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Lee CY, Jin SY, Choi JH, Yoon TR, Park KS. Comparison of Short Curved Stems and Standard-length Single Wedged Stems for Cementless Total Hip Arthroplasty. Hip Pelvis 2024; 36:120-128. [PMID: 38825821 PMCID: PMC11162871 DOI: 10.5371/hp.2024.36.2.120] [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: 03/16/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 06/04/2024] Open
Abstract
Purpose The purpose of this study was to compare the clinical and radiographic outcomes with use of short-curved stems versus standard-length single wedged stems over a minimum follow-up period of five years. Materials and Methods A retrospective study of primary total hip arthroplasties performed using the Fitmore® stem (127 hips, 122 patients) and the M/L taper® stem (195 hips, 187 patients) between October 2012 and June 2014 was conducted. The clinical and radiographic outcomes were obtained for evaluation over a minimum follow-up period of five years. Results In both the Fitmore® and M/L taper® groups, the mean Harris hip score improved from 52.4 and 48.9 preoperatively to 93.3 and 94.5 at the final follow-up, respectively (P=0.980). The mean Western Ontario and McMaster Universities Osteoarthritis Index scores also improved from 73.3 and 76.8 preoperatively to 22.9 and 25.6 at the final follow-up, respectively (P=0.465). Fifteen hips (Fitmore®: 14 hips; M/L taper®: one hip, P<0.001) developed intraoperative cracks and were treated simultaneously with cerclage wiring. Radiography showed a radiolucent line in 24 hips in the Fitmore® group and 12 hips in the M/L taper® group (P=0.125). Cortical hypertrophy was detected in 29 hips (Fitmore® group: 28 hips; M/L taper® group: one hip, P<0.001). Conclusion Similarly favorable clinical and radiographic outcomes were achieved with use of both short-curved stems and standard-length single wedged stems. However, higher cortical hypertrophy and a higher rate of femoral crack were observed with use of Fitmore® stems.
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Affiliation(s)
- Chan Young Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Sheng-Yu Jin
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Ji Hoon Choi
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Taek-Rim Yoon
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Kyung-Soon Park
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
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Hunter M, Fawley DW, Diaz R, Barrett W, Croker S, Gorab R. Five-Year Survivorship of Total Hip Arthroplasty With a Proximally Coated, Medially Collared, Triple-Tapered Femoral Stem: A Retrospective, Multicenter Registry Review. Cureus 2024; 16:e59462. [PMID: 38826998 PMCID: PMC11141789 DOI: 10.7759/cureus.59462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Background The anterior approach for total hip arthroplasty (THA) has gained popularity in recent years. Some surgeons have been hesitant to adopt the approach due to concerns over increased complications such as intraoperative fracture, stem loosening, and stem revision. This study aims to evaluate the all-cause revision rate and survivorship of a collared, triple-tapered stem that was designed specifically for use with the anterior approach in THA to enhance outcomes and reduce adverse events. Methodology A retrospective outcomes review was conducted to assess survivorship and clinical outcomes for a specific proximally coated, medially collared triple-tapered (MCTT) femoral stem. Results In a cohort of 5,264 hips, Kaplan-Meier survivorship estimates (95% confidence interval [CI]; N with further follow-up), with survivorship defined as no revision of any component for any reason at five years after the index procedure, were 98.9% (97.8%-99.4%; 43) under the clinical assumption and 99.6% (99.4%-99.7%; 894) under the registry assumption. With survivorship defined as stem revision for any reason, survivorship estimates at five years postoperatively were 99.6% (99.3%-99.8%; 43) under the clinical assumption and 99.8% (99.7%-99.9%; 894) under the registry assumption. The mean follow-up time was 94.52 days (standard deviation [SD] 2.24, range 90.03-96.02). At five years postoperatively, the mean Harris Hip Score was 95.19, and the mean Hip Disability and Osteoarthritis Outcome Score Junior (HOOS JR) score was 98.66. Conclusions Our evaluation demonstrates excellent construct and stem survivorship and very low complication rates at midterm postoperative follow-up.
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Affiliation(s)
| | | | | | | | - Sean Croker
- Clinical Research, DePuy Synthes, Warsaw, USA
| | - Robert Gorab
- Orthopedic Surgery, Hoag Orthopedics Institute, Irvine, USA
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3
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Guizzardi S, Colangelo MT, Mirandola P, Galli C. Modeling new trends in bone regeneration, using the BERTopic approach. Regen Med 2023; 18:719-734. [PMID: 37577987 DOI: 10.2217/rme-2023-0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Aim: Bibliometric surveys are time-consuming endeavors, which cannot be scaled up to meet the challenges of ever-expanding fields, such as bone regeneration. Artificial intelligence, however, can provide smart tools to screen massive amounts of literature, and we relied on this technology to automatically identify research topics. Materials & methods: We used the BERTopic algorithm to detect the topics in a corpus of MEDLINE manuscripts, mapping their similarities and highlighting research hotspots. Results: Using BERTopic, we identified 372 topics and were able to assess the growing importance of innovative and recent fields of investigation such as 3D printing and extracellular vescicles. Conclusion: BERTopic appears as a suitable tool to set up automatic screening routines to track the progress in bone regeneration.
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Affiliation(s)
- Stefano Guizzardi
- Department of Medicine & Surgery, Histology & Embryology Lab, University of Parma, Parma, 43126, Italy
| | - Maria Teresa Colangelo
- Department of Medicine & Surgery, Histology & Embryology Lab, University of Parma, Parma, 43126, Italy
| | - Prisco Mirandola
- Department of Medicine & Surgery, Histology & Embryology Lab, University of Parma, Parma, 43126, Italy
| | - Carlo Galli
- Department of Medicine & Surgery, Histology & Embryology Lab, University of Parma, Parma, 43126, Italy
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Nooh A, Hart A, Tanzer M. Intermediate to Long-Term Outcomes of a Short, Tapered, Highly Porous, Proximally Coated Cementless Femoral Stem. J Arthroplasty 2023:S0883-5403(23)00351-0. [PMID: 37044224 DOI: 10.1016/j.arth.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Short cementless stems in total hip arthroplasty have gained increasing popularity, yet on-going studies of many of these implants are lacking. The aim of this study was to evaluate the minimum 5 year clinical and radiological results of a short, highly porous single tapered-wedge cementless femoral implant. METHODS A retrospective study of 281 hips in 256 patients who had a minimum 5-year follow-up and underwent primary total hip arthroplasty (THA) between 2010 and 2016 were evaluated. Clinical and radiological results, complications, and the presence of postoperative thigh pain were evaluated. RESULTS The mean follow-up was 8 years (range, 5 to 12 years). Clinically, patients had significant improvement in the average patient related outcome scores (PROMS) postoperatively (Harris Hip Score: pre 47 vs post 95, University of California Los Angeles (UCLA) activity scale: pre 4 vs post 6, Western Ontario and McMaster Universities Arthritis Index (WOMAC): pre 51 vs post 3, SF-12 Physical Component Summary (PCS): pre 32 vs post 52, SF-12 Mental Component Summary (MCS): pre 49 vs post 55 (P<0.001)). Radiographic signs of ingrowth were present in all hips. There were three patients (1.1%) who developed transient thigh pain postoperatively, all of which resolved with non-operative management. CONCLUSION This study provides the longest follow-up of this short, highly porous single tapered-wedge cementless femoral stem in the literature. This short single wedge stem with its highly porous coating demonstrated reproducible bone ingrowth in all patients, and significant functional improvement with a very low rate of transient thigh pain.
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Affiliation(s)
- Anas Nooh
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada; Department of Orthopaedic Surgery, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Adam Hart
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
| | - Michael Tanzer
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
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Fawley DW, Croker S, Irving JF, Swank ML. Intermediate-Term Survivorship of Total Hip Arthroplasty With a Proximally Coated Tapered-Wedge Femoral Stem: A Retrospective, Multi-Center Registry Review. Cureus 2023; 15:e36623. [PMID: 37155454 PMCID: PMC10122831 DOI: 10.7759/cureus.36623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Short tapered-wedge stems have been used frequently over the past decade, but long-term follow-up data are not readily available in the literature. METHODS A retrospective outcomes review was conducted to assess survivorship and clinical outcomes for the TRI-LOCK® Bone Preservation Stem (TRI-LOCK BPS; DePuy Synthes, Warsaw, IN, USA), a proximally coated, tapered-wedge femoral stem. RESULTS In a cohort of 2,040 hips, Kaplan-Meier survivorship estimates (95% CI {confidence interval}; N with further follow-up, where N is the number of hips remaining at each post-operative interval), with survivorship defined as no revision of any component for any reason were 96.6% (92.8%,98.4%; 45) at eight years under the clinical assumption and 98.6% (97.9%,99.1%; 90) at 14 years under the registry assumption. With survivorship defined as stem revision for any reason, estimates were 97.7% (93.7%,99.2%; 45) at eight years under the clinical assumption and 99.2% (98.6%,99.5%; 90) under the registry assumption. Mean Harris Hip Scores and WOMAC scores were 90.08 and 21.98, respectively, at 10 years postoperatively. CONCLUSION Our evaluation demonstrates excellent construct and stem survivorship and clinical outcomes at intermediate-term postoperative follow-up.
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Affiliation(s)
| | - Sean Croker
- Clinical Research, DePuy Synthes, Warsaw, USA
| | - John F Irving
- Orthopaedic Surgery, Connecticut Orthopaedics, Hamden, USA
| | - Michael L Swank
- Orthopaedic Surgery, Cincinnati Orthopaedic Research Institute, Cincinnati, USA
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Nelson JT, Zheng H, Hallstrom BR, Hughes RE, Mont MA, Masini MA. Are Short Stems Associated With Higher Fracture Rates and Early Revision Rates in Primary Total Hip Arthroplasty? A Noninferiority Analysis. J Arthroplasty 2023:S0883-5403(23)00008-6. [PMID: 36639113 DOI: 10.1016/j.arth.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/22/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This study aimed to determine if "short" femoral stems were noninferior to (at least as good as) standard-length stems in regards to 90-day periprosthetic fracture and 1-year revision rates. METHODS Using the MARCQI implant registry, a retrospective study of statewide data was carried out on 64,084 total hip arthroplasties (THAs) between 2012 and 2017. We noticed an increase in the use of "short" uncemented femoral hip stems during THA. Chi-square tests were used to test homogeneity of categorical variables. The covariates included in the analyses were identified using modern epidemiological methods. A Type I probability of 0.05 was used as the level of statistical significance. Inverse probability of treatment weighting (IPTW) was used to mitigate confounding variables. RESULTS One hundred and seven stems were implanted by surgeons in the state of Michigan. They were classified according to the Khanuja Classification System as Type 2A (trapezoidal, double-tapered calcar loading, n = 3,281), Type 3 (calcar loading with lateral flare, n = 1,898), and Type 4 (shortened, tapered, conventional, n = 19,580), and were compared to standard-length, type 5, stems (n = 33,322) in regards to the 2 outcomes (periprosthetic fractures and 1-year revision rates). Overall, 1-year revision and the 90-day fracture rates were 1.3% (791/57,853) and 1.1% (631/57,968), respectively. Noninferiority was established for all short stems at the clinical threshold of an odds ratio (OR) of 1.5 with P-values <0.05 for 90-day fractures. In regards to 1-year revision rates, noninferiority was also established for Type 3 and 4 stems (P < .05). CONCLUSION The increased use of "short stems" in Michigan did not lead to increased 1-year revision or 90-day fracture rates.
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Affiliation(s)
- Joseph T Nelson
- Dignity Health Medical Group, Arizona Creighton University School of Medicine- Phoenix, Phoenix, Arizona
| | - Huiyong Zheng
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brian R Hallstrom
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Richard E Hughes
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael A Mont
- Northwell Health Orthopaedic Institute at Lenox Hill, New York, New York
| | - Michael A Masini
- Department of Orthopedic Surgery, St. Joseph Mercy Hospital, Ann Arbor, Michigan
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Sharpe FE, Sharpe KP, McCarty CP, Ebramzadeh E. Load Sharing in the Femur Using Strut Allografts: A Biomechanical Study. Arthroplast Today 2022; 15:68-74. [PMID: 35464338 PMCID: PMC9018542 DOI: 10.1016/j.artd.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/01/2022] [Accepted: 02/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background Femoral strut allografts are used in revision hip arthroplasty for management of bone loss associated with implant failure or periprosthetic fractures. They have also been used to treat unremitting thigh pain in well-fixed cementless femoral stems, to address the differential in structural stiffness between the stem and femoral shaft. Our study used an in vitro biomechanical model to measure the effect of placement of allografts on femoral strains, to determine their load-sharing capacity. Material and methods Three rosette strain gauges were applied to the femoral surface of each of 6 cadaveric femurs, at the stem tip level on anterior, medial, and lateral cortices. After stem implantation, cortical strut allografts were applied to the lateral femoral shaft and secured with 4 Dall-Miles cables. A fourth gauge was placed on the midpoint of the allograft. Strains were recorded in the intact femur, then the implanted femur with and without the allograft under simulated physiologic loading in a load frame. Results Reduction in distal femoral principal strains, between 12% and 59%, was seen in all cortices following placement of the allograft. Under axial loading, 30% of the strain in the lateral cortex was borne by the allograft. Greater reductions in strain, by as much as 59%, occurred under axial load and torque. Conclusion The results of this biomechanical model indicate that by placement of an allograft, cortical strains can be reduced to levels approaching those in an intact femur, supporting this technique for treatment of unremitting thigh pain in well-fixed prostheses.
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Affiliation(s)
- Frances E. Sharpe
- Department of Hand and Orthopedic Surgery, Southern California Permanente Medical Group and University of Southern California Keck School of Medicine, Fontana Medical Center, Fontana, CA, USA
| | | | - Colin P. McCarty
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA, USA
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA, USA
- Corresponding author. The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Department of Orthopaedic Surgery, 403 West Adams Blvd, Los Angeles, CA 90007, USA. Tel.: +1 213 742 1440.
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8
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[Translated article] Results of the short neck-retaining stem prostheses CFP with a minimum follow-up of 10 years. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Berlanga-de-Mingo D, Pons-Cabrafiga M. Resultado del vástago corto con preservación del cuello femoral CFP con un seguimiento mínimo de 10 años. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:176-181. [DOI: 10.1016/j.recot.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/29/2021] [Accepted: 09/07/2021] [Indexed: 10/19/2022] Open
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Yoo JI, Cha Y, Lee YK, Ha YC, Koo KH. Do Cementless Short Tapered Stems Reduce the Incidence of Thigh Pain After Hip Arthroplasty? Systematic Review and Meta-Analysis. J Korean Med Sci 2022; 37:e41. [PMID: 35166078 PMCID: PMC8845099 DOI: 10.3346/jkms.2022.37.e41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine whether short tapered stems reduce the rate of thigh pain through a systematic review and meta-analysis of comparative studies between short tapered stems and standard-length tapered stems. METHODS We conducted a meta-analysis of comparative studies: 1) retrospective studies and 2) randomized controlled trials (RCTs), on 2 stem designs: short tapered stem versus standard-length tapered stem. Studies were selected by means of the following criteria: 1) study design: retrospective comparative studies, prospective comparative studies, RCTs; 2) study population: patients with total hip arthroplasty or hemiarthroplasty for hip disease or hip fracture; 3) intervention: short tapered stem and standard tapered stem; and 4) outcomes; thigh pain, other clinical results. RESULTS Among the 250 articles that were identified at the initial search, 6 studies, 4 RCTs and 2 retrospective comparative studies, were included in this meta-analysis. In the analysis of retrospective studies, the short tapered stem reduced the risk of thigh pain compared to the standard tapered stem (risk ratio [RR] = 0.13; 95% confidence interval [CI], 0.02-0.09; Z = -2.07; P = 0.039). However, in the analysis of RCTs, the incidence of thigh pain was similar between the two stem designs (RR = 1.21; 95% CI, 0.76-1.93; Z = 0.82; P = 0.410). Overall meta-analysis including all studies showed that the short tapered stem did not reduce the incidence of thigh pain compared to the standard-length tapered stem (RR = 0.91; 95% CI, 0.59-1.40; Z = -0.44, P = 0.663). CONCLUSIONS We did not find a significant difference in the incidence of thigh pain between short tapered stem and standard tapered stem in hip arthroplasty. TRIAL REGISTRATION PROSPERO Identifier: CRD42021231240.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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11
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Yang H, Kim K, Kim HS, Yoo JJ. Total Hip Arthroplasty Performed with a Novel Design Type 1 Femoral Stem: A Retrospective Minimum 5-Year Follow-up Study. Clin Orthop Surg 2022; 14:28-34. [PMID: 35251538 PMCID: PMC8858893 DOI: 10.4055/cios21048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/19/2021] [Accepted: 06/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background The Bencox M stem is a mid-short type 1 stem with additional unique design features. It has a reduced stem length and a lateral shoulder to facilitate minimally invasive surgery, as well as an angular lateral shoulder and a trapezoidal neck to minimize stem-liner impingement. There have been many mid-term reports on type 1 stems, but no results have been reported so far on this novel design type 1 femoral stem. This study presents the clinical and radiological outcomes of total hip arthroplasty performed with the M stem after a minimum 5-year follow-up. Methods From July 2014 to February 2015, 125 primary total hip arthroplasties using the M cementless femoral stem were performed on 112 patients in our hospital. Among them, 94 patients (106 hips) were eligible for the study and were followed up for more than 5 years. Our primary outcome was clinical results, which were evaluated by the Harris Hip Score (HHS), thigh pain, noise, and other complications. Secondary outcome was radiological outcomes. Seventy-seven hips were evaluated radiologically with attention to implant fixation, migration, loosening of component, degree of stress shielding, radiolucent lines, focal osteolysis, heterotopic ossification, and the evidence of impingement between the stem and liner. Results The average HHS improved from 54.6 points (range, 24–67 points) to 96.8 points (range, 91–100 points) at the latest follow-up. Three hips (2.8%) had intermittent thigh pain, which was tolerable without medication. Five hips (4.7%) had ceramic-related noise. There were no other complications such as infection, nerve injury, dislocation, or revision. All implants showed radiographic evidence of stable fixation by bone ingrowth without migration. Fifty-seven hips (74%) showed mild femoral stress shielding. Distal cortical hypertrophy was detected in 7 hips (9%), and heterotopic ossification was observed in 17 hips (22%). No implant demonstrated focal osteolysis and notching of the femoral neck or shoulder on radiographs. Conclusions The minimum 5-year results of total hip arthroplasty performed with the M cementless femoral stem were encouraging clinically and radiologically. A long-term follow-up will be necessary to evaluate its longevity.
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Affiliation(s)
- Hanbual Yang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Kangbaek Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hong Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Uçan V, Ezici V, Aliyev O, Uzer G, Tuncay İ, Yıldız F. Comparison of tapered-wedge short and standard-length femoral stems in single-stage bilateral direct anterior total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:3119-3127. [PMID: 34347131 DOI: 10.1007/s00264-021-05152-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/17/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was performed to compare short and standard-length tapered-wedge-type femoral stems in single-stage bilateral total hip arthroplasty (THA) through a direct anterior approach (DAA). MATERIALS AND METHODS The patients were divided into two groups according to their femoral stem types as short tapered-wedge stem and standard-length tapered-wedge stem groups. Outcome parameters were the surgical time, estimated blood loss (EBL), length of stay (LOS), thigh pain, Harris Hip Score (HHS), and visual analog scale (VAS) score clinically, and canal fill ratio (CFR), coronal plan alignment of the stems, subsidence, and postoperative leg length difference (LLD), radiologically. RESULTS The short-stem group and standard-length-stem group consisted of 20 patients (40 hips, mean age 52.0 ± 14.1) and 22 patients (44 hips, mean age 49.4 ± 11.9), respectively. There were no significant differences between the groups in terms of mean surgical times (p = 0.6), EBL (p = 0.2), LOS (p = 0.2), the rate of thigh pain (p = 0.4), improvements in HHS (p = 0.4) and VAS scores (p = 0.6), LLD (p = 0.3), amount of subsidence (p = 0.9), and varus or valgus misalignment (p = 0.7). The CFR at the level of the lesser trochanter was significantly higher in the short-stem group (0.79 ± 0.1) than the standard-length-stem group (0.73 ± 0.1) (p < 0.01). CONCLUSION In single-stage bilateral THA through DAA, short, tapered-wedge femoral stems provide similar radiographic and functional results to standard stems at short-term follow-up.
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Affiliation(s)
- Vahdet Uçan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - Volkan Ezici
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - Orkhan Aliyev
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - Gökçer Uzer
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - İbrahim Tuncay
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - Fatih Yıldız
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey.
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Crawford DA, Adams JB, Morris MJ, Berend KR, Lombardi AV. Distal femoral cortical hypertrophy not associated with thigh pain using a short stem femoral implant. Hip Int 2021; 31:722-728. [PMID: 32186204 DOI: 10.1177/1120700020913872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Thigh pain following a well-fixed total hip arthroplasty (THA) remains problematic and a source of patient dissatisfaction. The purpose of this study is to evaluate if the development of distal femoral cortical hypertrophy (DFCH) is associated with postoperative thigh pain after THA. METHODS All patients who underwent an uncomplicated primary THA via a direct anterior approach with the Taperloc Microplasty (Zimmer Biomet, Warsaw, IN, USA) implant between 2011 and 2015 were mailed a pain drawing questionnaire. Radiographs were reviewed at 1 year minimum to determine cortical thickness change from immediate post-op. Thigh pain was compared to DFCH. 293 patients were included in the study. RESULTS Mean follow-up was 3.2 years. A total of 218 hips (74%) had cortical hypertrophy in Gruen zone 3 and 165 hips (56%) had cortical hypertrophy in Gruen zone 5. 52 hips (18%) had ⩾25% cortical hypertrophy in zone 3 and 91 hips (31%) had ⩾25% cortical hypertrophy in zone 5. A total of 44 patients (15%) reported anterior thigh pain and 43 patients (15%) reported lateral thigh pain. Development of DFCH in either Gruen zone 3 or 5 was not associated with anterior or lateral thigh pain. Stem size was positively correlated with zone 3 hypertrophy and inversely related to zone 5 hypertrophy. Thigh pain was not associated with patient age, gender, activity level or stem size. CONCLUSIONS The development of distal femoral cortical hypertrophy after THA with a short stem implant was high, but not associated with patient-reported anterior or lateral thigh pain.
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Affiliation(s)
| | | | - Michael J Morris
- Joint Implant Surgeons, Inc., New Albany, OH, USA.,Mount Carmel Health System, New Albany, OH, USA
| | - Keith R Berend
- Joint Implant Surgeons, Inc., New Albany, OH, USA.,Mount Carmel Health System, New Albany, OH, USA
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc., New Albany, OH, USA.,Mount Carmel Health System, New Albany, OH, USA.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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14
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Tatani I, Solou K, Panagopoulos A, Lakoumentas J, Kouzelis A, Megas P. Short-term clinical and radiological results of two different design metaphyseal fitting femoral stems in total hip arthroplasty: a prospective, randomized trial. J Orthop Surg Res 2021; 16:316. [PMID: 34001204 PMCID: PMC8127309 DOI: 10.1186/s13018-021-02465-8] [Citation(s) in RCA: 2] [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: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 11/12/2022] Open
Abstract
Background There is great design variability on short femoral stems available on the market. This study aims to evaluate the short-term clinical and radiological results of two different design short femoral stems, both classified as shortened tapered stems. Methods From March 2016 to March 2018, a prospective, randomized, parallel-group design study was conducted to compare functional and radiological outcomes of 45 patients underwent THA using the Tri-Lock Bone Preservation Stem and 45 patients underwent THA with the Minima S stem at a minimum 2 years of follow-up. Patients were assessed clinically and radiographically prior to surgery as well as at 3, 6, 12, and 24 months postoperatively. Primary outcomes were the change in health-related quality of life assessed with Western Ontario and McMaster Universities Osteoarthritis Index and 36-Item Short Form Health Survey and also the incidence of all hip-related complications. Secondary aims included hip function evaluated with the Harris hip score, rates of patient satisfaction, and the outcomes of a detailed radiological analysis. Results There were no significant differences between the 2 study groups in terms of patient-reported outcomes measurements, satisfaction scores, and complication rates at any of the measurement times. In both groups, stable fixation and radiographic osseointegration were achieved. However, analysis of the calcar region showed that 57.8% and 28.9% of patients had grade 1 or 2 stress shielding, in Tri-Lock and Minima S implantation group, respectively (p=0.015). Regarding coronal alignment, stems were placed in slight varus, valgus, and neutral position in 51.1%, 13.3%, and 35.6% of patients, respectively, in Tri-Lock BPS group. The Minima S stem was implanted at slight varus and valgus in 60% and 40% of patients, respectively, and neither stem in the exact neutral position. Conclusions Both different design short femoral stems demonstrated excellent clinical performance at short-term follow up. Nevertheless, concerns were raised regarding the incidence of stress shielding phenomenon and mild discrepancies in coronal stem alignment during implantation. The clinical impact of these observations should be further evaluated through larger cohorts and longer follow-up. Trial registration ISRCTN registry, ISRCTN10096716. Registered on May 8, 2018—Retrospectively registered
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Affiliation(s)
- I Tatani
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece.
| | - K Solou
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece
| | - A Panagopoulos
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece
| | - J Lakoumentas
- Laboratory Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - A Kouzelis
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece
| | - P Megas
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece
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15
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Hamilton WG. CORR Insights®: No Clinically Important Differences in Thigh Pain or Bone Loss Between Short Stems and Conventional-length Stems in THA: A Randomized Clinical Trial. Clin Orthop Relat Res 2021; 479:778-780. [PMID: 33165047 PMCID: PMC8083832 DOI: 10.1097/corr.0000000000001567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 01/31/2023]
Affiliation(s)
- William G Hamilton
- W. G. Hamilton, Clinical Instructor, Anderson Orthopedic Research Institute, Alexandria, VA, USA
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16
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Won SH, Park JW, Lee YK, Ha YC, Koo KH. No Clinically Important Differences in Thigh Pain or Bone Loss Between Short Stems and Conventional-length Stems in THA: A Randomized Clinical Trial. Clin Orthop Relat Res 2021; 479:767-777. [PMID: 33009239 PMCID: PMC8083837 DOI: 10.1097/corr.0000000000001505] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/26/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Short-length stems were developed to reduce bone loss of the proximal femur and potentially decrease the incidence of thigh pain after cementless THA. However, it remains unknown whether short stems indeed reduce bone loss or the frequency of thigh pain. QUESTIONS/PURPOSES Is there a difference between short- and standard-length stems in terms of: (1) the frequency or severity of thigh pain, (2) modified Harris hip scores, (3) implant loosening, or (4) bone mineral density as measured by dual-energy x-ray absorptiometry? METHODS Between March 2013 and January 2014, three surgeons performed 205 primary THAs. To be eligible, patients needed to be at least 20 years of age, have not undergone previous history of hip surgery, and have no metabolic bone disease. A total of 100 patients were randomized to receive THA either with a short stem (n = 56) or with a standard-length stem (n = 44). Both stems were proximally coated, tapered, cementless stems. Compared with standard stems, short stems typically were 30- to 35-mm shorter. A total of 73% (41 of 56) and 77% (34 of 44) of those groups, respectively, were accounted for at a minimum of 5 years and were analyzed. The presence of thigh pain during activity was evaluated using a 10-point VAS, and the modified Harris hip score was calculated by research assistants who were blinded to the treatment groups. Plain radiographs were taken at 6 weeks, 6 months, and 12 months postoperatively, and every 1 year thereafter; loosening was defined as subsidence > 3 mm or a position change > 3° on serial radiographs. Radiological assessment was performed by two researchers who did not participate in the surgery and follow-up evaluations. Bone mineral density of the proximal femur was measured using dual-energy x-ray absorptiometry at 4 days, 1 year, 2 years, and 5 years postoperatively. The primary endpoint of our study was the incidence of thigh pain during 5-year follow-up. Our study was powered at 80% to detect a 10% difference in the proportion of patients reporting thigh pain at the level of 0.05. RESULTS With the numbers available, we found no difference between the groups in the proportion of patients with thigh pain; 16% (9 of 56) of patients in the short-stem group and 14% (6 of 44) of patients in the standard-stem group experienced thigh pain during the follow-up period (p = 0.79). In all patients, the pain was mild or moderate (VAS score of 4 or 6 points). Among the 15 available patients who reported thigh pain, there was no difference between the implant groups in mean severity of thigh pain (4.3 ± 0.8 versus 4.2 ± 0.7; p = 0.78). There were no between-group differences in the short versus standard-length stem groups in terms of mean modified Harris hip score by 5 years after surgery (89 ± 13 versus 95 ± 7 points; p = 0.06). No implant was loose and no hip underwent revision in either group. Patients in the short-stem group showed a slightly smaller decrease in bone mineral density in Gruen Zones 2, 3, and 5 than those in the standard-stem group did; the magnitude of the difference seems unlikely to be clinically important. CONCLUSION We found no clinically important differences (and few differences overall) between short and standard-length THA stems 5 years after surgery in a randomized trial. Consequently, we recommend that clinicians use standard-length stems in general practice because standard-length stems have a much longer published track record in other studies, and short stems can expose patients to the uncertainty associated with novelty, without any apparent offsetting benefit. LEVEL OF EVIDENCE Level I, therapeutic study.
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MESH Headings
- Absorptiometry, Photon
- Adult
- Arthralgia/diagnosis
- Arthralgia/etiology
- Arthralgia/physiopathology
- Arthralgia/prevention & control
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/instrumentation
- Biomechanical Phenomena
- Bone Density
- Female
- Hip Joint/diagnostic imaging
- Hip Joint/physiopathology
- Hip Joint/surgery
- Hip Prosthesis
- Humans
- Male
- Middle Aged
- Osteoporosis/diagnostic imaging
- Osteoporosis/etiology
- Osteoporosis/physiopathology
- Osteoporosis/prevention & control
- Pain Measurement
- Pain Threshold
- Pain, Postoperative/diagnosis
- Pain, Postoperative/etiology
- Pain, Postoperative/physiopathology
- Pain, Postoperative/prevention & control
- Prosthesis Design
- Range of Motion, Articular
- Recovery of Function
- Republic of Korea
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Seok-Hyung Won
- S.-H. Won, Y.-K. Lee, K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- J.-W. Park, Y.-C. Ha, Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
- K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Wee Park
- S.-H. Won, Y.-K. Lee, K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- J.-W. Park, Y.-C. Ha, Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
- K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Young-Kyun Lee
- S.-H. Won, Y.-K. Lee, K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- J.-W. Park, Y.-C. Ha, Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
- K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Yong-Chan Ha
- S.-H. Won, Y.-K. Lee, K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- J.-W. Park, Y.-C. Ha, Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
- K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- S.-H. Won, Y.-K. Lee, K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- J.-W. Park, Y.-C. Ha, Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
- K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, 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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18
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Pons-Cabrafiga M, Arias de la Torre J, Berlanga-de-Mingo D, Lobo-Escolar L. Is diaphyseal fixation of short neck-retaining stem prostheses related to the size of the implant? Hip Int 2021; 31:196-200. [PMID: 32538203 DOI: 10.1177/1120700020932937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Short-stem hip prostheses present variable proximal femoral bone radiological findings. The aims of this study were to analyse, in our patients with implanted collum femoris-preserving (CFP) stems, cancellous bone remodelling, cortical distal hypertrophy and pedestal formation, and the relationship between those radiological changes that suggest distal fixation with the size of the stem. METHODS From October 2001 to December 2012 a total of 199 consecutive primary total hip arthroplasties in 180 patients were performed at our department using the CFP stem and followed up for a minimum of 5 years until December 2017. RESULTS Stress shielding was present in 74% of oversized stems cases, but in normal or undersized stems, stress shielding was present in 8.5%. Cortical hyperthrophy was observed in 49% of the oversized stems and in 6% of the normal or undersized ones. Finally, non-statistically significant differences (p = 0.089) in pedestal formation were found, present in 16.3% of the oversized stems and in 6% of normal or undersized ones. CONCLUSIONS Oversized stems cause more stress shielding and distal cortical hypertrophy in the distal part of the stem, which indicates distal fixation in bigger sizes of stem.
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19
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Yoshitani J, Kabata T, Kajino Y, Ohmori T, Ueno T, Ueoka K, Tsuchiya H. The use of density mapping in the analysis of thigh pain after total hip arthroplasty in patients with well-fixed tapered wedge stems. J Orthop Surg (Hong Kong) 2021; 28:2309499020930306. [PMID: 32529916 DOI: 10.1177/2309499020930306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The mechanisms underlying thigh pain in patients with well-fixed cementless femoral components after total hip arthroplasty (THA) remains unclear. We hypothesized that the thigh pain is correlated with the initial contact state of the stem and aimed to investigate the relation between thigh pain and the initial contact state. MATERIALS AND METHODS A total of 209 hips of 184 patients were analysed in this retrospective case-control study. The patients were divided into a thigh pain group (n = 13 hips) and a control group (without thigh pain, n = 196). Post-operative stem contact images were three-dimensionally visualized by a density mapping function using computed tomography data, which quantified the stem contact area according to Gruen zones. Thigh pain was defined as anterior or anterolateral pain upon loading at 3-month post-operatively. RESULTS Thirteen hips (6.2%) had thigh pain; however, all the hips demonstrated stable bony ingrowth radiographically. The thigh pain group had a significantly lower contact area in zone 2 (p = 0.014). The multivariate logistic regression analysis showed that the contact area of zone 2 was negatively correlated with thigh pain [odds ratio (OR): 0.858, p = 0.018], and the canal flare index was negatively correlated with the development of thigh pain (OR: 0.336, p = 0.026). CONCLUSIONS We identified an association between the initial contact state and post-operative thigh pain. Our data demonstrated that proper lateral contact prevents the occurrence of thigh pain in THA using a tapered wedge stem.
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Affiliation(s)
- Junya Yoshitani
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Takaaki Ohmori
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Takuro Ueno
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Ken Ueoka
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
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20
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Pardo F, Bordini B, Castagnini F, Giardina F, Faldini C, Traina F. Are powder-technology-built stems safe? A midterm follow-up registry study. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:10. [PMID: 33471238 PMCID: PMC7817598 DOI: 10.1007/s10856-020-06481-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Powder technology was developed to bring together the mechanical features and high porosity of titanium. However, the high porosity may theoretically compromise mechanical resistance. Literature is deficient about the use and safety profile of cementless femoral implants built using additive manufacturing (in particular electron beam melting technology, EBM). The purpose of this study was to evaluate the survival rates and the reason for revisions (especially implant breakage) of the first two EBM-built stems at a mid-term follow-up, using a joint arthroplasty registry. METHODS The registry of Prosthetic Orthopedic Implant (RIPO) was investigated about cementless stems implanted from 2010 to 2017. Stems built with EBM technology (Parva and Pulchra stems; Adler Ortho, Milan, Italy) were compared to all the other cementless stems implanted during the same period, acting as control group. The survival rates and reasons for revision were assessed. RESULTS No stem breakage occurred. At 5-year follow-up, the survival rates of the two cohorts were not statistically different (96.8% EBM stems, 98.0% standard cementless stems; p > 0.05). In the EBM stems, aseptic loosening occurred in 1.7% of the cases at the latest follow-up. CONCLUSIONS This large cohort showed that mechanical resistance is not a concern in EBM stems at mid-term follow-up. However, larger populations and longer follow-ups are needed to further validate these results.
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Affiliation(s)
- Francesco Pardo
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
| | - Federico Giardina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
| | - Cesare Faldini
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
- DIBINEM, University of Bologna, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
- DIBINEM, University of Bologna, Bologna, Italy
- University of Messina, Messina, Italy
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21
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Chen Z, Li B, Chen K, Feng J, Wang Y, Liu Z, He C. Malalignment and distal contact of short tapered stems could be associated with postoperative thigh pain in primary total hip arthroplasty. J Orthop Surg Res 2021; 16:67. [PMID: 33468189 PMCID: PMC7816452 DOI: 10.1186/s13018-021-02215-w] [Citation(s) in RCA: 2] [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: 12/07/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Short tapered stem placement has been extensively employed in total hip arthroplasty (THA). Suboptimal fixation tends to cause postoperative complications, such as thigh pain. However, it remains unclear whether poor seating/alignment of short tapered stems contributes to thigh pain. In this study, we retrospectively examined the factors that might be associated with thigh pain. METHODS Medical records of 230 patients who had undergone THAs at our hospital were reviewed retrospectively. All patients received the same mediolateral (ML) short tapered femoral stems. The association between thigh pain and patients' demographics, radiographic findings, or the type of fitting of the femoral stems was investigated. RESULTS In our cohort, 68 patients (27.8%) presented with thigh pain. Among 203 type I fit patients, 62 (30.5%) developed thigh pain, while only 6 out of 43 (12.2%) type II fit patients had thigh pain, with the differences being statistically significant (x2 = 6.706, p = 0.01). In addition, hip anteroposterior radiographs exhibited that the stem angulation (mean 2.52°), the variation in angulation (mean 1.32°), and the extent of femoral stem subsidence (mean 0.29 cm) were greater in patients with thigh pain than in their counterparts without thigh pain (all p < 0.05). CONCLUSION Malalignment and improper seating of short tapered stems could be at least one of the reasons for post-THA thigh pain. The distal contact between the stem tip and the medial femoral cortex might result in thigh pain. Our study suggested that distal implant contact should be avoided, and stem alignment should be meticulously performed in the placement of ML short tapered femoral stems for THA.
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Affiliation(s)
- Zhijie Chen
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Bin Li
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Kaizhe Chen
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Jianmin Feng
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Yi Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Zhihong Liu
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Chuan He
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China.
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Buttaro MA, Slullitel PA, Oñativia JI, Nally F, Andreoli M, Salcedo R, Comba FM, Piccaluga F. 4- to 8-year complication analysis of 2 'partial collum' femoral stems in primary THA. Hip Int 2021; 31:75-82. [PMID: 31558044 DOI: 10.1177/1120700019879360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Compare the clinical and radiological outcome of CFP stem with the MiniHip design in a prospective series, with special interest in intraoperative periprosthetic fracture (IPPF). METHODS We prospectively followed 101 cases treated with the MiniHip stem (Group 1) and 89 with the CFP stem (Group 2) operated between 2010 and 2014. No significant demographic differences were observed between both groups. Median follow-up was 72 months. Average stem length was 41% shorter in the MiniHip group (p < 0.001). Radiological parameters were measured and a logistcic regression model was created to evaluate factors associated with IPPF. RESULTS Mean mHHS improved from 54 to 95 in the MiniHip group (p < 0.001) and from 64 to 98 in the CFP group (p < 0.001). No significant differences were observed in terms of loosening, infection or instability. We observed 7 IPPFs (3.68%), 3 in group 1 and 4 in group 2. After adjusting for confounders, CFP was not associated with a greater risk of IPPF (OR 3.23; 95% CI, 0.250-42.034, p = 0.368), however, a more complex fracture pattern was observed with this stem design. Prior acetabular fractures were associated with IPPF (OR 66.85; 95% CI, 1.142-3911, p = 0.043). Compared to Dorr A femurs, type Dorr B appeared protective against IPPF (OR 0.039; 95% CI, 0.001-1.109, p = 0.058). Valgus alignment tended to increase the risk of IPPF (OR 20.59; 95% CI 0.870-487.221, p = 0.061). CONCLUSIONS MiniHip showed similar radiological outcomes to CFP at short- to mid-term follow-up without increasing IPPFs with a shorter stem length. Given that CFP produced a more complex IPPF pattern, surgeons should be cautious with alignment of this particular design, especially in Dorr A femur.
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Affiliation(s)
- Martin A Buttaro
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Pablo A Slullitel
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - José I Oñativia
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Nally
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Mauro Andreoli
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Salcedo
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Fernando M Comba
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Piccaluga
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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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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Abstract
AIMS Short, bone-conserving femoral components are increasingly used in total hip arthroplasty (THA). They are expected to allow tissue-conserving implantation and to render future revision surgery more straightforward but the long-term data on such components is limited. One such component is the global tissue-sparing (GTS) stem. Following the model for stepwise introduction of new orthopaedic implants, we evaluated early implant fixation and clinical outcome of this novel short-stem THA and compared it to that of a component with established good long-term clinical outcome. METHODS In total, 50 consecutive patients ≤ 70 years old with end-stage symptomatic osteo-arthritis were randomized to receive THA with the GTS stem or the conventional Taperloc stem using the anterior supine intermuscular approach by two experienced hip surgeons in two hospitals in the Netherlands. Primary outcome was implant migration. Patients were followed using routine clinical examination, patient reported outcome using Harris Hip Score (HHS), Hip Disability And Osteoarthritis Outcome Score (HOOS), EuroQol five-dimension questionnaire (EQ5D), and Roentgen Stereophotogrammetric Analysis (RSA) at three, six, 12, and 24 months. This study evaluated the two-year follow-up results. RESULTS In addition to the initial migration pattern of distal migration (subsidence, Y-translation) and retroversion (Y-rotation) also exhibited by the Taperloc stem, the GTS stem showed an initial migration pattern of varization (X-translation combined with Z-rotation) and posterior translation (Z-translation). However, all components stabilized aside from one Taperloc stem which became loose secondary to malposition and was later revised. Clinical outcomes and complications were not statistically significantly different with the numbers available. CONCLUSION A substantially different and more extensive initial migration pattern was seen for the GTS stem compared to the Taperloc stem. Although implant stabilization was achieved, excellent long-term survival similar to that of the Taperloc stem should not be inferred. Especially in the absence of clinically proven relevant improvement, widespread usage should be postponed until long-term safety has been established. Cite this article: Bone Joint J 2020;102-B(6):699-708.
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Affiliation(s)
- Marc J Nieuwenhuijse
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Stephan B W Vehmeijer
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Nina M C Mathijsen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Stefan B Keizer
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
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Granger L, Bankes M, Sandiford NA. Cortical Strut Graft for Enigmatic Thigh Pain in Uncemented Total Hip Replacement. Cureus 2020; 12:e8233. [PMID: 32582493 PMCID: PMC7306660 DOI: 10.7759/cureus.8233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims Enigmatic thigh pain in uncemented femoral components of a total hip replacement can be severe and disabling. Treatment can be conservative or surgical with cortical strut graft or revision of the femoral stem. Cortical strut grafting may offer good results with reduced morbidity. The aim of this study was to report the functional and radiographic outcomes of four patients with enigmatic thigh pain treated with cortical strut allograft. Materials and Methods Between 2016 and 2018, four women underwent cortical strut allografting at two centres. All patients had an uncemented, proximally porous S-ROM femoral implant (DePuy, Warsaw, In, USA). All other causes of anterolateral thigh pain were excluded. The mean age was 36.7 years (range: 29-51 years). Patients were followed up for a minimum of 14 months (range: 14-38 months). The University of California, Los Angles (UCLA) activity score, pain scores, complications, and radiographs at six weeks, three months, six months, nine months and one year were recorded. Results Mean UCLA activity scores increased from 3.2 (range: 2-4) to 6.2 (range: 6-7) post-operatively. Radiologically, all four patients had complete osseointegration of their strut grafts. Pain scores decreased at six weeks and at six months. One deep venous thrombosis occurred. One patient experienced recurrence of anterolateral thigh pain 26 months post-strut graft, which resolved with protected weight-bearing and analgesia for three months. Conclusions In uncemented femoral prostheses, cortical strut grafting to treat enigmatic thigh pain can reduce symptoms and increase activity without the need to revise a well-fixed femoral stem. We add to the growing body of evidence that this can be a successful surgical technique.
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Affiliation(s)
- Luke Granger
- Orthopaedics, Leicester Orthopaedic Rotation (East Midlands South), Leicester, GBR
| | - Marcus Bankes
- Trauma and Orthopaedics, Guy's and St Thomas' Hospital, London, GBR
| | - Nemandra A Sandiford
- Joint Reconstruction Unit (Hip and Knee), Southland Teaching Hospital, Invercargill, NZL
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Chanda S, Mukherjee K, Gupta S, Pratihar DK. A comparative assessment of two designs of hip stem using rule-based simulation of combined osseointegration and remodelling. Proc Inst Mech Eng H 2019; 234:118-128. [DOI: 10.1177/0954411919890998] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The stem–bone interface of cementless total hip arthroplasty undergoes an adaptive process of bone ingrowth until the two parts become osseointegrated. Another important phenomenon associated with aseptic loosening of hip stem is stress-shielding induced adverse bone remodelling. The objective of this study was to preclinically assess the relative performances of two distinct designs of hip stems by addressing the combined effect of bone remodelling and osseointegration, based on certain rule-based criteria obtained from the literature. Premised upon non-linear finite element analyses of patient-specific implanted femur models, the study attempts to ascertain in silico outcome of the hip stem designs based on an evolutionary interfacial condition, and to further comment on the efficacy of the rule-based technique on the prediction of peri-prosthetic osseointegration. One of the two hip stem models was a trade-off design obtained from an earlier shape optimization study, and the other was based on TriLock stem (DePuy). Both designs predicted similar long-term osseointegration (∼89% surface), although trade-off stem predicted higher post-operative osseointegration. Proximal bone resorption was found higher for TriLock (by ∼110%) as compared to trade-off model. The rule-based technique predicted clinically coherent osseointegration around both stems and appears to be an alternative to expensive mechanobiology-based schemes.
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Affiliation(s)
- Souptick Chanda
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, India
| | - Kaushik Mukherjee
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Sanjay Gupta
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Dilip Kumar Pratihar
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
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Nahas S, Patel A, Blucher N, Vedi V. Independent assessment and outcomes of 196 short-tapered stems short-term follow-up and review of the literature. J Orthop Surg (Hong Kong) 2019; 26:2309499018812236. [PMID: 30453838 DOI: 10.1177/2309499018812236] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Longer term outcome data are now becoming available for short-tapered femoral stems for cementless total hip arthroplasty. The shorter stem has a metaphyseal fit, loading the bone in this area, leading to physiological bone remodelling. It is also bone preserving, as it is 35 mm shorter. It may be easier to insert through a smaller incision and potentially reduce complication rates. We present a retrospective single surgeon case series of 196 patients (>53% follow-up over 5 years). All patients had the cementless 'Microplasty Taperloc' (Biomet). Primary outcome measures were femoral component revision rates. Secondary outcome measures included complications, patient-reported functional outcome scores (Oxford hip) and radiographic evidence of loosening. METHODS: Patients were identified using electronic software. All were routinely followed up and assessed in clinic since implant introduction in 2009. Oxford hip scores were routinely obtained. A surgeon who had not carried out the procedure independently assessed radiographs. RESULTS: One hundred ninety-six patients were identified. The revision rate was 0.5% due to an intraoperative peri-prosthetic fracture of the femur identified on post-operative radiograph. The complication rate was 2%, attributable to: subsidence of the prosthesis (one hip), post-operative dislocation (two hips), one of which required acetabular revision. Oxford hip scores increased on average from 21 to 45 (pre- to post-operatively). There were no signs of radiographic loosening. CONCLUSION: The results show that using the short-tapered stem is proving so far to be a reliable and safe alternative to its longer counterpart, with low complication rates in the short term.
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Jacquel A, Le Viguelloux A, Valluy J, Saffarini M, Bonin N. A shortened uncemented stem offers comparable positioning and increased metaphyseal fill compared to a standard uncemented stem. J Exp Orthop 2019; 6:28. [PMID: 31240502 PMCID: PMC6593034 DOI: 10.1186/s40634-019-0197-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/14/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Shortened stems are increasingly used in uncemented total hip arthroplasty (THA) as they represent a compromise between the metaphyseal anchorage of short stems and the facilitated axial alignment of standard stems. The purpose of this study was to compare the metaphyseal canal-fill ratio (CFR) and axial alignment of a shortened double-tapered stem with those of a standard stem. The hypothesis was that the shortened stem would achieve greater metaphyseal fill and comparable axial alignment. METHODS The authors reviewed routine follow-up anteroposterior radiographs taken 2 months after THA to evaluate metaphyseal fill and axial alignment of a shortened stem (n = 96) and a standard stem (n = 101). The CFR was calculated at the level of the tip and superior margin of the lesser trochanter. Stem alignment was defined as the angle between the stem axis and the proximal anatomic femoral axis. Stems were classified as being in varus or valgus alignment if they deviated by more than 3° from the anatomic axis of the femur. RESULTS Hips implanted with shortened and standard stems had comparable demographics and axial alignment (1.1° ± 1.7° vs 0.8° ± 1.2°; p = 0.331). However, varus alignment was observed in 5% of shortened stems compared to only 1% of standard stems, though this difference was not significant (p = 0.111). The femoral CFR was greater using shortened stems than using standard stems, both at the level of the tip of the lesser trochanter (0.91 ± 0.05 vs 0.85 ± 0.08; p < 0.001) and at its superior margin (0.76 ± 0.06 vs 0.72 ± 0.07; p < 0.001). CONCLUSIONS Compared to the standard stem, the shortened stem had increased metaphyseal filling and equivalent alignment. These findings suggest that shortened stems could provide adequate metaphyseal fixation and correct alignment. Further studies remain necessary to evaluate how shortened stems perform in terms of osseointegration, clinical outcomes and survival.
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Affiliation(s)
- Alexandre Jacquel
- Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon-Ortho-Clinic, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Augustin Le Viguelloux
- Centre Hospitalier William Morey, 4 Rue Capitaine Drillien, 71100, Chalon Sur Saône, France
| | - Jeremy Valluy
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland
| | - Mo Saffarini
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland.
| | - Nicolas Bonin
- Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon-Ortho-Clinic, 8 Avenue Ben Gourion, 69009, Lyon, France
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29
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Tatani I, Panagopoulos A, Diamantakos I, Sakellaropoulos G, Pantelakis S, Megas P. Comparison of two metaphyseal-fitting (short) femoral stems in primary total hip arthroplasty: study protocol for a prospective randomized clinical trial with additional biomechanical testing and finite element analysis. Trials 2019; 20:359. [PMID: 31208433 PMCID: PMC6580512 DOI: 10.1186/s13063-019-3445-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 05/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Total hip replacement has recently followed a progressive evolution towards principles of bone- and soft-tissue-sparing surgery. Regarding femoral implants, different stem designs have been developed as an alternative to conventional stems, and there is a renewed interest towards short versions of uncemented femoral implants. Based on both experimental testing and finite element modeling, the proposed study has been designed to compare the biomechanical properties and clinical performance of the newly introduced short-stem Minima S, for which clinical data are lacking with an older generation stem, the Trilock Bone Preservation Stem with an established performance record in short to midterm follow-up. METHODS/DESIGN In the experimental study, the transmission of forces as measured by cortical surface-strain distribution in the proximal femur will be evaluated using digital image correlation (DIC), first on the non-implanted femur and then on the implanted stems. Finite element parametric models of the bone, the stem and their interface will be also developed. Finite element predictions of surface strains in implanted composite femurs, after being validated against biomechanical testing measurements, will be used to assist the comparison of the stems by deriving important data on the developed stress and strain fields, which cannot be measured through biomechanical testing. Finally, a prospective randomized comparative clinical study between these two stems will be also conducted to determine (1) their clinical performance up to 2 years' follow-up using clinical scores and gait analysis (2) stem fixation and remodeling using a detailed radiographic analysis and (3) incidence and types of complications. DISCUSSION Our study would be the first that compares not only the clinical and radiological outcome but also the biomechanical properties of two differently designed femoral implants that are theoretically classified in the same main category of cervico-metaphyseal-diaphyseal short stems. We can hypothesize that even these subtle variations in geometric design between these two stems may create different loading characteristics and thus dissimilar biomechanical behaviors, which in turn could have an influence to their clinical performance. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number, ID: ISRCTN10096716 . Retrospectively registered on May 8 2018.
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Affiliation(s)
- I Tatani
- Orthopaedic Department, University Hospital of Patras, Patras, Greece
| | - A Panagopoulos
- Orthopaedic Department, University Hospital of Patras, Patras, Greece.
| | - I Diamantakos
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
| | - G Sakellaropoulos
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Sp Pantelakis
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
| | - P Megas
- Orthopaedic Department, University Hospital of Patras, Patras, Greece
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Innmann MM, Weishorn J, Bruckner T, Streit MR, Walker T, Gotterbarm T, Merle C, Maier MW. Fifty-six percent of proximal femoral cortical hypertrophies 6 to 10 years after Total hip arthroplasty with a short Cementless curved hip stem - a cause for concern? BMC Musculoskelet Disord 2019; 20:261. [PMID: 31142303 PMCID: PMC6542080 DOI: 10.1186/s12891-019-2645-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/20/2019] [Indexed: 01/24/2023] Open
Abstract
Background Thigh pain and cortical hypertrophies (CH) have been reported in the short term for specific short hip stem designs. The purpose of the study was to investigate 1) the differences in clinical outcome, thigh pain and stem survival for patients with and without CHs and 2) to identify patient and surgery-related factors being associated with the development of CHs. Methods A consecutive series of 233 patients with 246 hips was included in the present retrospective diagnostic cohort study, who had received a total hip arthroplasty (THA) between December 2007 and 2009 with a cementless, curved, short hip stem (Fitmore, Zimmer, Warsaw, IN, USA). Clinical and radiographic follow-up, including the radiographic parameters for hip geometry reconstruction, were prospectively assessed 1, 3, and 6 to 10 years after surgery. Results Cortical hypertrophies were observed in 56% of the hips after a mean of 7.7 years, compared to 53% after 3.3 years being mostly located in Gruen zone 3 and 5. There was no significant difference for the Harris Hip Score and UCLA score for patients with and without CHs. Only one patient with a mild CH in Gruen zone 5 and extensive heterotopic ossifications around the neck of the stem reported thigh pain. The Kaplan Meier survival rate after 8.6 years was 99.6% (95%-CI; 97.1–99.9%) for stem revision due to aseptic loosening and no association with CHs could be detected. Postoperative increase in hip offset was the only risk factor being associated with the development of CHs in the regression model (ΔHO; OR 1.1 (1.0–1.2); p = 0.001). Conclusions The percentage of cortical hypertrophies remained almost constant in the mid-term compared to the short-term with the present cementless short hip stem design. The high percentage of cortical hypertrophies seems not be a cause for concern with this specific implant in the mid-term. Level of evidence Diagnostic Level IV
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Affiliation(s)
- Moritz M Innmann
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Johannes Weishorn
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Marcus R Streit
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tilman Walker
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Gotterbarm
- Department of Orthopaedic and Trauma Surgery, Kepler University Hospital, Med Campus III Krankenhausstraße 9, 4021, Linz, Austria
| | - Christian Merle
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Michael W Maier
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Abstract
AIMS Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components. MATERIALS AND METHODS A literature review was performed using the EMBASE, Medline, and Cochrane databases. Strict inclusion and exclusion criteria were used to identify studies reporting clinical and radiological follow-up for short-stemmed hip arthroplasties. RESULTS A total of 28 studies were eligible for inclusion. This included 5322 hips in 4657 patients with a mean age of 59 years (13 to 94). The mean follow-up was 6.1 years (0.5 to 20). The mean Harris Hip Score improved from 46 (0 to 100) to 92 (39 to 100). The mean Oxford Hip Score improved from 25 (2 to 42.5) to 35 (12.4 to 48). The mean Western Ontario & McMaster Universities Osteoarthritis Index improved from 54 (2 to 95) to 22 (0 to 98). Components were aligned in a neutral coronal alignment in up to 90.9% of cases. A total of 15 studies reported component survivorship, which was 98.6% (92% to 100%) at a mean follow-up of 12.1 years. CONCLUSION Short-stemmed femoral implants show similar improvement in clinical and radiological outcomes compared with conventional length implants. Only mid-term survivorship, however, is known. An abundance of short components have been developed and used commercially without staged clinical trials. Long-term survival is still unknown for many of these components. There remains tension between innovation and the moral duty to ensure that the introduction of new implants is controlled until safety and patient benefit are demonstrated. Implant innovation and subsequent use should be driven by proven clinical outcomes, rather than market and financial forces, and ethical practice must be ensured. Cite this article: Bone Joint J 2019;101-B:502-511.
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Affiliation(s)
- S Lidder
- Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Australia
| | - D J Epstein
- Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Australia
| | - G Scott
- Bone and Joint Research Unit, The Royal London Hospital, London, UK
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Lee SJ, Yoon KS. Favorable Functional Recovery and Stem Stability after Hip Arthroplasty with a Short Metaphyseal Stem in Elderly Patients with Osteoporotic Femoral Neck Fractures. Hip Pelvis 2019; 31:11-17. [PMID: 30899710 PMCID: PMC6414405 DOI: 10.5371/hp.2019.31.1.11] [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] [Received: 11/15/2018] [Revised: 01/06/2019] [Accepted: 01/28/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Short stems have recently become widely used; however, concerns about the initial secure fixation of a short stem in osteoporotic bone remain. The aim of this study was to evaluate the short-term clinical and radiological results of using a short cementless metaphyseal stabilizing tapered stem for senile osteoporotic femoral neck fractures. Materials and Methods Thirty-eight arthroplasties (31 bipolar hemiarthroplasties and 7 total hip arthroplasties) were performed for osteoporotic femoral neck fractures in patients older than 65 years (10 males and 28 females). The mean age was 76.1 years and the mean follow-up was 2.9 years. We retrospectively evaluated clinical results, focusing on walking performance, thigh pain, and radiologic results, with special regard to signs of stem stability and osteointegration. Results Mean Harris hip score was 84.3 points and 68.4% of patients regained their preoperative walking performance. No patients complained about thigh pain. No osteolysis or loosening was observed during the follow-up, and all but 1 stem showed signs of stable bone ingrowth. Conclusion Short, metaphyseal stabilizing tapered stems could be a reliable treatment option for osteoporotic femoral neck fractures.
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Affiliation(s)
- Soong Joon Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Slullitel PA, Oñativia JI, Llano L, Comba F, Zanotti G, Piccaluga F, Buttaro MA. Periprosthetic stress fracture around a well-fixed type 2B short uncemented stem. SICOT J 2018; 4:33. [PMID: 30058529 PMCID: PMC6065269 DOI: 10.1051/sicotj/2018031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/21/2018] [Indexed: 12/16/2022] Open
Abstract
Despite the theoretical advantages of uncemented short stems, postoperative thigh pain is still matter of concern and can be attributed to different causes. We report a peculiar case of a stress fracture around a short cementless stem with cervico-metaphyseal fixation in an otherwise healthy patient. We implanted a MiniHipTM stem in a 43 year-old male professional golf player for the treatment of primary osteoarthritis using a ceramic on ceramic bearing. Against medical advice, the patient started to play soccer at the 4th postoperative month and was completely asymptomatic to that extent; but at 8 months follow-up and without a history of trauma he started complaining about progressive hip pain. After ruling out infection and loosening, histological analysis from a bone biopsy confirmed the diagnosis of stress fracture. Although revision surgery was initially scheduled, pain started to decrease gradually with protected weight-bearing (crutches) and disappeared around the first postoperative year, remaining the patient asymptomatic at 2 and half years of follow-up, with radiographs depicting a healed fracture with a hypertrophic callus. We encourage surgeons to be aware of the existence of periprosthetic stress fractures as a source of thigh pain (sometimes intractable), and despite being infrequent, they should always be contemplated, providing that these cases can be managed conservatively with rest and limited weight-bearing. After this uncommon case, we suggest to align the stem in order to equally distribute loads onto the medial calcar and the lateral femoral cortical.
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Affiliation(s)
- Pablo Ariel Slullitel
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Jose Ignacio Oñativia
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Lionel Llano
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Fernando Comba
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gerardo Zanotti
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Piccaluga
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Martin Alejandro Buttaro
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Giardina F, Castagnini F, Stea S, Bordini B, Montalti M, Toni A. Short Stems Versus Conventional Stems in Cementless Total Hip Arthroplasty: A Long-Term Registry Study. J Arthroplasty 2018; 33:1794-1799. [PMID: 29395723 DOI: 10.1016/j.arth.2018.01.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/26/2017] [Accepted: 01/05/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Short stems in total hip arthroplasty (THA) have recently gained increasing popularity, allowing mini-invasive exposures and bone-sparing approaches. However, long-term studies and recommendations for the routine use are not available. The aim of this report was to compare the survival rates and the reasons for revision of short stems versus conventional stems in cementless THAs, in a registry-based population. METHODS The Registry of Prosthetic Orthopedic Implants (RIPO) was inquired about cementless THAs performed since 2000 to 2016. The stems were divided into short (<12 cm) and conventional ones, and then, classified according to the classification by Feyen and Shimmin: short stems with neck-retaining osteotomy (group A: 1684 hips), short stems with standard osteotomy (group B: 2727 THAs), and conventional stems (group C: 57,359 cases). Demographics, survivorships, and reasons for revision were investigated and compared. RESULTS Short stems were preferentially implanted in younger patients and normal morphologies. Short and conventional stems showed comparable survival rates at long-term follow-up (>90% at 15 years). The rates of stem aseptic loosening, intraoperative fractures, and periprosthetic fractures were similar in the 3 groups. Group B had higher rates of revisions due to primary instability (early dislocations and impingement-related events; P < .05). Revisions due to pain were nonsignificantly higher in group B. CONCLUSION Short stems are reliable implants at long-term follow-up. The comparison with conventional stems showed no additional risk of premature aseptic loosening and intraoperative and periprosthetic fractures. However, the high rate of revisions due to pain and, mostly, primary instability should be investigated in clinical trials.
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Affiliation(s)
- Federico Giardina
- Hip and Knee Surgery Department, Rizzoli Orthopedic Institute, Bologna, Italy
| | | | - Susanna Stea
- Medical Technology Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Maurizio Montalti
- Hip and Knee Surgery Department, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Aldo Toni
- Hip and Knee Surgery Department, Rizzoli Orthopedic Institute, Bologna, Italy
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Abstract
Over the last two decades, several conservative femoral prostheses have been designed. The goals of conservative stems include: the spearing of the trochanteric bone stock; a more physiological loading in the proximal femur reducing the risk of stress shielding; and to avoid a long stem into the diaphysis preventing impingement with the femoral cortex and thigh pain. All stems designed to be less invasive than conventional uncemented stems are commonly named ‘short stems’. However, this term is misleading because it refers to a heterogeneous group of stems deeply different in terms of design, biomechanics and bearing. In the short-term follow-up, all conservative stems provided excellent survivorship. However, variable rates of complications were reported, including stem malalignment, incorrect stem sizing and intra-operative fracture. Radiostereometric analysis (RSA) studies demonstrated that some conservative stems were affected by an early slight migration and rotation within the first months after surgery, followed by a secondary stable fixation. Dual-energy x-ray absorptiometry (DEXA) studies demonstrated an implant-specific pattern of bone remodelling. Although the vast majority of stems demonstrated a good osseointegration, some prostheses transferred loads particularly to the lateral and distal-medial regions, favouring proximal stress shielding and bone atrophy in the great trochanter and calcar regions.
Cite this article: EFORT Open Rev 2018;3:149-159. DOI: 10.1302/2058-5241.3.170052
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Italy; Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Italy
| | - Guido Grappiolo
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Italy
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Epinette JA, Brax M, Chammaï Y. A predictive radiological analysis of short stems versus both shortened and long stems in primary hip replacement: A case-control study of 100 cases of Metha versus ABG II and Omnifit HA at 2-8years' follow-up. Orthop Traumatol Surg Res 2017; 103:981-986. [PMID: 28899823 DOI: 10.1016/j.otsr.2017.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/21/2017] [Accepted: 07/31/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Short hip stems, intended to conserve bone stock and ensure a more physiological distribution of stress in the femur under loading, are meeting with renewed interest. Radiologic semiology is not known exactly, particularly in relation to conventional implants; we therefore conducted a case-control study of 3 types of implant differing only in stem length: short, shortened or long. The aim was: (1) to compare radiographic aspects, (2) to attempt to systematize medium-term radiologic status for the 3 types, and (3) to assess the impact of radiographic aspect on loosening and revision rates. HYPOTHESIS The short Metha stem is better adapted to the recipient bone than longer stems, without sacrificing stability. MATERIAL AND METHODS A prospective series comprising the first 100 selected cases of hip replacement using the short Metha stem was compared to two other series of 100 "long" (Omnifit HA) and 100 "shortened" (ABG II) stems at comparable follow-up: 4.05±1.44years (range: 2-8years) for Metha, 4.48±0.97years (range: 2-8years) for Omnifit, and 4.75±2.07years (range: 2-8years) for ABG II. Selection criteria in this initial phase were very strict: young age and/or high activity level, with good bone stock and femoral morphology suited to fitting a Metha stem (no "stovepipe" or "champagne-flute" femurs), for which 12.8% of primary hip replacements were selected. Matching was performed by sampling on criteria of age, gender, body-mass index and etiology. Radiographic parameters were compared between the short stem group and the two control groups and classified according to Engh-Massin score (10 points for fixation and 17 for stability). RESULTS The short Metha stem provided excellent fixation scores: 7.65/10, versus 7.16 (P=0.003) and 5.92 (P=0.0001) for ABG II and Omnifit, respectively. Likewise, stability was scored 14.23/17 for Metha, vs. 14.51 (NS) and 11.83 (P=0.0001) respectively, and the total score was higher for Metha (21.88/27) than ABG II (21.67; P=0.03) or, more particularly, Omnifit (17.83; P=0.0001). The Metha stem was never associated with thigh pain or periprosthetic fracture. 8-year survival was 100%, without significant difference with respect to ABG II (100%; NS) or Omnifit (98.8%; 95% CI: 0.964-1; NS). DISCUSSION The apparent radiologic superiority of the short Metha stem requires long-term confirmation in non-selected series. Meanwhile, Metha can be asserted to have demonstrated optimal compromise between lasting bone anchorage and respect of bone physiology under loading at medium term. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- J-A Epinette
- Clinique Médico-Chirurgicale, 200, rue d'Auvergne, 62700 Bruay-La-Buissière, France.
| | - M Brax
- Centre Hospitalier, 64, avenue du Professeur-Leriche, 67500 Haguenau, France
| | - Y Chammaï
- Centre Hospitalier, 64, avenue du Professeur-Leriche, 67500 Haguenau, France
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Comparison of hip muscle volume between fit-and-fill stem and tapered-wedge stem after total hip arthroplasty using the anterolateral approach. J Orthop Sci 2017; 22:1102-1106. [PMID: 28890224 DOI: 10.1016/j.jos.2017.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/12/2017] [Accepted: 08/18/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND In total hip arthroplasty (THA) surgery, hip muscle preservation is important in strengthening the stability of the hip and improving the activities of the patient. However, whether the type of femoral stem affects the recovery of the hip muscles remains unknown. The aim of this study was to compare the postoperative hip muscle recovery among femoral stem varieties after THA. METHODS The computed tomography (CT) images of 44 patients (44 hips) who underwent THA using an anterolateral approach were reviewed. Twenty-two patients received a fit-and-fill (FF) stem and 22 received the tapered-wedge (TW) stem. The volumes of the gluteus maximus (GMA), gluteus medius (GME), and obturator internus (OI) were measured on three-dimensional models reconstructed using preoperative and 6-month postoperative CT images. Relationships between muscle volume changes and factors including the femoral stem length were evaluated. RESULTS The GMA and GME volumes increased postoperatively by 8.2% and 8.3%, respectively, in the FF stem group and 7% and 6%, respectively, in the TW stem group, with no group differences. In contrast, the OI volume decreased postoperatively by 17.8% in the FF group and was preserved in TW group (p < 0.001). Moreover, OI volume was decreased in 19 patients (86%) in the FF group and in 11 patients (50%) in the TW group (p = 0.01). The normalized stem length was significantly associated with the postoperative change in OI volume (r = -0.45, p = 0.002). CONCLUSIONS The TW stem showed a significant advantage over the FF stem in terms of OI preservation. Surgeons should pay close attention during surgery to avoid OI injury when using different femoral stem types. We suggest that a short and reduced lateral shoulder femoral stem is a better choice for the preservation of external rotation muscles.
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