and the Forgotten Hip (FHS) scores. A multiple linear regression statistical analysis was performed to assess the link between the mHHS, the age, body mass index (BMI), BMD, gender, and ASA grade. RESULTS Fifty patients were included (29 men, 21 women), with an average age of 62 ± 12 years and an average BMI of 27 ± 5 kg/m2. At two year follow-up, on multivariate analysis, excellent mHHS (≥ 90%) was significantly associated with only two parameters: a BMI ≤ 25 kg /m2 with an odd ratio OR = 10 (CI95% [2.1-48.3], p = 0.004) and a BMD ≥ 72 mg/cm3 with an odd ratio OR = 4.87 (CI95% [1.2-18.6], p = 0.02). CONCLUSION The short-term PROMs after cementless THA are impacted by pre-operative cancellous bone density. However, the BMI remains the most influential parameter on the clinical outcomes.
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El-Daly I, Rondon A, Pinto S, Chappard C, Grimal Q, Sariali E. Modification of regional bone mineral density due to femoral rasping in cementless proximally fixed total hip arthroplasty. Orthop Traumatol Surg Res 2020; 106:543-550. [PMID: 32265175 DOI: 10.1016/j.otsr.2019.11.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Three-dimensional planning (3DP) in total hip arthroplasty using computed tomography (CT) to analyze bone mineral density (BMD) at the stem-femur interface has a high reported accuracy and excellent mid-term results in the literature. However, 3DP does not take into account the effect of femoral rasping on BMD distribution within the rasped cavity. Characterizing the impact of femoral rasping on BMD may help avoid mechanical failures, but this data is not accurately investigated. Therefore, we set out a cadaveric study to identify if: (1) Femoral rasping modified regional BMD in areas considered critical for bone anchorage of cementless metaphyseally fixed anatomic stems. (2) In areas of bone-implant contact with an initial high BMD, does femoral rasping increase BMD? HYPOTHESIS Femoral rasping increases BMD in some zones considered critical for bone anchorage of cementless metaphyseally fixed anatomic stems within the rasped femoral cavity. METHODS Four cadaveric femurs were selected to undergo a rasping procedure similar to surgical techniques used for metaphyseally fixed anatomic stems. Images of femurs before and after rasping were obtained with a micro-CT scanner (pixel size 35μm). BMD values before and after rasping were compared in a trabecular bone ring of 3mm thickness around the cavity created by the rasps, in a region extending 3cm above and 2cm below the middle of the lesser trochanter. RESULTS Average BMD increased significantly after rasping in 3 of the 4 femurs (13% (0.27 to 0.30) (p=0.004)), 12% (0.32 to 0.36 (p=0.034)) and 15% (0.4 to 0.46 (p=0.001)), while there was no significant variation in the last femur (0.32 to 0.32 (p>0.05)). Increases in regional BMD were significantly higher in the lateral and medial areas, as well as in the most distal femoral regions. There were significantly lower variations of BMD in regions with initially higher BMD. DISCUSSION Current opinion considers trabecular bone debris from femoral rasping to have an impact on final stem position and outcome. Our study has demonstrated an overall positive effect of femoral rasping on BMD in the rasped cavity. Understanding this in the context of 3DP may help avoid mechanical failures such as, suboptimal implant fit, fill, and stability as well as femoral fractures during stem implantation. LEVEL OF EVIDENCE IV, Prospective in vitro study.
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Affiliation(s)
- Ibraheim El-Daly
- Service d'orthopédie, hôpital Pitié-Salpêtrière, 47-83, boulevard de Hôpital, 75013 Paris, France.
| | - Andres Rondon
- Inserm UMR S 1146, CNRS UMR 7371, laboratoire d'imagerie biomédicale, Sorbonne université, 75006 Paris, France
| | - Stefroy Pinto
- Inserm UMR S 1146, CNRS UMR 7371, laboratoire d'imagerie biomédicale, Sorbonne université, 75006 Paris, France
| | - Christine Chappard
- Osteo-Articular Bioengineering and Bioimaging (B2OA) university Denis Diderot, CNRS, 10, avenue de Verdun, 75010 Paris, France
| | - Quentin Grimal
- Inserm UMR S 1146, CNRS UMR 7371, laboratoire d'imagerie biomédicale, Sorbonne université, 75006 Paris, France
| | - Elhadi Sariali
- Service d'orthopédie, hôpital Pitié-Salpêtrière, 47-83, boulevard de Hôpital, 75013 Paris, France; Inserm UMR S 1146, CNRS UMR 7371, laboratoire d'imagerie biomédicale, Sorbonne université, 75006 Paris, France
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Tostain O, Debuyzer E, Benad K, Putman S, Pierache A, Girard J, Pasquier G. Ten-year outcomes of cementless anatomical femoral implants after 3D computed tomography planning. Follow-up note. Orthop Traumatol Surg Res 2019; 105:937-942. [PMID: 31255501 DOI: 10.1016/j.otsr.2019.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/28/2019] [Accepted: 04/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pre-operative 3D planning based on computed tomography (CT) imaging is used to optimise the restitution of normal hip anatomy during primary total hip arthroplasty (THA). Although CT planning has been proven effective and reproducible, its influence on long-term THA outcomes is unknown. In this 10-year follow-up study of patients managed with the same technique of CT-planned primary anatomical THA, the objectives were to assess femoral implant survival, long-term functional outcomes, 10-year outcomes of titanium modular femoral necks, and associations with the dislocation rate. Hypothesis Pre-operative CT planning of primary THA ensures achievement of the NICE criterion of a lower than 5% femoral revision rate within 10 years. MATERIAL AND METHODS The study included 61 patients (61 hips) managed between 2004 and 2007 by CT-planned primary THA via the posterior approach, with an uncemented anatomical femoral component (SPS®, Symbios); when deemed necessary by the surgeon to restore normal anatomy, a titanium modular femoral neck was used (35/61 patients). After 10 years, 17 patients had died and 3 were lost to follow-up, leaving 41 patients with a mean age of 76 years (range, 60-91 years) for re-evaluation. Clinical outcomes were assessed by determining the Harris Hip Score (HHS) and the Postel-Merle d'Aubigné (PMA) score, which were compared to baseline values. Radiographs were evaluated using the AGORA Roentgenographic Assessment system (ARA). RESULTS The 10-year femoral component survival rate was 96% (95%CI, 88;99%). Revision was required in 4 patients, to treat delayed peri-prosthetic fractures (n=2) or to correct initial cup malposition (n=2). No changes occurred from 2010 to last follow-up in the mean HHS (90 [95%CI, 84;95] and 91 [95%CI, 77;96], respectively) or mean PMA score (16 [95%CI, 14;17] and 15.5 [95%CI, 14;16.5], respectively). The mean ARA score was 5.2 (range, 3-6) at last follow-up. No complications related to the use of modular femoral necks were recorded. Dislocation occurred in 2 patients, but in neither was the pre-operative plan followed during surgery. DISCUSSION The SPS® stem produced good 10-year clinical and radiographic outcomes. No patients experienced complications related to use of a titanium modular femoral neck. The restoration of anatomical hip geometry made possible by pre-operative CT planning provided sustained clinical improvements with a low complication rate. LEVEL OF EVIDENCE IV, retrospective observational cohort study.
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Affiliation(s)
- Olivier Tostain
- Service d'orthopédie, département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, Lille 59037, France; Faculté de médecine, université Lille-Nord-de-France, Lille 59000, France.
| | - Emmanuel Debuyzer
- Service d'orthopédie, département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, Lille 59037, France; Faculté de médecine, université Lille-Nord-de-France, Lille 59000, France
| | - Kevin Benad
- Service d'orthopédie, département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, Lille 59037, France; Faculté de médecine, université Lille-Nord-de-France, Lille 59000, France
| | - Sophie Putman
- Service d'orthopédie, département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, Lille 59037, France; Faculté de médecine, université Lille-Nord-de-France, Lille 59000, France
| | - Adeline Pierache
- Unité de Méthodologie - Biostatistique et Data Management-Maison Régionale de la Recherche Clinique - CHRU de Lille, Lille, France
| | - Julien Girard
- Service d'orthopédie, département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, Lille 59037, France; Faculté de médecine, université Lille-Nord-de-France, Lille 59000, France
| | - Gilles Pasquier
- Service d'orthopédie, département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, Lille 59037, France; Faculté de médecine, université Lille-Nord-de-France, Lille 59000, France
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Kim JT, Jeong HJ, Lee SJ, Kim HJ, Yoo JJ. Does Proximally Coated Single-Wedge Cementless Stem Work Well in Dorr Type C Femurs? Minimum 10-year Followup. Indian J Orthop 2019; 53:94-101. [PMID: 30905988 PMCID: PMC6394166 DOI: 10.4103/ortho.ijortho_160_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) with a proximally coated single-wedge (PSW) cementless stem had been generally considered not to be suitable for Dorr Type C femurs. This study compares the long term outcomes of PSW stem according to the type of proximal femoral geometry. MATERIALS AND METHODS 307 primary THAs in 247 patients were performed with PSW cementless stem and followed up for over 10 years in this retrospective study. According to Dorr's criteria, 89 femurs were classified as Type A, 156 as Type B, and 62 as Type C. They were followed up for an average of 13.2 years (range 10.0-17.3 years). All the hips were evaluated clinically and radiologically. RESULTS There was no significant difference in stem survivorship and clinical outcomes including the incidence of thigh pain and the mean postoperative Harris hip score (HHS) in all three groups. No significant differences were observed in osteolysis, pedestal formation, or cortical hypertrophy among the groups. Radiolucent lines <2 mm in thickness in Gruen zone 4 and 7 (P = 0.003 and P = 0.044, respectively), spot-weld (P < 0.001), and stress shielding (P = 0.010) of proximal femur were more pronounced in Dorr C type femora than in Type A or B. Fifty-six intraoperative fractures were identified among 307 hips with PSW stems. The incidence of intraoperative or postoperative femoral fractures was not significantly different among the groups. CONCLUSIONS From over a 10-year followup, the PSW stem provided a recommendable option with satisfactory outcomes and excellent stem survivorship regardless of the Dorr type.
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Affiliation(s)
- Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Yeongtong-gu, Suwon-si, Gyeonggi-do, Korea
| | - Hyung Jun Jeong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Soong Joon Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea,Medical Research Center, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea,Address for correspondence: Dr. Jeong Joon Yoo, Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. E-mail:
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Abstract
INTRODUCTION The design of the cementless Symax-HA femoral stem is based on geometrical analysis of human femoral anatomy to optimise the fit within the femur. The stem combines an anatomical proximal section enabling a metaphyseal anchorage with a straight distal section. This results in an improved proximal load transfer. We aimed to determine the overall survival of total hip arthroplasty (THA) in patients operated at our institution with the Symax stem. Secondly, we investigated the cause of revision for patients having THA including the Symax stem. METHODS The study is a registry study with results from a single centre, Vejle Hospital. From the Danish Hip -Arthroplasty Registry, we identified all THAs operated with the Symax stem. The primary outcome was revision. The secondary outcomes were aseptic loosening, periprosthetic fracture, and all other causes for revision. RESULTS In total, 1,055 THAs were performed in 875 patients. The median 6.5-year survival rate was 97.5% (95% confidence interval [CI]: 96.6%-98.3%). 29 THAs had undergone revision due to the following causes: periprosthetic fracture (n = 11); aseptic loosening of the cup (n = 1); infection (n = 5); dislocation (n = 10); and component failure (n = 2). There was no revision due to aseptic loosening of the stem. CONCLUSIONS From the Danish Hip Arthroplasty Registry, we identified the overall 6.5-year survival rate to be 95% for cementless THAs. In the present study, the Symax stem has a median 6.5-year survival rate at 97.5% (96.6%-98.3%). No revisions were due to aseptic loosening but the stem had a relative high prevalence of periprosthetic fractures.
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Rondon A, Sariali E, Vallet Q, Grimal Q. Modal analysis for the assessment of cementless hip stem primary stability in preoperative THA planning. Med Eng Phys 2017; 49:79-88. [PMID: 28888789 DOI: 10.1016/j.medengphy.2017.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 07/10/2017] [Accepted: 07/30/2017] [Indexed: 02/09/2023]
Abstract
This numerical vibration finite element (FE) study introduces resonance three-dimensional planning (RP3D) to assess preoperatively the primary stability of a cementless stem for total hip arthroplasty. Based on a patient's CT-scan and a numerical model of a stem, RP3D aims at providing mechanical criteria indicative of the achievable primary stability. We investigate variations of the modal response of the stem to changes of area and apparent stiffness of the bone-implant interface. The model is computationally cheap as it does not include a mesh of the bone. The apparent stiffness of the bone is modeled by springs attached to the nodes of the stem's mesh. We investigate an extended range of stiffness values while, in future works, patient's specific Hounsfield values could be used to define stiffness. We report modal frequencies, shapes, and a ratio of elastic potential energies (rEPE) that quantifies the proximal motion that should be minimum for a stable stem. The modal response exhibits a clear transition between loose and tight contact as area and stiffness of the interface increase. rEPE thresholds that could potentially discriminate preoperatively between stable and unstable stems are given for a Symbios SPS® size C stem.
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Affiliation(s)
- Andres Rondon
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, F-75006, Paris.
| | - Elhadi Sariali
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, F-75006, Paris; AP-HP, Hôpital Pitié Salpêtrière, Orthopedic Surgery Department, F-75013, Paris
| | - Quentin Vallet
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, F-75006, Paris
| | - Quentin Grimal
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, F-75006, Paris
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Peng MJQ, Chen HY, Hu Y, Ju X, Bai B. Finite Element Analysis of porously punched prosthetic short stem virtually designed for simulative uncemented Hip Arthroplasty. BMC Musculoskelet Disord 2017; 18:295. [PMID: 28693543 PMCID: PMC5504632 DOI: 10.1186/s12891-017-1651-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 06/29/2017] [Indexed: 01/25/2023] Open
Abstract
Background There is no universal hip implant suitably fills all femoral types, whether prostheses of porous short-stem suitable for Hip Arthroplasty is to be measured scientifically. Methods Ten specimens of femurs scanned by CT were input onto Mimics to rebuild 3D models; their *stl format dataset were imported into Geomagic-Studio for simulative osteotomy; the generated *.igs dataset were interacted by UG to fit solid models; the prosthesis were obtained by the same way from patients, and bored by punching bears designed by Pro-E virtually; cements between femora and prosthesis were extracted by deleting prosthesis; in HyperMesh, all compartments were assembled onto four artificial joint style as: (a) cemented long-stem prosthesis; (b) porous long-stem prosthesis; (c) cemented short-stem prosthesis; (d) porous short-stem prosthesis. Then, these numerical models of Finite Element Analysis were exported to AnSys for numerical solution. Results Observed whatever from femur or prosthesis or combinational femora-prostheses, “Kruskal-Wallis” value p > 0.05 demonstrates that displacement of (d) ≈ (a) ≈ (b) ≈ (c) shows nothing different significantly by comparison with 600 N load. If stresses are tested upon prosthesis, (d) ≈ (a) ≈ (b) ≈ (c) is also displayed; if upon femora, (d) ≈ (a) ≈ (b) < (c) is suggested; if upon integral joint, (d) ≈ (a) < (b) < (c) is presented. Conclusions Mechanically, these four sorts of artificial joint replacement are stabilized in quantity. Cemented short-stem prostheses present the biggest stress, while porous short-stem & cemented long-stem designs are equivalently better than porous long-stem prostheses and alternatives for femoral-head replacement. The preferred design of those two depends on clinical conditions. The cemented long-stem is favorable for inactive elders with osteoporosis, and porously punched cementless short-stem design is suitable for patients with osteoporosis, while the porously punched cementless short-stem is favorable for those with a cement allergy. Clinically, the strength of this study is to enable preoperative strategy to provide acute correction and decrease procedure time.
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Affiliation(s)
- Matthew Jian-Qiao Peng
- Guangdong Orthopedics Implantation key Lab, Orthopedics Department of 1st Affiliated Hospital, Guangzhou Medical University, 151 YanJiangXi Rd, Guangzhou, 510120, China
| | - Hai-Yan Chen
- Guangdong Orthopedics Implantation key Lab, Orthopedics Department of 1st Affiliated Hospital, Guangzhou Medical University, 151 YanJiangXi Rd, Guangzhou, 510120, China
| | - Yong Hu
- Neural Electrophysiology Lab, University of Hong Kong, Room 501, Haking Wong Building, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - XiangYang Ju
- Clinical Physics & Bioengineering Department, University of Glasgow, 378 Sauchiehall St., Glasgow, G2 3JZ, UK
| | - Bo Bai
- Guangdong Orthopedics Implantation key Lab, Orthopedics Department of 1st Affiliated Hospital, Guangzhou Medical University, 151 YanJiangXi Rd, Guangzhou, 510120, China.
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Comparison of anatomic vs. straight femoral stem design in total hip replacement - femoral canal fill in vivo. Hip Int 2017; 27:241-244. [PMID: 27886361 DOI: 10.5301/hipint.5000439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The femoral canal fill between an anatomic and a straight prosthesis design in cementless total hip arthroplasty (THA) was compared. We hypothesised that the anatomic SPS stem has higher proximal fill and lesser distal fill than the straight stem. MATERIAL AND METHODS The femoral canal fill was measured on 3 months routine postoperative x-rays at 5 levels of the stem in 50 consecutive patients, aged 35-83 years, who underwent 56 THA procedures by a single surgeon in this hospital. 22 patients received a straight design Ceramconcept Global stem, 34 patients received an anatomic design Symbios SPS stem. Both anteroposterior (AP) and lateral x-rays were combined to suggest a 3-D measurement. RESULTS On the AP x-rays, the canal fill was significantly higher using the anatomic design stem at the proximal measurement levels, and was significantly higher at the distal levels using the straight stem. With the AP and lateral x-rays combined, the canal fill at the proximal levels was also significantly higher in the anatomic groups, nonsignificantly lower at the central level and significantly lower at the distal levels. DISCUSSION In THA surgery, achieving high fill at the metaphysis of the femur and less fill at the diaphysis has been suggested to result in satisfactory outcome and high stability of the prosthesis. This study demonstrated that, compared to straight stem design, an anatomically designed stem has a significantly higher metaphyseal femoral canal fill.
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Stable migration pattern of an ultra-short anatomical uncemented hip stem: a prospective study with 2 years radiostereometric analysis follow-up. Hip Int 2017; 27:259-266. [PMID: 28165591 DOI: 10.5301/hipint.5000458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Shorter, anatomically shaped and proximally loading stems have been developed to achieve better stress distribution and be more bone preserving. The purpose of this prospective study was to evaluate the migration pattern of the Proxima™ ultra-short uncemented stem using radiostereometric analysis (RSA), and to review the literature regarding the migration of short stemmed hip arthroplasty. METHODS 25 patients (28 hips) with hip osteoarthritis received a Proxima stem during total hip arthroplasty (THA). To measure stem migration, repeated RSA examinations were done during a 2 year follow up period. The patients were evaluated with the hip specific (HOOS) and the generic health (EQ5D) scores up to 1 year, and clinically for 6 years postoperatively. RESULTS Almost all migration occurred within the first 3 months, with mean subsidence of 0.22 mm and varus rotation of 1.04°, being the primary effect variables. After the third postoperative month and up to the 2 year RSA follow up no further significant migration occurred. The outcome scores showed substantial improvement after 1 year. No revisions were performed or indicated for any stem after a mean clinical follow up of 72.1 months. CONCLUSIONS Like many other uncemented stems, the Proxima showed early migration up to 3 months hereafter osseointegration seems to have occurred. The achieved stability and clinical outcomes indicate favorable early results for this stem in younger patients who have good bone quality and average BMI. We found, however, the surgical technique to be slightly more demanding compared to conventional stems owing to the unique implant design that necessitates specific adjusted femoral cutting and broaching procedures.
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Three-dimensional analysis of the proximal anterior femoral flare and torsion. Anatomic bases for metaphyseally fixed short stems design. INTERNATIONAL ORTHOPAEDICS 2017; 41:2017-2023. [PMID: 28283706 DOI: 10.1007/s00264-017-3435-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/28/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE The use of femoral stems with a short metaphyseal fixation may lead to fractures or subsidence. Such failures may be related to a mismatch between the torsions or the sagittal flares of the stem and the femur. The goal of our study was to perform a 3D analysis of the proximal metaphyseal femur anatomy with a special focus on the anterior proximal flare and torsion. Such data may help to detect the outlier patients for whom a short metaphyseal fixation should be avoided. METHODS A prospective study included 80 consecutive patients who underwent a primary cementless THA with a 3D CT-scan based pre-operative planning. A femoral frame was determined in order to analyse the proximal metaphyseal torsion and flares of the femur. RESULTS The mean metaphyseal torsion was 21.6° ± 7° at 5 mm above the lesser trochanter (LT) and 34.7° ± 8.8 at 15 mm under LT generating a differential torsion of 13° around the LT. The mean flare index was 4.3 ± 0.9 medially, 3.7 ± 0.8 laterally, 2 ± 0.6 anteriorly and 3.1 ± 0.6 posteriorly. The anterior flare was the only flare significantly correlated to the bone density, to the age and to the femoral off-set: the higher the anterior flare index, the younger the patient, the higher the bone density and the higher the femoral offset. The anterior flare was not significantly correlated to the femoral anteversion, the metaphyseal torsion and the coronal neck-shaft angle. CONCLUSION The proximal femoral metaphysis presents a highly variable anterior flare and torsion that may explain a mismatch between the femur and the femoral stem, consequently generating a risk of subsidence or fracture when using shortly fixed stems. LEVEL OF EVIDENCE Level IV.
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CORR Insights ®: Two- to 4-year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern. Clin Orthop Relat Res 2017; 475:384-386. [PMID: 27506972 PMCID: PMC5213935 DOI: 10.1007/s11999-016-5019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/03/2016] [Indexed: 01/31/2023]
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Xu J, Xie Z, Zhao J, Gao Y, Zhao H, Peng L, Qu Y. Results of a hydroxyapatite-coated femoral stem (Corail) in Chinese: a minimum 10-year follow-up. SPRINGERPLUS 2016; 5:1983. [PMID: 27917354 PMCID: PMC5110457 DOI: 10.1186/s40064-016-3656-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/04/2016] [Indexed: 12/04/2022]
Abstract
Background
Due to the adverse effects of cemented hip arthroplasty, uncemented stems with hydroxyapatite (HA) coating reduces these risks and enhanced integration. The concept of an extensive HA coating for the fixation of a tapered femoral stem (Corail®) was introduced, which can achieve durable biological fixation and preserve normal periprosthetic bone activity. Here we describe the clinical and radiological outcome in patients with the Corail® stem. Methods 92 total hip replacements in 81 patients using the Corail® stem were followed-up. 47 patients were women, and the mean age at surgery was 62.9 ± 8.7 (34–71) years. The indications included: osteoarthritis of the hip (71.1%), avascular necrosis (13.6%), femur neck fractures in elderly (9.7%) and post-traumatic osteoarthritis (6.8%). Findings
Eight patients died during follow-up. The revision was only found in two patients due to line wear and resulted in an 10-year Kaplan–Meier estimated overall survival rate of 97.83%. The clinical results were good, with a mean Harris hip score of 92.3 ± 5.6 (72–100). The mean total Merle d’Aubigné and Postel score was 6.8 ± 0.5 pre-operatively and 16.1 ± 1.4 at latest follow-up. All unrevised implants were radiographically stable, with a mean liner wear of 0.07 mm/year. Conclusion This long-term analysis confirmed the durability of the functional and radiographic results. Our findings suggest the long-term results of Corail® HA-coated stem are more satisfactory which is preferable to any other system.
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Affiliation(s)
- Jianda Xu
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000 Jiangsu China
| | - Zikang Xie
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000 Jiangsu China
| | - Jianning Zhao
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000 Jiangsu China.,Nanjing Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002 Jiangsu China
| | - Yi Gao
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000 Jiangsu China
| | - Hong Zhao
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000 Jiangsu China
| | - Libo Peng
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000 Jiangsu China
| | - Yuxing Qu
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Affiliated to Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000 Jiangsu China
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The cementless fibre mesh coated anatomic femoral stem: 12 to 23 years clinical and radiological outcome study. Hip Int 2016; 26:479-485. [PMID: 27396233 DOI: 10.5301/hipint.5000377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this study was to assess the long-term clinical and radiographic results, and possible reasons for failure of two versions of the cementless fibre-metal coated anatomical femoral component. METHODS 99 patients (119 hips) were evaluated at an average of 16.7 years (range, 12 to 23 years) following primary THA. Developmental dysplasia of the hip (DDH) was the most common pathology (n = 37 hips). Structural femoral head autografts were used to increase cup coverage in 23 hips. Vertical and horizontal migration of acetabular and femoral components and osteolysis around the components were assessed using conventional radiolography. For clinical evaluation, the Harris Hip Score and Merle D'Aubigne scale were used preoperatively and at final follow up. Implant survival was calculated according to the Kaplan-Meier survivorship analysis and failure was defined as component's revision for any reason. RESULTS The cumulative survival rate of the anatomical femoral stem was 64.2% at 19.8 years, with a worst-case scenario of 41%. The cumulative survival rate of the total hip arthroplasty was 51% at 19.8 years, with a worse case scenario of 38%. The mean preoperative Harris Hip Score of 42 points improved to 88 postoperatively. The mean preoperative Merle D'Aubigne functional score of 3.5 improved to 5.2 points at the time of final follow-up. In 36 hips (41.6%) osteolysis was found in Gruen zone 1, proximal to the ingrowth surface. CONCLUSIONS The cementless fibre-metal coated anatomical femoral component showed favourable long-term clinical and radiological results. Proximal coating seems to protect bone implant interface from wear debris induced osteolysis during the second decade.
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WANG LING, PENG XIFENG, SUN CHANGNING, WANG HUAYI, LI DICHEN, ZHU JINYU, JIN ZHONGMIN, MIHCIN SENAY, LIU CHAOZONG. THE DETERMINATION OF THE VOLUMETRIC WEAR FOR SURGICALLY RETRIEVED HIP IMPLANTS BASED ON CMM. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The effects of wear mechanisms on the long-term survivorship of artificial hip implants emphasized the importance of determining the 3D volumetric wear in retrieved hip replacements. Traditional methods for determining the volumetric wear on acetabular cups require reference surface from a pre-worn model, which is not feasible for clinical retrieved implants. In this study, a methodology based on co-ordinate measuring machine (CMM) measurement is proposed to reconstruct the reference surface by applying a mathematical model on those selected unworn regions of the acetabular liners. For validation purposes, three polyethylene liners from 5-million-cycle hip simulator testing were employed, whose wear volume at different measurement points was determined by applying the developed method and the results were compared to those determined via traditional approaches. Volumetric loss estimated by the developed method was found to correlate well with the results estimated by the traditional methods ([Formula: see text]). Moreover, two surgically retrieved inserts were analyzed using the developed methodology. The wear volume estimated from the two retrieved liners was also found to agree well with the observation from X-ray photograph. Results demonstrated that the proposed method is effective in determining the volumetric wear for retrieved components providing viable unworn regions on the liner.
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Affiliation(s)
- LING WANG
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an 710054, P. R. China
| | - XIFENG PENG
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an 710054, P. R. China
| | - CHANGNING SUN
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an 710054, P. R. China
| | - HUAYI WANG
- Department of Orthopaedics, Xijing Hospital, the Fourth Military Medical University, Xi’an 710032, P. R. China
| | - DICHEN LI
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an 710054, P. R. China
| | - JINYU ZHU
- Department of Orthopaedics, Xijing Hospital, the Fourth Military Medical University, Xi’an 710032, P. R. China
| | - ZHONGMIN JIN
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an 710054, P. R. China
- School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - SENAY MIHCIN
- Institute for Medical Science and Technology, University of Dundee, Dundee, DD2 1FD, UK
| | - CHAOZONG LIU
- John Scale Centre for Biomedical Engineering, University College London, Royal National Orthopaedic Hospital, Stanmore, HA74LP, UK
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Cementless hydroxyapatite coated hip prostheses. BIOMED RESEARCH INTERNATIONAL 2015; 2015:386461. [PMID: 25802848 PMCID: PMC4352755 DOI: 10.1155/2015/386461] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/16/2014] [Accepted: 12/30/2014] [Indexed: 12/13/2022]
Abstract
More than twenty years ago, hydroxyapatite (HA), calcium phosphate ceramics, was introduced as a coating for cementless hip prostheses. The choice of this ceramic is due to its composition being similar to organic apatite bone crystals. This ceramic is biocompatible, bioactive, and osteoconductive. These qualities facilitate the primary stability and osseointegration of implants. Our surgical experience includes the implantation of more than 4,000 cementless hydroxyapatite coated hip prostheses since 1990. The models implanted are coated with HA in the acetabulum and in the metaphyseal area of the stem. The results corresponding to survival and stability of implants were very satisfactory in the long-term. From our experience, HA-coated hip implants are a reliable alternative which can achieve long term survival, provided that certain requirements are met: good design selection, sound choice of bearing surfaces based on patient life expectancy, meticulous surgical technique, and indications based on adequate bone quality.
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Jones C, Aqil A, Clarke S, Cobb JP. Short uncemented stems allow greater femoral flexibility and may reduce peri-prosthetic fracture risk: a dry bone and cadaveric study. J Orthop Traumatol 2015; 16:229-35. [PMID: 25701257 PMCID: PMC4559535 DOI: 10.1007/s10195-015-0343-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 02/07/2015] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Short femoral stems for uncemented total hip arthroplasty have been introduced as a safe alternative to traditional longer stem designs. However, there has been little biomechanical examination of the effects of stem length on complications of surgery. This study aims to examine the effect of femoral stem length on torsional resistance to peri-prosthetic fracture. MATERIALS AND METHODS We tested 16 synthetic and two paired cadaveric femora. Specimens were implanted and then rapidly rotated until fracture to simulate internal rotation on a planted foot, as might occur during stumbling. 3D planning software and custom-printed 3D cutting guides were used to enhance the accuracy and consistency of our stem insertion technique. RESULTS Synthetic femora implanted with short stems fractured at a significantly higher torque (27.1 vs. 24.2 Nm, p = 0.03) and angle (30.3° vs. 22.3°, p = 0.002) than those implanted with long stems. Fracture patterns of the two groups were different, but showed remarkable consistency within each group. These characteristic fracture patterns were closely replicated in the pair of cadaveric femora. CONCLUSIONS This new short-stemmed press-fit femoral component allows more femoral flexibility and confers a higher resistance to peri-prosthetic fracture from torsional forces than long stems.
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Affiliation(s)
- Christopher Jones
- MSK Lab, 7th Floor, Lab Block, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
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Wiater JM, Moravek JE, Budge MD, Koueiter DM, Marcantonio D, Wiater BP. Clinical and radiographic results of cementless reverse total shoulder arthroplasty: a comparative study with 2 to 5 years of follow-up. J Shoulder Elbow Surg 2014; 23:1208-14. [PMID: 24561176 DOI: 10.1016/j.jse.2013.11.032] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/19/2013] [Accepted: 11/22/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Most studies of reverse total shoulder arthroplasty (RTSA) involve cemented humeral stems. To our knowledge, this is the first study to compare the results of cementless RTSA, using a porous-coated stem designed for uncemented fixation, with cemented RTSA. METHODS A prospective database of patients undergoing RTSA was retrospectively reviewed for patients with a diagnosis of cuff tear arthropathy or severe rotator cuff deficiency with minimum 2-year follow-up. Of these, 37 patients had cemented RTSA and 64 patients had cementless RTSA. Outcome measures included Constant-Murley scores, American Shoulder and Elbow Surgeons scores, visual analog pain scale scores, range of motion, patient satisfaction, and radiographic evidence of complication. RESULTS Compared with preoperative values, both cohorts demonstrated significant improvements (P < .01) in all functional scores, active forward elevation, and active internal rotation. There was no significant difference (P > .05) in comparing the changes in these values after surgery between the cemented and cementless cohorts. On radiographic evaluation, there was no evidence of loosening or humeral components "at risk" of loosening in either group. There was no significant difference (P = 1.0) in the incidence of humeral component radiolucent lines between the cemented and uncemented cohorts. There was no significant difference (P = .30) in the incidence of scapular notching between the cemented (n = 8) and uncemented (n = 10) cohorts. CONCLUSION Cementless fixation of a porous-coated RTSA humeral stem provides clinical and radiographic outcomes equivalent to those of cemented stems at minimum 2-year follow-up. With advantages such as simplified operative technique, no cement-related complications, greater ease of revision, and long-lasting biologic fixation, uncemented fixation may provide several benefits over cemented fixation.
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Affiliation(s)
- J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA.
| | - James E Moravek
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
| | - Matthew D Budge
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
| | - Denise M Koueiter
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA
| | | | - Brett P Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
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Yamako G, Chosa E, Zhao X, Totoribe K, Watanabe S, Sakamoto T, Nakane N. Load-transfer analysis after insertion of cementless anatomical femoral stem using pre- and post-operative CT images based patient-specific finite element analysis. Med Eng Phys 2014; 36:694-700. [DOI: 10.1016/j.medengphy.2014.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 01/30/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
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So K, Kaneuji A, Matsumoto T, Matsuda S, Akiyama H. Is the bone-bonding ability of a cementless total hip prosthesis enhanced by alkaline and heat treatments? Clin Orthop Relat Res 2013; 471:3847-55. [PMID: 23539125 PMCID: PMC3825883 DOI: 10.1007/s11999-013-2945-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cementless total hip arthroplasty (THA) implants using alkaline and heat treatments were developed to enhance bone bonding. Although bone-bonding ability of the alkali- and heat-treated titanium surface has been demonstrated in animal studies, it remains unknown whether it enhances or provides durable bone bonding in humans. QUESTIONS/PURPOSES We therefore (1) determined long-term survivorship, function, and radiographic signs of failure of fixation of alkali- and heat-treated THA implants; and (2) histologically examined their bone-bonding ability in two human retrievals. METHODS We retrospectively reviewed 58 patients who underwent 70 primary THAs, of whom 67 were available for minimum followup of 8 years (average, 10 years; range, 8-12 years). Survival rate was calculated. Hip function was evaluated using the Japan Orthopaedic Association (JOA) hip scores, and radiographic signs of implant failure were determined from anteroposterior radiographs. Two retrieved implants were investigated histologically. RESULTS Using revision for any reason as the end point, the overall survival rate was 98% (95% confidence interval, 96%-100%) at 10 years. The patients' average JOA hip scores improved from 47 points preoperatively to 91 points at the time of the last followup. No implant had radiographic signs of loosening. Histologically we observed bone in the pores 2 weeks after implantation in one specimen and apparently direct bonding between bone and the titanium surface in its deep pores 8 years after implantation. CONCLUSIONS Cementless THA implants with alkaline and heat treatments showed a high survival rate. Further study is required to determine whether the treatment enhances direct bone bonding.
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Affiliation(s)
- Kazutaka So
- Department of Orthopaedic Surgery, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606-8507 Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Tadami Matsumoto
- Department of Orthopaedic Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606-8507 Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606-8507 Japan
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