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Ciais G, Massin V, Tibbo M, Dardenne T, Abdellaoui M, Ricón J, Antoni M, Laumonerie P. Stress shielding following radial head arthroplasty: the impact of preoperative bone quality. J Shoulder Elbow Surg 2024; 33:1665-1671. [PMID: 38697508 DOI: 10.1016/j.jse.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/21/2024] [Accepted: 03/03/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND We sought to assess if the medullary diameter to cortical width ratio (MD:CW), canal flair index (CFI), and canal fill (CF) of the proximal radius were associated with the presence of stress shielding (SS) after a MoPyC radial head arthroplasty. MATERIALS AND METHODS We conducted a retrospective, international, multicenter (4 centers) study. A total of 100 radial head arthroplasties in 64 women and 36 men with a mean age of 58.40 years ± 14.90 (range, 25.00-91.00) were included. Radiographic measurements, including MD:CW, CFI, CF, and postoperative SS were captured at a mean follow-up of 3.9 years ± 2.8 (range, 0.5-11). RESULTS SS was identified in 60 patients. Mean preoperative MD:CW, CFI, and CF were 0.55 ± 0.09, 1.05 ± 0.18, and 0.79 ± 0.11, respectively. The presence of SS was significantly associated with MD:CW (adjusted odds ratio = 13.66; P = .001), and expansion of the stem (adjusted odds ratio = 3.78; P = .001). The amount of the SS was significantly correlated with expansion of the stem (aβ 4.58; P < .001). CONCLUSIONS Our study found that MD:CW was an independent risk factor of SS after MoPyc radial head arthroplasty. Autoexpansion of the MoPyc stem significantly increased the risk of SS and its extent. Further studies involving multiple implants designs are needed to confirm the preliminary observations presented in the current study.
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Affiliation(s)
- Grégoire Ciais
- Department of Orthopedic Surgery, Clinique Jouvenet, Paris, France
| | - Valentin Massin
- Department of Orthopedic Surgery, La Timone Hospital, Marseille, France
| | - Meagan Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Theopol Dardenne
- Department of Orthopedic Surgery, Pellegrin Hospital, Bordeaux, France
| | | | - Javier Ricón
- Department of Orthopedic Surgery, Hopital Vega Baja de Orihuela, Calle Pais Valenciano, Orihuela, Alicante, Spain
| | - Maxime Antoni
- Department of Orthopedic Surgery, Clinique de l'orangerie, Strasbourg, France
| | - Pierre Laumonerie
- Department of Orthopedic Surgery, Pellegrin Hospital, Bordeaux, France.
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Staunton P, Alhojailan K, Desgagne C, Epure L, Zukor D, Huk O, Antoniou J. Acute Periprosthetic Hip Fractures With Short, Uncemented Femoral Stems. J Arthroplasty 2024:S0883-5403(24)00572-2. [PMID: 38851408 DOI: 10.1016/j.arth.2024.05.087] [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: 12/12/2023] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Uncemented femoral stems in hip arthroplasty have shown excellent long-term results, and several systematic studies indicate satisfactory performance of short stems. However, biomechanical and finite element analysis studies have suggested that shorter stems allow greater micromotion, producing greater strain at the implant-bone interface, which potentially increases the risk for periprosthetic fracture (PPF). We sought to assess this risk within our unit. METHODS Our institution's arthroplasty database was searched for all primary total hip arthroplasties using short femoral stems performed between July 14, 2009 and August 29, 2022. The overall PPF rate and the PPF rate for individual femoral stems were established. Preoperative X-rays for each case were analyzed to characterize individual proximal femoral geometry. A data analysis was performed to identify risk factors for PPF. RESULTS For the time period assessed, 3,192 short femoral stems were implanted. This included 1,561 of stem A and 1,631 of stem B. Women constituted 55.37% of the cohort. The average patient age was 66 years (range, 22 to 95). The PPF rate was 0.6%, with 19 PPFs identified at a follow-up of 3 months. There was a significantly higher fracture rate in stem A (0.96%) compared to stem B (0.25%) (P ≤ .01). Proximal femoral geometry, age, and sex were not determined to be risk factors for PPF in our cohort. Individual surgeons and surgical approaches appeared to confer no increased risk. There was no significant difference in average stem length, but multivariate analysis identified stem type and stem length as an independent risk factor for PPF. CONCLUSIONS Our study identified individual stem and stem length as independent risk factors for PPF within our cohort. PPF is a multifactorial issue, and consensus on emerging risk factors such as implant design will hopefully inform decisions that can provide further risk reduction for individual patients.
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Affiliation(s)
- Peter Staunton
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | - Khalifa Alhojailan
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | | | - Laura Epure
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada
| | - David Zukor
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | - Olga Huk
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | - John Antoniou
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
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Rougereau G, Bourdier JA, Langlais T, Boisrenoult P, Pujol N. Is there a femoral morphology at risk of a cervical or pertrochanteric fracture? Description and validation of the "Neck shaft ratio" and the "Intertrochanteric distal ratio" after analyzing a continuous cohort of 126 bilateral fractures of the proximal femur. Orthop Traumatol Surg Res 2024; 110:103874. [PMID: 38556208 DOI: 10.1016/j.otsr.2024.103874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/24/2023] [Accepted: 02/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Proximal femur fractures constitute a public health concern given their high frequency and the aging population. The frequency of a contralateral fracture occurring can reach up to 15% of cases. Certain historical or demographic factors constitute risk factors for refracture, but the type of fracture, either of the femoral neck (FN) or pertrochanteric (PT), cannot be predicted. The objectives of this retrospective study were: firstly, to analyze several anatomical markers in order to determine whether they predispose to a certain type of fracture in the event of contralateral refracture, and secondly, to determine the predictive power of these possible radiological markers for the type of contralateral fracture. HYPOTHESIS The hypothesis was that the "Neck shaft ratio" (NSR) and the "Intertrochanteric distal ratio" (ITDR) made it possible to determine a proximal femoral morphology at risk of FN and/or PT fracture in the event of a second fracture. MATERIAL AND METHODS This continuous retrospective single-center series from January 2011 to December 2019 of patients who presented with bilateral fractures of the proximal femurs was analyzed. Radiographs, taken after the first fracture, of the contralateral femur were studied. Morphological measurements previously described in the literature were carried out as well as the NSR (ratio of the medial cortical thicknesses of the femoral neck at its narrowest and basicervical level) and the ITDR (ratio of the medial diaphyseal cortical thicknesses at 5mm and 20mm from the distal portion of the lesser trochanter). One hundred and twenty-six patients were included: 46/126 (36.5%) had bilateral FN, 50/126 (39.7%) bilateral PT and 30/126 (23.8%) one of each. RESULTS Only NSR and ITDR were significant predictive measures for FN or PT fracture type [0.54±0.11 vs. 0.81±0.16 (p<0.0001) and 0. 85±0.1 vs. 0.68±0.1 (p<0.0001), respectively]. These two ratios had an excellent predictive value for the type of fracture occurring on the contralateral side [NSR: AUC ROC = 0.91 (95% CI; 0.86-0.96); ITDR: AUC ROC = 0.81 (95% CI; %, 0.74-0.89)]. The NSR had excellent intra- and inter-observer reproducibility with an interclass correlation coefficient of 0.93 [95% CI: 0.86-0.97] and 0.91 [95% CI: 0.82-0.96] respectively, the same also applied for the ITDR with interclass correlation coefficient values of 0.93 [95% CI: 0.87-0.97] and 0.86 [95% CI: 0.73-0.93] respectively. DISCUSSION The NSR and ITDR ratios offer a simple and reproducible means to predict a morphological predisposition to a certain fracture type, respectively an FN and PT on the side contralateral to an initial osteoporotic proximal femur fracture. A prospective cohort study would be useful in defining a possible prognostic nature on the occurrence and/or time until refracture. LEVEL OF EVIDENCE III; retrospective control case.
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Affiliation(s)
- Grégoire Rougereau
- Service de chirurgie orthopédique et traumatologique, Hôpital Mignot, Université Versailles Saint-Quentin-en-Yvelines, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France; Service de chirurgie orthopédique, Université Sorbonne, Hôpital de la Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Jean-Arthur Bourdier
- Service de chirurgie orthopédique et traumatologique, Hôpital Mignot, Université Versailles Saint-Quentin-en-Yvelines, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - Tristan Langlais
- Service de chirurgie orthopédique, Université de Toulouse, Hôpital des enfants Purpan, 330, avenue de Grande Bretagne, 31300 Toulouse, France
| | - Philippe Boisrenoult
- Service de chirurgie orthopédique et traumatologique, Hôpital Mignot, Université Versailles Saint-Quentin-en-Yvelines, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - Nicolas Pujol
- Service de chirurgie orthopédique et traumatologique, Hôpital Mignot, Université Versailles Saint-Quentin-en-Yvelines, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
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Ashkenazi I, Benady A, Ben Zaken S, Factor S, Abadi M, Shichman I, Morgan S, Gold A, Snir N, Warschawski Y. Radiological Comparison of Canal Fill between Collared and Non-Collared Femoral Stems: A Two-Year Follow-Up after Total Hip Arthroplasty. J Imaging 2024; 10:99. [PMID: 38786553 PMCID: PMC11121886 DOI: 10.3390/jimaging10050099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Collared femoral stems in total hip arthroplasty (THA) offer reduced subsidence and periprosthetic fractures but raise concerns about fit accuracy and stem sizing. This study compares collared and non-collared stems to assess the stem-canal fill ratio (CFR) and fixation indicators, aiming to guide implant selection and enhance THA outcomes. This retrospective single-center study examined primary THA patients who received Corail cementless stems between August 2015 and October 2020, with a minimum of two years of radiological follow-up. The study compared preoperative bone quality assessments, including the Dorr classification, the canal flare index (CFI), the morphological cortical index (MCI), and the canal bone ratio (CBR), as well as postoperative radiographic evaluations, such as the CFR and component fixation, between patients who received a collared or a non-collared femoral stem. The study analyzed 202 THAs, with 103 in the collared cohort and 99 in the non-collared cohort. Patients' demographics showed differences in age (p = 0.02) and ASA classification (p = 0.01) but similar preoperative bone quality between groups, as suggested by the Dorr classification (p = 0.15), CFI (p = 0.12), MCI (p = 0.26), and CBR (p = 0.50). At the two-year follow-up, femoral stem CFRs (p = 0.59 and p = 0.27) were comparable between collared and non-collared cohorts. Subsidence rates were almost doubled for non-collared patients (19.2 vs. 11.7%, p = 0.17), however, not to a level of clinical significance. The findings of this study show that both collared and non-collared Corail stems produce comparable outcomes in terms of the CFR and radiographic indicators for stem fixation. These findings reduce concerns about stem under-sizing and micro-motion in collared stems. While this study provides insights into the collar design debate in THA, further research remains necessary.
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Affiliation(s)
| | | | | | - Shai Factor
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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Upadhyay PK, Shah N, Kumar V, Mirza SB. Hydroxyapatite ceramic-coated femoral components in younger patients followed up for 27 to 32 years. Bone Jt Open 2024; 5:286-293. [PMID: 38591124 PMCID: PMC11002557 DOI: 10.1302/2633-1462.54.bjo-2023-0136.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Aims This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged less than 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component. Methods We describe the survival, radiological, and functional outcomes of 33 patients (38 THAs) at a mean follow-up of 27 years (25 to 32) between 1988 and 2018. Results Of the surviving 30 patients (34 THAs), there were four periprosthetic fractures: one underwent femoral revision after 21 years, two had surgical fixation as the stem was deemed stable, and one was treated nonoperatively due to the patient's comorbidities. The periprosthetic fracture patients showed radiological evidence of change in bone stock around the femoral stem, which may have contributed to the fractures; this was reflected in change of the canal flare index at the proximal femur. Two patients (two hips) were lost to follow-up. Using aseptic loosening as the endpoint, 16 patients (18 hips; 48%) needed acetabular revision. None of the femoral components were revised for aseptic loosening, demonstrating 100% survival. The estimate of the cumulative proportion surviving for revisions due to any cause was 0.97 (standard error 0.03). Conclusion In young patients with high demands, the Furlong HAC-coated femoral component gives excellent long-term results.
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Affiliation(s)
- Piyush K. Upadhyay
- Cumberland Infirmary, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
- School of Engineering University of Warwick, Coventry, UK
| | - Nirav Shah
- University Hospitals Sussex NHS Foundation Trust, West Sussex, UK
| | - Vishal Kumar
- Manchester University NHS Foundation Trust (MFT), Manchester, UK
| | - Saqeb B. Mirza
- Trauma and Orthopaedics, University Hospital Wales, Cardiff, UK
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Kirsch M, Kremer H, Fabbri C, Capdevielle P, Collignon F, Mainard D. Osseointegration of a hydroxyapatite-coated stem in femoral neck fractures in the over-80 s. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1535-1541. [PMID: 38267791 DOI: 10.1007/s00590-024-03835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE In the over-80 s, femoral bone is often osteoporotic and unlikely to be conducive to periprosthetic bone rehabitation. This observation often leads to cemented fixation for hemiarthroplasty in femoral neck fracture. Hydroxyapatite is a bioactive coating that has already demonstrated its osteoinductive properties. Our hypothesis is that hydroxyapatite enables prosthetic osseointegration in patients over 80, as well as periprosthetic cortical thickening. The objective was to evaluate the osseointegration of a hydroxyapatite-coated femoral stem in femoral neck fractures in the over-80 s, and the evaluation of the periprosthetic bone regeneration permitted by hydroxyapatite. METHODS This was a retrospective study. Osseointegration and periprosthetic bone regeneration were assessed on pre-operative, immediate post-operative and last follow-up radiographs with Engh score, O-SS score, cortical index, Canal Bone Ration (CBR) and Canal Fill Ratio (CFR). RESULTS One hundred and forty-six patients were included. At last follow-up, 99.3% (n = 145) of stems were osseointegrated. The mean Engh score was 19.9 [SD 3.1]. The mean O-SS score was 19.1 [SD 2.4], corresponding to very good osseointegration. The mean CBR at last follow-up was 0.48 [SD 0.07], corresponding to a non-osteoporotic femur. There was a significant difference with pre-operative CBR (p < 0,001). The pre-operative cortical index and the index at the last follow-up were significantly different for all levels of measurement (p < 0,001). The CFR at last follow-up was also significantly different with the post-operative CFR (p < 0,001). CONCLUSION This study shows the value of using a hydroxyapatite-coated stem on senile, osteoporotic bone to improve cortical thickness along the entire length of femoral bone.
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Affiliation(s)
- Mathias Kirsch
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France.
| | - Hugo Kremer
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
| | - Camille Fabbri
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
| | - Pierre Capdevielle
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
| | - Florian Collignon
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
| | - Didier Mainard
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
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Berliner ZP, Jawad MU, Matzko C, Cooper HJ, Rodriguez JA, Hepinstall MS. Proximal radiolucent lines around fully hydroxyapatite-coated tapered femoral stems: should we be concerned? Hip Int 2024; 34:49-56. [PMID: 37306146 DOI: 10.1177/11207000231178269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Radiolucent lines occasionally develop around the proximal aspect of fully hydroxyapatite (HA)-coated tapered femoral stems after total hip arthroplasty (THA). It was hypothesised that distal wedging of stems may predispose to proximal radiolucent line formation, which may negatively impact clinical outcome. METHODS All primary THA performed with a collarless fully HA-coated stem that had a minimum of 1 year of radiographic follow-up were identified in a surgical database (n = 244). Radiographic measures of proximal femoral morphology and femoral canal fill at the middle and distal thirds of the stem were analysed for association with the presence of proximal radiolucent lines. Linear regression was used to explore any association between radiolucent lines and patient reported outcome measures (PROMs), available in 61% of patients. RESULTS Proximal radiolucent lines developed in 31 cases (12.7%) at final follow-up. Dorr A femoral morphology and increased canal-fill at the distal ⅓ of the stem correlated with the development of radiolucent lines (p < 0.001). No correlation was observed between pain or PROMs and the presence of proximal radiolucent lines. DISCUSSION We observed an unexpectedly high incidence of proximal femoral radiolucent lines about collarless fully HA coated stems. Distal-only implant wedging in Dorr A bone may compromise proximal fixation. Although this finding did not correlate with short-term outcomes, the long-term clinical impact requires further study.
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Affiliation(s)
- Zachary P Berliner
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Muhammad Umar Jawad
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Chelsea Matzko
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - H John Cooper
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jose A Rodriguez
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Rohe S, Böhle S, Matziolis G, Jacob B, Brodt S. Plain radiographic indices are reliable indicators for quantitative bone mineral density in male and female patients before total hip arthroplasty. Sci Rep 2023; 13:19886. [PMID: 37963967 PMCID: PMC10645725 DOI: 10.1038/s41598-023-47247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 11/10/2023] [Indexed: 11/16/2023] Open
Abstract
Osteoporosis is underdiagnosed in patients undergoing total hip arthroplasty (THA). Bone mineral density measurement by dual-energy X-ray absorptiometry (DXA) is the gold standard, but indices on plain hip radiographs also seemed to be reliable screening tools in female or Asian ethnicities in previous studies. Given the lack of knowledge about male patients and Caucasian ethnicities, this study was conducted to evaluate plane hip radiographic indices as a screening tool for osteopenia and osteoporosis in Caucasian female and also male patients before undergoing THA. A retrospective analysis of 216 elderly patients with pre-existing DXA before hip arthroplasty was performed and four indices were calculated on plain hip radiographs: Canal-Flare-Index (CFI), Canal-Calcar-Ratio (CCR), Canal-Bone-Ratio (CBR) 7 and 10 cm below the lesser trochanter. They were correlated with femoral neck DXA T-scores by Pearson's correlation and intraclass correlation coefficient, and a ROC analysis was performed. A total of 216 patients (49.5% male) were included. CBR-7 and -10 were highly correlated (p < 0.001) with femoral neck T-score in males (Pearson's correlation CBR-7 r = - 0.60, CBR-10 r = - 0.55) and females (r = - 0.74, r = - 0.77). CBR-7 and -10 also showed good diagnostic accuracy for osteoporosis in the ROC analysis in males (CBR-7: AUC = 0.75, threshold = 0.51; CBR-10: 0.63; 0.50) and females (CBR-7: AUC = 0.87, threshold = 0.55; CBR-10: 0.90; 0.54). Indices such as the Canal Bone Ratio (CBR) 7 or 10 cm below the lesser trochanter on plain hip radiographs are a good screening tool for osteopenia and osteoporosis on plain hip radiographs and can be used to initiate further diagnostics like the gold standard DXA. They differ between male and female patients.
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Affiliation(s)
- Sebastian Rohe
- Orthopaedic Department of the Waldkliniken Eisenberg, Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Sabrina Böhle
- Orthopaedic Department of the Waldkliniken Eisenberg, Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Benjamin Jacob
- Orthopaedic Department of the Waldkliniken Eisenberg, Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Department of the Waldkliniken Eisenberg, Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Bökeler U, Liener U, Vogeley N, Mayer B, Horsch C, Tröster F, Eschbach D, Ruchholtz S, Knauf T. Value of Proximal Femur Geometry in Predicting Occult Hip Fracture. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1987. [PMID: 38004036 PMCID: PMC10673107 DOI: 10.3390/medicina59111987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Patients with occult hip fractures are a difficult subgroup to treat. MRI is the gold standard for diagnosing occult proximal femur fractures but is costly and may not be readily available in an emergency setting. The purpose of this study was to determine whether changes in the proximal femur geometry can predict the likelihood of an occult hip fracture in patients presenting with hip pain following a ground-level fall. Material and Methods: Patients admitted to the hospital with a clinical suspicion of a hip fracture but initial negative radiographs over a seven-year period were included. All patients were additionally investigated with an MRI scan, and retrospectively, six radiologic parameters were obtained on plain radiographs: The cortical thickness index (CTI), the canal to calcar ratio (CCR), the canal flare index (CFI), the morphological cortical index (MCI), the canal bone ratio (CBR) and the canal bone aria ratio (CBAR). Subsequently the result of the plain radiographic indices of the patients with a negative MRI (Group A, no occult fracture) were compared to those with a positive MRI (Group B, occult fracture). Results: A total of 78 patients (59 female, 19 male) could be included in the study. The mean age was 82 years. The univariate analyses revealed a poor predictive ability of all radiological parameters with AUC values ranging from 0.515 (CBR) to 0.626 (CTI), whereas a multivariate prognostic model demonstrated improved prognosis (AUC = 0.761) for the CTI (p = 0.024), CBAR (p = 0.074) and CRR (p = 0.081) as the most promising predictive radiological parameters. Conclusions: Single radiologic indices obtained from conventional X-rays of the proximal femur have a weak predictive value in detecting occult fractures of the hip and cannot be used as clinical decision-making factors.
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Affiliation(s)
- Ulf Bökeler
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart, Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Ulrich Liener
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart, Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Nils Vogeley
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart, Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Benjamin Mayer
- Department for Epidemiology and Medical Biometry, University of UIm, 89081 Ulm, Germany; (B.M.); (C.H.)
| | - Cornelia Horsch
- Department for Epidemiology and Medical Biometry, University of UIm, 89081 Ulm, Germany; (B.M.); (C.H.)
| | - Fridolin Tröster
- Department for Diagnostic and Interventional Radiology, Marienhospital Stuttgart, 70199 Stuttgart, Germany
| | - Daphne Eschbach
- MVZ Hessisch Lichtenau e.v., Kaufungen, 34123 Kassel, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35043 Marburg, Germany
| | - Tom Knauf
- Orthopaedische Klinik Hessisch Lichtenau, 37235 Hessisch Lichtenau, Germany;
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Shichman I, Lawrence KW, Berzolla E, Hernandez CS, Man-El R, Warschawski Y, Snir N, Schwarzkopf R, Hepinstall MS. Comparison of canal fill and radiolucent line formation between two fully coated, hydroxyapatite tapered stems: a 2-year follow-up after total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:6945-6954. [PMID: 37428271 DOI: 10.1007/s00402-023-04944-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 06/04/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Comparison between fully hydroxyapatite (HA)-coated stems with differing geometry are lacking in the total hip arthroplasty (THA) literature. This study aimed to compare femoral canal fill, radiolucency formation, and 2-year implant survivorship between two commonly used, HA-coated stems. METHODS All primary THAs performed with two fully HA-coated stems (Polar stem, Smith&Nephew, Memphis, TN and Corail stem, DePuy-Synthes, Warsaw, IN) with a minimum 2-year radiographic follow-up were identified. Radiographic measures of proximal femoral morphology based on the Dorr classification and femoral canal fill were analyzed. Radiolucent lines were identified by Gruen zone. Perioperative characteristics and 2-year survivorship were compared between stem types. RESULTS A total of 233 patients were identified with 132 (56.7%) receiving the Polar stem (P) and 101 (43.3%) receiving the Corail stem (C). No differences were observed with respect to proximal femoral morphology. Femoral stem canal fill at the middle third of the stem was greater for P stem patients than for C stem patients (P stem; 0.80 ± 0.08 vs. C stem; 0.77 ± 0.08, p = 0.002), while femoral stem canal fill at the distal third of the stem and presence of subsidence were comparable between groups. A total of six and nine radiolucencies were observed in P stem and C stem patients, respectively. Revision rate at 2-year (P stem; 1.5% vs C stem; 0.0%, p = 0.51) and latest follow-up (P stem; 1.5% vs C stem; 1.0%, p = 0.72) did not differ between groups. CONCLUSION Greater canal fill at the middle third of the stem was observed for the P stem compared to the C stem, however, both stems demonstrated robust and comparable freedom from revision at 2-year and latest follow-up, with low incidences of radiolucent line formation. Mid-term clinical and radiographic outcomes for these commonly used, fully HA-coated stems remain equally promising in THA despite variations in canal fill.
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Affiliation(s)
- Ittai Shichman
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA.
- Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel.
| | - Kyle W Lawrence
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
| | - Emily Berzolla
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
| | - Carlos Sandoval Hernandez
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
| | - Rani Man-El
- Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel
| | - Nimrod Snir
- Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
| | - Matthew S Hepinstall
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
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11
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Zhao C, Li X, Liu P, Chen Z, Sun G, Dai J, Wang X. Predicting fracture classification and prognosis with hounsfield units and femoral cortical index: A simple and cost-effective approach. J Orthop Sci 2023:S0949-2658(23)00259-2. [PMID: 37839977 DOI: 10.1016/j.jos.2023.08.020] [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: 05/22/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The relationship between bone density and fracture has been widely studied and recognized, and the role of cortical bone in proximal femoral fractures has also been increasingly studied. However, both the determination of bone mineral density (BMD) and the determination of cortical mass are expensive and cumbersome. The purpose of this study is to investigate whether two readily available indicators, Hounsfield Units (HUs) and femoral cortical index (FCI), can be used to predict hip fracture classification and prognosis. METHODS A retrospective study was conducted on 110 patients with hip fragility fractures. Cortical index was calculated on fractured and contralateral femur FCI, with HUs calculated on the proximal femur. The correlation of the FCI and HU with diabetes, hypertension, and related indicators, such as albumin, creatinine, and urea nitrogen levels, were also analyzed in the study. RESULTS Both the Evans classification of intertrochanteric fractures and the Garden and Pauwels classifications of femoral neck fractures showed that as the severity of the fracture increased, the HUs and FCI decreased. Age and albumin level also had a negative correlation with HUs and FCI. There was also a significant correlation between HUs and FCI. CONCLUSIONS The HUs and FCI, which can be easily and quickly obtained, can be used to predict the classification and prognosis of hip fractures.
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Affiliation(s)
- Chen Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, PR China
| | - Xiaodong Li
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, PR China
| | - Pengcheng Liu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Zhaoxun Chen
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, PR China
| | - Guantong Sun
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, PR China
| | - Jingjing Dai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, PR China.
| | - Xiaoqing Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, PR China.
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12
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Yun HH, Lee WS, Shin YB, Yoon TH. Periprosthetic Occult Femoral Fracture: An Unknown Side Effect of Press-Fit Fixation in Primary Cementless Total Hip Arthroplasty. Hip Pelvis 2023; 35:88-98. [PMID: 37323549 PMCID: PMC10264232 DOI: 10.5371/hp.2023.35.2.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose The objectives of this study were to examine the prevalence and risk factors for development of periprosthetic occult femoral fractures during primary cementless total hip arthroplasty (THA) and to assess the clinical consequences of these fractures. Materials and Methods A total of 199 hips were examined. Periprosthetic occult femoral fractures were defined as fractures not detected intraoperatively and on postoperative radiographs, but only observed on postoperative computed tomography (CT). Clinical, surgical, and radiographic analysis of variables was performed for identification of risk factors for periprosthetic occult femoral fractures. A comparison of stem subsidence, stem alignment, and thigh pain between the occult fracture group and the non-fracture group was also performed. Results Periprosthetic occult femoral fractures were detected during the operation in 21 (10.6%) of 199 hips. Of eight hips with periprosthetic occult femoral fractures that were detected around the lesser trochanter, concurrent periprosthetic occult femoral fractures located at different levels were detected in six hips (75.0%). Only the female sex showed significant association with an increased risk of periprosthetic occult femoral fractures (odds ratio for males, 0.38; 95% confidence interval, 0.15-1.01; P=0.04). A significant difference in the incidence of thigh pain was observed between the occult fracture group and the non-fracture group (P<0.05). Conclusion Occurrence of periprosthetic occult femoral fractures is relatively common during primary THA using tapered wedge stems. We recommend CT referral for female patients who report unexplained early postoperative thigh pain or developed periprosthetic intraoperative femoral fractures around the lesser trochanter during primary THA using tapered wedge stems.
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Affiliation(s)
- Ho Hyun Yun
- Department of Orthopaedic Surgery, VHS Medical Center, Seoul, Korea
| | - Woo Seung Lee
- Department of Orthopaedic Surgery, VHS Medical Center, Seoul, Korea
| | - Young Bin Shin
- Department of Orthopaedic Surgery, VHS Medical Center, Seoul, Korea
| | - Tae Hyuck Yoon
- Department of Orthopaedic Surgery, VHS Medical Center, Seoul, Korea
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13
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Pothong W, Adulkasem N. Comparative evaluation of radiographic morphologic parameters for predicting subsequent contralateral fragility hip fracture. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05789-8. [PMID: 36991284 DOI: 10.1007/s00264-023-05789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Subsequent contralateral fragility hip fracture (SCHF) is one of the most serious conditions in osteoporotic patients due to high morbidity and mortality. This study aimed to investigate the predictive ability of radiographic morphologic parameters for SCHF in patients diagnosed with unilateral fragility hip fractures. METHODS We conducted a retrospective observational study of unilateral fragility hip fracture patients between April 2016 and December 2021. Radiographic morphologic parameters, including canal-calcar ratio (CCR), cortical thickness index (CTI), canal-flare index (CFI), and morphological cortical index (MCI), were measured from patients' contralateral proximal femur anteroposterior radiographic study to evaluate the risk of SCHF. Multivariable logistic regression analysis was employed to determine the adjusted predictive ability of the radiographic morphologic parameters. RESULTS Of the included 459 patients, 49 (10.7%) experienced SCHF. All radiographic morphologic parameters demonstrated excellent performance in predicting SCHF. After being adjusted by patients' age, BMI, visual impairment status, and dementia, CTI revealed the greatest adjusted odds ratio for SCHF of 35.05 (95% CI 7.34 to 167.39, p < 0.001) followed by CFI (OR = 13.32; 95% CI 6.50 to 27.32, p < 0.001), MCI (OR = 5.60; 95% CI 2.84 to 11.04, p < 0.001), and CCR (OR = 4.50; 95% CI 2.32 to 8.72, p < 0.001). CONCLUSION CTI demonstrated the greatest odds ratio for SCHF, followed by CFI, MCI, and CCR. These radiographic morphologic parameters could provide a preliminary prediction for SCHF in elderly patients presenting with unilateral fragility hip fractures.
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Affiliation(s)
- Witit Pothong
- Orthopaedics Unit, Lamphun Hospital, Lamphun, Thailand
| | - Nath Adulkasem
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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14
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Liu Y, Li C, Cao Z, Wang X, Wen J, Ping H, Kong X, Chai W. Undetected Intraoperative Periprosthetic Femoral Fractures in Patients Undergoing Primary Total Hip Arthroplasty: A Retrospective Case Series and Literature Review. Orthop Surg 2023; 15:758-765. [PMID: 36647808 PMCID: PMC9977600 DOI: 10.1111/os.13646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 11/30/2022] [Accepted: 12/08/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Periprosthetic fracture in total hip arthroplasty (THA) can be catastrophic, and early detection and appropriate management are vital to the overall prognosis. This study aimed to describe and summarize the features of undetected intraoperative periprosthetic femoral fractures (IPFFs) in primary THA patients and treatment measures and to review the relevant literature. METHODS We reviewed a total of 6350 primary THAs performed at our institution between January 2013 and December 2020 and screened all IPFFs. Of 138 IPFFs, 24 were undetected and met the inclusion criteria. We recorded and compared basic patient and operative information and measured some parameters to evaluate canal morphologies based on preoperative radiographs. We also compared fracture line characteristics using postoperative radiographs to summarize the features of intraoperative fractures and propose treatment strategies. The Kolmogorov-Smirnov test was used to test the normality of the variable distributions. Measured parameters in all groups were analyzed using one-way analysis of variance and compared using Dunnett's test. The χ2 and Fisher exact tests were used to compare reoperation rates across the groups. Interrater and intrarater reliability were evaluated by intraclass correlation coefficients. RESULTS Among the 24 hips, there was no significant difference in patient demographics, basic operative information or morphology. The incidence of IPFFs in primary THA patients was 2.17%, and up to 17.4% of IPFFs were undetected until postoperative fluoroscopy. The incidence of undetected IPFFs among all primary THA patients was 0.38% and varied by stem type, with the highest incidence in femurs with either anatomical (1.04%, 4/385) or modular stems (0.90%, 9/1003). Femurs with anatomical stems had a higher reoperation rate. The distal periprosthetic (Gruen zone 4) fracture line of femurs with tapered stems was more prone to involve the medial or lateral bone cortex, which could cause instability. CONCLUSION An undetected IPFF is most likely in femurs fitted with a prosthesis of an inappropriate size or type. Anatomical stems will most likely cause unstable fractures; thus, it is recommended to use them with caution and note the possibility of medial distal femoral fracture. Improper modular stem type or size selection results in longitudinal fractures of the distal femur, and prophylactic cerclage wire binding is recommended in dysplastic hips. Incorrect use of tapered stems in well-ossified femurs may cause distal femoral fractures involving the medial or lateral bone cortex. Intraoperative fluoroscopy after implantation may help detect hidden fractures.
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Affiliation(s)
- Yubo Liu
- School of MedicineNankai UniversityTianjinChina,Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
| | - Chao Li
- Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,National Clinical Research Center for OrthopaedicsSports Medicine & RehabilitationBeijingChina
| | - Zheng Cao
- School of MedicineNankai UniversityTianjinChina,Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
| | - Xin Wang
- School of MedicineNankai UniversityTianjinChina,Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
| | - Jiaxin Wen
- School of MedicineNankai UniversityTianjinChina,Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
| | - Hangyu Ping
- School of MedicineNankai UniversityTianjinChina,Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
| | - Xiangpeng Kong
- Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,National Clinical Research Center for OrthopaedicsSports Medicine & RehabilitationBeijingChina
| | - Wei Chai
- Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,National Clinical Research Center for OrthopaedicsSports Medicine & RehabilitationBeijingChina
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15
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Zhou X, Ji H, Wu J, Chen H, Yang Y. A lower canal fill rate and unreestablished vertical femoral offset may increase the risk of the postoperative periprosthetic fractures after cementless bipolar hemiarthroplasty for femoral neck fractures in elderly patients. PLoS One 2023; 18:e0285789. [PMID: 37205653 DOI: 10.1371/journal.pone.0285789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Periprosthetic fractures (PPFs) is one of the major causes of failure of hip arthroplasty with cementless stem; however, studies on the incidence and risk factors of PPFs after cementless hemiarthroplasty for femoral neck fractures (FNFs) are lacking. METHODS This retrospective study included patients who underwent cementless bipolar hemiarthroplasty for displaced intracapsular FNFs. The demographic data were reviewed, Dorr classification was used to describe morphology of the femur, radiological parameters were measured including stem-shaft angle, canal fill ratio (CFR), canal flare index (CFI), morphologic cortical index (MCI), canal calcar ratio (CCR), and vertical and horizontal femoral offset. RESULTS The sample comprised 10 men and 46 women (affected hip: left, 38; right, 18). The mean patient age was 82.82±10.61 (range, 69-93) years, and the mean hemiarthroplasty to PPFs time was 26.28±14.04 (range, 6.54-47.77) months. Seven (12.28%) patients had PPFs. A significant relationship was found between the incidence of PPF and CFR (p = 0.012), patients had a significantly smaller femoral stem CFR (0.76%±0.11%) than controls (0.85%±0.09%). The PPFs group had a significant shorter and unreestablished vertical femoral offset (p = 0.048). CONCLUSIONS A smaller femoral stem CFR associated with a potentially unacceptably high PPFs risk in uncemented hemiarthroplasty for displaced FNFs may result from mismatched prosthesis and bone dimensions in the elderly population, especially when accompanied by a poorly reestablished vertical femoral offset. With increasing evidence of the benefits of cemented fixation, a cemented stem for the treatment of displaced intracapsular FNFs is recommended for such a elderly frail population.
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Affiliation(s)
- Xiaoxiao Zhou
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Houlin Ji
- Jinji Lake Community Health Service Center of Suzhou Industrial Park, 215000, Jiangsu, China
| | - Jiajun Wu
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Haixiao Chen
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Zhejiang, China
| | - Yang Yang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Zhejiang, China
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16
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Homma Y, Zhuang X, Ohtsu H, Ishii S, Shirogane Y, Hayashi K, Watari T, Baba T, Ishijima M. Highly accurate acoustical prediction using support vector machine algorithm for post-operative subsidence after cementless total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:187-192. [PMID: 36416898 DOI: 10.1007/s00264-022-05641-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Acoustic analysis has recently been applied to cementless total hip arthroplasty (THA). The aim of this study was to develop a machine learning algorithm to predict post-operative subsidence with high accuracy. METHODS The acoustic parameters of the hammering sounds during a broaching procedure for 62 hips in 55 patients who underwent THAs with cementless taper-wedged stem were analysed. The patient's basic background such as age, sex, height, weight and body mass index, the femoral morphological parameters and the hammering sound characteristics of 24 features of normalised sound pressure (nSP) in 24 frequency ranges were applied to binary classification using a support vector machine using the following models with different features: model A, nSP only; model B, nSP + patients' basic background features; model C, nSP + patients' basic background features + femoral morphological parameters. RESULTS In 62 hips with 310 hammering sounds, 12 hips (19.4%) showed ≥ 3 mm of post-operative subsidence; hence, 60 hammering sounds were set as positive examples and 250 hammering sounds were set as negative examples. The AUC was very high in all models. The accuracy (AUC/sensitivity/specificity/positive predictive value/negative predictive value/accuracy rate) of each model was as follows: model A, 0.963/0.656/0.996/0.980/0.925/0.934; model B, 0.9866/0.675/1.000/1.000/0.928/0.937 and model C, 0.998/0.750/1.000/1.000/0.950/0.957. CONCLUSION In this study, we developed a high-accuracy machine learning algorithm for post-operative subsidence using acoustic parameters and additional pre-operative features. Our results represent a step toward the realisation of acoustic monitoring to avoid the complication in cementless THA.
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Affiliation(s)
- Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Graduate School of Medicine, Juntendo University, Tokyo, Japan. .,Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Xu Zhuang
- Department of Medicine for Orthopaedics and Motor Organ, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroshi Ohtsu
- Clinical Research and Trial Center, Juntendo University, Tokyo, Japan
| | - Seiya Ishii
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Yuichi Shirogane
- Department of Medicine for Orthopaedics and Motor Organ, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Koju Hayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Taiji Watari
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
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17
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Effect of femoral stem surface coating on clinical and radiographic outcomes of cementless primary total hip arthroplasty: a patient-matched retrospective study. INTERNATIONAL ORTHOPAEDICS 2023; 47:165-174. [PMID: 36385185 PMCID: PMC9668389 DOI: 10.1007/s00264-022-05629-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE This study aims to determine whether changing the stem coating grants superior outcomes at a minimum follow-up of five years. METHODS Retrospective review of a consecutive series of primary total hip arthroplasties (THAs) operated by direct anterior approach between 01/01/2013 and 31/12/2014. Two stems were compared, which were identical except for their surface coating; "the Original stem" was fully coated with hydroxyapatite (HA), while "the ProxCoat stem" was proximally coated with plasma-sprayed titanium and HA. Matching was performed. Clinical assessment included modified Harris hip score (mHHS), Oxford hip score (OHS), and forgotten joint score (FJS). Radiographic assessment evaluated alignment, subsidence, pedestal formation, heterotopic ossification, radiolucent lines ≥ 2 mm, spot welds, cortical hypertrophy, and osteolysis. RESULTS 232 hips received the Original stem and 167 the ProxCoat stem, from which respectively five hips (2.2%) and no hips (0%) underwent revision. Matching identified two groups of 91 patients, with comparable patient demographics. At > five years follow-up, there were no differences in OHS (16 ± 6 vs 15 ± 5; p = 0.075) nor FJS (81 ± 26 vs 84 ± 22; p = 0.521), but there were differences in mHHS (89 ± 15 vs 92 ± 12; p = 0.042). There were no differences in alignment, subsidence, pedestal formation, heterotopic ossification, cortical hypertrophy, and osteolysis. There were differences in prevalence of proximal radiolucent lines (12% vs 0%; p < 0.001) and distal spot welds (24% vs 54%; p < 0.001). CONCLUSION At a minimum follow-up of five years, this study on matched patients undergoing primary THA found that ProxCoat stems results in significantly fewer radiolucent lines, more spot welds, and less revisions than Original stems, thus suggesting better bone ingrowth.
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18
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Wang Z, Tutaworn T, Wishman MD, Levin JE, Hentschel IG, Lane JM. Fracture Risk Assessment Tool Scores and Radiographical Bone Measurements in Total Hip Arthroplasty Patients. J Arthroplasty 2022; 37:2381-2386. [PMID: 35738364 DOI: 10.1016/j.arth.2022.06.015] [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: 04/28/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Osteoporosis is a major risk factor for periprosthetic fractures (PPFx) in total hip arthroplasty (THA) patients but is not routinely screened for in this population. Given the availability of hip x-rays and preoperative screenings, Fracture Risk Assessment Tool (FRAX) scores and radiographic bone measurements are potentially promising, novel risk stratification tools. This study aims to characterize FRAX scores and radiographic bone measurements in THA and PPFx patients. METHODS A retrospective chart review for demographic variables and FRAX scores was performed on 250 THA and 40 PPFx patients. Radiographic bone measurements including cortical thicknesses (both antero-posterior [AP] and lateral), canal to calcar ratio, canal flare index, and Dorr classifications were obtained from preoperative x-rays. Correlation between FRAX scores and radiographic bone measurements was investigated with linear regressions. FRAX scores and radiographic bone measurements were compared between the THA and PPFx patients. Multivariate logistic regressions were used to identify factors predicting PPFx. RESULTS FRAX scores were significantly correlated with both AP (P < .001) and lateral (P = .007) cortical thicknesses. Compared to THA patients, those with PPFx had significantly higher FRAX scores (P = .003) and lower AP cortical thickness (P = .005). Multivariate logistic regressions demonstrated that FRAX major osteoporotic fracture risk score and AP cortical thickness were independent predictors of PPFx (P = .001 and .024, respectively). CONCLUSION Cortical thicknesses are good proxy measurements of osteoporosis-related fracture risk in THA patients. In addition, both major and AP cortical thickness indices are promising tools for identifying patients who are at a high risk of PPFx in the THA population.
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Affiliation(s)
- Zhaorui Wang
- Weill Cornell Medical College, New York, New York
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19
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Toro G, Pola E, Miranda R, Conte M, Braile A, Pezzella R, De Cicco A, D'auria S, Piscopo A, Panni AS. Extracapsular femoral neck fractures treated with total hip arthroplasty: identification of a population with better outcomes. Orthop Rev (Pavia) 2022; 14:38576. [DOI: 10.52965/001c.38576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Femoral neck fractures (FNF) are associated to patient’s disability, reduced quality of life and mortality. None of the fixation devices commonly used for extracapsular (EC) FNF (i.e., dynamic hip screws (DHS) and intramedullary nails (IN)) is clearly superior to the other, especially in case of unstable fractures (31.A2 and 31.A3 according to AO/OTA classification). The aim of our study was to identify a sub-population of patients with EC fractures in which better outcomes could be obtainable using total hip arthroplasty (THA). Methods All patients with EC unstable fractures treated with THA were included in the present study. Demographic data, American Society of Anesthesiologists (ASA) score, hospitalization length, transfusion rate, implant-related complications and mortality rate were collected. Clinical outcomes were evaluated using the Oxford Hip Score (OHS), while patients’ general health status through the 12 Item Short Form questionnaires (SF-12). Results 30 patients (7 male; 23 female) with a mean age of 78.8 years were included. The 1-year mortality rate was 13.3%. The mean OHS was 27.5, while the mean SF-12 were 45.84 for the mental item and 41.6 for the physical one. Age was the only factor associated with the OHS and patients older than 75 years presented a 12- fold higher risk of developing bad outcomes. Conclusions THA seems to be a viable option for unstable EC fractures, with good clinical outcomes, especially in patients younger than 75 years of age. The mortality rate associated with THA in EC fractures is low and anyway comparable with IN.
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Affiliation(s)
| | | | | | - Michele Conte
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”; Unit of Orthopaedics and Traumatology, Ospedale Sacro Cuore di Gesù Fatebenefratelli
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20
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Ivanova S, Vuillemin N, Hapa O, Siebenrock KA, Keel MJB, Tosounidis TH, Bastian JD. Revision of a Failed Primary Total Hip Arthroplasty following Excessive Reaming with a Medial Cup Protrusion. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091254. [PMID: 36143931 PMCID: PMC9503264 DOI: 10.3390/medicina58091254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Atraumatic intrapelvic protrusion of the acetabular component following excessive reaming of the acetabulum with a far medial positioning of the cup is a rare, but serious complication of a total hip arthroplasty (THA). This study analyzes the factors contributing to this uncommon complication and presents the outcome after the revision surgery using the Ganz reinforcement ring combined with a bone graft and plating of the posterior column and/or screws for the anterior column. Materials and Methods: A retrospective case series study with seven patients (four males, mean age 76 ± 10 years (60−86)) that underwent a revision THA within 24 ± 17 days (5−60) after an atraumatic periprosthetic acetabular fracture with a medial cup protrusion was performed. All fractures were reconstructed with a Ganz reinforcement ring and bone graft with a mean follow-up of 1.7 ± 1.7 years (0.5−5). Radiographs were evaluated for the following: (i) cup positioning immediately after the primary THA and the revision surgery, (ii) cup migration in the follow-up, and (iii) fracture healing. Results: The position of the acetabular component as assessed on the postoperative radiographs after the index surgery and before the complete medial cup protrusion showed a cup placement beyond the ilioischial line indicative of a fracture of the medial wall. The revision surgery with the reconstruction of the medial wall with a Ganz reinforcement ring combined with a bone graft restored in the presented cases the center of rotation in the horizontal direction with a statistical significance (p < 0.05). During the follow-up, there was no aseptic loosening with the relevant cup migration or significant change in the position of the acetabular cup at the final follow-up (p > 0.05) after the revision. All seven fractures and bone grafts realized a bone union until the latest follow-up. Conclusions: Following excessive reaming, the acetabular component was placed too far medially and resulted in an intrapelvic cup protrusion. An unstable cup following a fracture of the medial wall was evident on the immediate postoperative radiographs. In the case of the medial wall perforation with an intrapelvic cup protrusion after the primary THA, the reconstruction with a Ganz reinforcement ring was a successful treatment option resulting in the fracture healing and a stable cup positioning. Surgeons should be aware of that rare and probably underreported complication and restore the anatomic center of rotation by treating the defect intraoperatively.
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Affiliation(s)
- Silviya Ivanova
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Nicolas Vuillemin
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Onur Hapa
- Department of Orthopaedics and Traumatology, Faculty of Medicine Dokuz Eylül University, Izmir 35330, Turkey
| | - Klaus A. Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Marius J. B. Keel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Theodoros H. Tosounidis
- Department of Orthopaedic Surgery, Medical School, University of Crete, University Hospital, 71003 Heraklion, Crete, Greece
| | - Johannes D. Bastian
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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21
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McGoldrick NP, Cochran MJ, Biniam B, Bhullar RS, Beaulé PE, Kim PR, Gofton WT, Grammatopoulos G. Can We Predict Fracture When Using a Short Cementless Femoral Stem in the Anterior Approach? J Arthroplasty 2022; 37:S901-S907. [PMID: 35314289 DOI: 10.1016/j.arth.2022.03.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/10/2022] [Accepted: 03/13/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Short cementless femoral stems may allow for easier insertion with less dissection. The use of short stems with the anterior approach (AA) may be associated with a considerable perioperative fracture risk. Our aim was to evaluate whether patient-specific femoral and pelvic morphology and surgical technique, influence the perioperative fracture risk. Furthermore, we sought to describe important anatomical thresholds alerting surgeons. METHODS A single-center, multi-surgeon retrospective, case-control matched study was performed. Thirty nine periprosthetic fractures (3.4%) in 1,145 primary AA THAs using short cementless stems were identified. These were matched with 78 THA nonfracture controls for factors known to increase the fracture risk. A radiographic analysis using validated software measured femoral (canal flare index [CFI], morphological cortical index [MCI], and calcar-calcar ratio [CCR]) and pelvic (Ilium-ischial ratio [IIR], ilium overhang, and anterior superior iliac spine [ASIS] to greater trochanter distance) morphologies and surgical techniques (% canal fill). A multivariate and Receiver-Operator Curve (ROC) analysis was used to identify fracture predictors. RESULTS CFI (3.7 ± 0.6 vs 2.9 ± 0.4, P < .001) and CCR (0.5 ± 0.1 vs 0.4 ± 0.1, P = .006) differed. The mean IIR was higher in fracture cases (3.3 ± 0.6 vs 3.0 ± 0.5, P < .001). Percent canal fill was reduced in fracture cases (82.8 ± 7.6 vs 86.7 ± 6.8, P = .007). Multivariate and ROC analyses revealed a threshold CFI of 3.17 which was predictive of fracture (sensitivity: 84.6%/specificity: 75.6%). The fracture risk was 29 times higher when patients had CFI >3.17 and II ratio >3 (OR: 29.2 95% CI: 9.5-89.9, P < .001). CONCLUSION Patient-specific anatomical parameters are important predictors of a fracture-risk. A careful radiographic analysis would help identify those at a risk of early fracture using short stems, and alternative stem options should be considered.
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Affiliation(s)
- Niall P McGoldrick
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michael J Cochran
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Brook Biniam
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Raman S Bhullar
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul R Kim
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Wade T Gofton
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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22
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Alpaugh K, Chiu YF, Zlotnicki JP, Bendich I, Valle AGD, Bostrom MPG, Gausden EB. Femoral Component Undersizing and Alignment are Risk Factors for Early Periprosthetic Femur Fracture. J Arthroplasty 2022; 37:S604-S610. [PMID: 35283234 DOI: 10.1016/j.arth.2022.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Known risk factors for early periprosthetic femur fracture (PFF) following total hip arthroplasty (THA) include poor bone quality and the use of cementless implants. The association between femoral component size and alignment and the risk of early PFF is not well described. We evaluated radiographic parameters of femoral component sizing and alignment as risk factors for early PFF. METHODS From 16,065 primary cementless THAs, we identified 66 cases (0.41%) of early PFFs (<90 days from index THA) at a single institution between 2016 and 2020. Sixty early PFFs were (1:2) matched to 120 controls based on the femoral component model, offset, surgical approach, age, body mass index (BMI), and gender. Radiographic assessment of preoperative bone morphology and postoperative femoral component orientation included stem alignment, metaphyseal fill, and implant congruence with medial cortical bone. A multivariable logistic regression was built to identify radiographic risk factors associated with early PFF. RESULTS Markers of preoperative bone quality including canal calcar ratio (P = .003), canal flare index (P < .001), anteroposterior canal bone ratio (CBR) (P < .001), and lateral CBR (P < .001) were statistically associated with PFF. Distance between the medial cortical bone and implant was greater in cases of PFF (2.5 mm vs 1.4 mm) (P < .001). A multivariate analysis demonstrated that a larger lateral metaphyseal CBR (Odds Ratio [OR] 5), valgus implant alignment (OR 5), and medial implant-bone incongruity (OR 2) increased the risk of early PFF. CONCLUSION A larger lateral metaphyseal CBR, valgus component alignment, and implant incongruity with medial cortical bone posed the greatest radiographic risk for early PFF following cementless THA.
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Affiliation(s)
- Kyle Alpaugh
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York; Department of Orthopaedic Surgery, Arthroplasty Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Yu-Fen Chiu
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jason P Zlotnicki
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Ilya Bendich
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York
| | | | - Mathias P G Bostrom
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Elizabeth B Gausden
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York
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23
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Liu Y, Ma WJ, Huang K, Yang J, Zeng Y, Shen B. Radiographic indexes in AP hip radiographs prior to total hip arthroplasty reveal candidates with low BMD. Osteoporos Int 2022; 33:871-879. [PMID: 34775528 DOI: 10.1007/s00198-021-06231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/01/2021] [Indexed: 02/08/2023]
Abstract
UNLABELLED Using anteroposterior (AP) hip radiograph, we measured several indexes to investigate the association with bone mineral density (BMD) before THA and found a highly effective index to predict femoral BMD. This technique is helpful for both patients and clinicians to identify potential candidates with low BMD to whom DXA examination is particularly recommended. INTRODUCTION The purpose of the study is to identify patients with low bone mineral density (BMD) prior to total hip arthroplasty with the help of AP hip radiographs. METHODS Indexes on AP hip radiographs and T-scores from DXA examination of the lumbar spine and the affected hip were acquired from patients before THA. Indexes measured on AP hip radiographs including the canal calcar ratio (CCR), canal flare index (CFI), morphological cortical index (MCI), canal bone ratio (CBR), and canal bone area ratio (CBAR). The relevance between indexes and the T-score of femora was evaluated by correlation analysis, and the diagnostic value of indexes for osteopenia was examined by receiver operating characteristic (ROC) curves. RESULTS A total of 81 patients were included. The average value of CBR-7, CBR-10, and CBAR (7-10) were highly related to the T-score of femora (r = - 0.592, r = - 0.634, and r = - 0.631, respectively, p < 0.0001). Results of the intra- and interobserver variation assessment was excellent. CBR-7, CBR-10, and CBAR (7-10) were significantly different between the non-osteopenia and osteopenia groups (p < 0.0001). CBR-10 had the biggest area under curve (AUC), means the great diagnostic value for osteopenia in the proximal femora (AUC = 0.821, cutoff value = 0.3805). CONCLUSION The canal bone ratio at 10 × 10-2 m under the level of the lesser trochanter proved to be a great indicator of femoral osteopenia. Trial registration Chinese Clinical Trail Registry, ChiCTR2000041016. Registered 16 December 2020-Retrospectively registered, http://www.chictr.org.cn/listbycreater.aspx .
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Affiliation(s)
- Y Liu
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - W-J Ma
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - K Huang
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - J Yang
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Y Zeng
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - B Shen
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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24
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Wu X, Zhang L, Bian T, Man S, Li H, Liu W, Zhou Y. The correlation between volumetric bone mineral density and morphological parameters of the proximal femur and clinical outcomes in ankylosing spondylitis patients with hip involvement. BMC Musculoskelet Disord 2022; 23:24. [PMID: 34980053 PMCID: PMC8725399 DOI: 10.1186/s12891-021-04912-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background To measure volumetric bone mineral density (vBMD) with quantitative computed tomography (QCT) in the proximal femur of ankylosing spondylitis (AS) patients with hip involvement and analyze their correlations with radiographic and clinical parameters. Methods Sixty-five AS inpatients were enrolled in this study. The bone mineral density was measured by QCT and dual-energy x-ray absorptiometry (DXA), respectively. The morphological parameters of the proximal femur were measured on digital anteroposterior (AP) radiographs of the pelvis. The correlations between them were analyzed by SPSS software. Results The average trabecular vBMD measured at the femoral neck was 136.38 ± 25.58 mg/cm3. According to the BASRI-Hip score, group A consisted of 39 hips (0–2 score) and group B consisted of 26 hips (3–4 score). There were significant differences regarding trabecular CTXA equivalent T-score between group A and B at the femoral neck (p = 0.004); intertrochanteric region (p < 0.001) and greater trochanter (p = 0.001). The trabecular CTXA equivalent T-score at femoral neck had a negative correlation with disease duration (r = − 0.311, p = 0.012) and with CBR (r = − 0.319, p = 0.010). Conclusions The low trabecular bone density at the site of the hip was associated with the duration of disease progression and degree of hip involvement. Meanwhile, it had a correlation with hip function status although we failed to confirm a significant relationship between hip vBMD and disease activity.
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Affiliation(s)
- Xinfeng Wu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Liang Zhang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Tao Bian
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Siliang Man
- Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Hongchao Li
- Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Wei Liu
- Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Yixin Zhou
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
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25
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A Comparison of Risks and Benefits Regarding Hip Arthroplasty Fixation. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202111000-00001. [PMID: 34726640 PMCID: PMC8565793 DOI: 10.5435/jaaosglobal-d-21-00014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
Since the field-changing invention of noncemented hip arthroplasty fixation in the 1980s, noncemented fixation has been progressively replacing cemented fixation. However, analyses of fixation frequencies reveal new patterns in cement versus noncemented preferences. Although cementation is again gaining ground in the United States, noncemented models remain the dominant fixation mode, seen in more than 90% of all hip arthroplasties. This stark preference is likely driven by concerns regarding implant durability and patient safety. Although advances in surgical techniques, intensive perioperative care, and improved instrument have evolved in both methods, data from large arthroplasty registries reveal shifting risks in contemporary hip arthroplasty, calling the use of noncemented fixation into question. Varying risk profiles regarding sex, age, or health comorbidities and morphological and functional differences necessitate personalized risk assessments. Furthermore, certain patient populations, based on the literature and data from large registries, have superior outcomes from cemented hip arthroplasty techniques. Therefore, we wanted to critically evaluate the method of arthroplasty fixation in primary hip arthroplasties for unique patient populations.
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26
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Hadidi F, Khalil OA, Alhadidy A, Alqawaba R, Hammad Y, Samarah OQ, Hamdan M, Yasin MS, Hawa AF, AlRyalat A. Correlation between plain X-ray measurements and DXA scans, and its possible use as a screening tool for performing DXA scans. Int J Clin Pract 2021; 75:e14784. [PMID: 34482603 DOI: 10.1111/ijcp.14784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/02/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of this study is to determine if there is a relationship between radiological parameters measured using a plain X-ray and DXA scan score, and whether a plain X-ray can be used as surrogate imaging modality when DXA scan is not readily available. METHODS We included all patients who had both a DXA scan and a pelvis X-ray done from 1 January 2013 to 31 December 2017. Bone mineral density had been measured by DXA scanning of the femoral neck and the spine. Osteoporosis was defined by T-score of any site less than -2.5. Cortical thickness indices on the AP radiograph were calculated. RESULTS Sixty patients were involved in the study and were divided into two groups. Group A had 22 patients who had a T-Score on their DXA Scans ≤-2.5 SD at the femur neck or the spine with median ± SD (-2.5 ± 0.8, -2.8 ± 1.0), respectively. Group B had 38 patients who had a T-score on their DXA Scans of >-2.5 at the femur neck and the spine with median ± SD (-1.2 ± 0.9, -1.3 ± 1.0), respectively, which was significantly higher than the T-score of osteoporotic (group A) patients (P = .000) at both sites of measurement. The cortical thickness index (CTI) was significantly higher (P = .027) in group B mean ± SD (0.56 ± 0.07), compared with (0.51 ± 0.08) that in group A. CONCLUSION DXA imaging remains the gold standard for diagnosing osteoporosis and we advocate the use of CTI to detect the patients who need DXA screening in places where this modality is not readily available.
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Affiliation(s)
- Fadi Hadidi
- Special Surgery Department, Division of Orthopedic Surgery, Jordan University Hospital, Amman, Jordan
| | - Osama A Khalil
- Special Surgery Department, Division of Orthopedic Surgery, Jordan University Hospital, Amman, Jordan
| | - Azmy Alhadidy
- Special Surgery Department, Division of Orthopedic Surgery, Jordan University Hospital, Amman, Jordan
| | - Rula Alqawaba
- Special Surgery Department, Division of Orthopedic Surgery, Jordan University Hospital, Amman, Jordan
| | - Yazan Hammad
- Special Surgery Department, Division of Orthopedic Surgery, Jordan University Hospital, Amman, Jordan
| | - Omar Q Samarah
- Special Surgery Department, Division of Orthopedic Surgery, Jordan University Hospital, Amman, Jordan
| | - Mohammad Hamdan
- Special Surgery Department, Division of Orthopedic Surgery, Jordan University Hospital, Amman, Jordan
| | - Mohamad Samih Yasin
- Special Surgery Department, Division of Orthopedic Surgery, Jordan University Hospital, Amman, Jordan
| | - Ala' F Hawa
- Special Surgery Department, Division of Orthopedic Surgery, Jordan University Hospital, Amman, Jordan
| | - Aldeen AlRyalat
- Special Surgery Department, Division of Orthopedic Surgery, Jordan University Hospital, Amman, Jordan
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27
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Yamamoto N, Sukegawa S, Yamashita K, Manabe M, Nakano K, Takabatake K, Kawai H, Ozaki T, Kawasaki K, Nagatsuka H, Furuki Y, Yorifuji T. Effect of Patient Clinical Variables in Osteoporosis Classification Using Hip X-rays in Deep Learning Analysis. ACTA ACUST UNITED AC 2021; 57:medicina57080846. [PMID: 34441052 PMCID: PMC8398956 DOI: 10.3390/medicina57080846] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 01/08/2023]
Abstract
Background and Objectives: A few deep learning studies have reported that combining image features with patient variables enhanced identification accuracy compared with image-only models. However, previous studies have not statistically reported the additional effect of patient variables on the image-only models. This study aimed to statistically evaluate the osteoporosis identification ability of deep learning by combining hip radiographs with patient variables. Materials andMethods: We collected a dataset containing 1699 images from patients who underwent skeletal-bone-mineral density measurements and hip radiography at a general hospital from 2014 to 2021. Osteoporosis was assessed from hip radiographs using convolutional neural network (CNN) models (ResNet18, 34, 50, 101, and 152). We also investigated ensemble models with patient clinical variables added to each CNN. Accuracy, precision, recall, specificity, F1 score, and area under the curve (AUC) were calculated as performance metrics. Furthermore, we statistically compared the accuracy of the image-only model with that of an ensemble model that included images plus patient factors, including effect size for each performance metric. Results: All metrics were improved in the ResNet34 ensemble model compared with the image-only model. The AUC score in the ensemble model was significantly improved compared with the image-only model (difference 0.004; 95% CI 0.002–0.0007; p = 0.0004, effect size: 0.871). Conclusions: This study revealed the additional effect of patient variables in identification of osteoporosis using deep CNNs with hip radiographs. Our results provided evidence that the patient variables had additive synergistic effects on the image in osteoporosis identification.
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Affiliation(s)
- Norio Yamamoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (N.Y.); (T.Y.)
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan; (K.Y.); (K.K.)
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka 530-000, Japan
| | - Shintaro Sukegawa
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan;
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
- Correspondence: ; Tel.: +81-878-113-333
| | - Kazutaka Yamashita
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan; (K.Y.); (K.K.)
| | - Masaki Manabe
- Department of Radiation Technology, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan;
| | - Keisuke Nakano
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Kiyofumi Takabatake
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Hotaka Kawai
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan;
| | - Keisuke Kawasaki
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan; (K.Y.); (K.K.)
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Yoshihiko Furuki
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan;
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (N.Y.); (T.Y.)
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Diagnosis and Management of Intraoperative Fractures in Primary Total Hip Arthroplasty. J Am Acad Orthop Surg 2021; 29:e497-e512. [PMID: 33475301 DOI: 10.5435/jaaos-d-20-00818] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/20/2020] [Indexed: 02/01/2023] Open
Abstract
Intraoperative periprosthetic fractures are challenging complications that may affect implant stability and survivorship. Periprosthetic acetabular fractures are uncommon and infrequently are the focus of studies. Acetabular fractures are occasionally recognized after patients report unremitting groin pain weeks postoperatively. The widespread use of cementless acetabular cups might lead to higher number of fractures than is clinically detectable. Conversely, the incidence of intraoperative periprosthetic femoral fractures are more common and encompass a broad spectrum, ranging from a small cortical perforation to displaced fractures with an unstable prosthesis. Appropriate recognition, including mindfulness of preoperative patient and surgical risk factors, is critical to the successful management of acetabular and femoral complications. This comprehensive review article focuses on the incidence, patient and surgical risk factors, diagnosis, management, and clinical outcomes associated with intraoperative acetabular and femur fractures in primary total hip arthroplasty.
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Narayanan R, Elbuluk AM, Chen KK, Eftekhary N, Zuckerman JD, Deshmukh AJ. Does femoral morphology and stem alignment influence outcomes of cementless total hip arthroplasty with proximally coated double-tapered titanium stems? Hip Int 2021; 31:354-361. [PMID: 31912748 DOI: 10.1177/1120700019891702] [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 Stem subsidence and thigh pain can cause significant patient dissatisfaction after cementless THA. The purpose of this study was to examine the effect of proximal-femoral morphology and stem alignment on clinical outcomes using a double-tapered, cementless titanium femoral component. METHODS We retrospectively reviewed 281 consecutive, primary THAs from 2012 to 2014 with a mean follow-up of 4 years. Preoperative radiographs were used to assess femoral neck shaft angle (FNS), canal flare index (CFI), Dorr classification, and greater trochanter (GT) overhang. Postoperative radiographs were used to determine stem alignment and 6-week follow-up radiographs were used to determine subsidence. Clinical outcomes included thigh pain, leg-length discrepancy (LLD), patient-reported outcome measures (PROMs) and revision surgeries. RESULTS 271 stems (96%) did not subside (<4 mm) and 10 (4%) showed evidence of subsidence (>4 mm). Subsidence was significantly associated with subsequent revision surgery (p < 0.01). 278 stems (99%) were in neutral alignment and 3 in varus (1%). Alignment did not significantly influence subsidence, thigh pain, LLD, revisions, or PROMs. Femoral morphology measures (FNS, CFI, Dorr classification, and GT overhang) were not significantly associated with stem alignment, subsidence, LLD, or revisions. CFI was significantly associated with intraoperative calcar fractures (p = 0.02). GT overhang was associated with thigh pain (p = 0.03) and FNS was inversely associated with postoperative HOOS scores. CONCLUSIONS Subsidence and proximal-femoral morphology are potential sources of postoperative morbidity in certain cementless THA patients. In accordance with prior studies, CFI was identified as a potential risk factor for intraoperative calcar fractures. More research into preoperative femoral morphologies, such as GT overhang and FNS, is warranted as these may contribute to unsatisfactory results related to cementless THA.
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Affiliation(s)
| | | | - Kevin K Chen
- NYU Langone Orthopedic Hospital, New York, NY, USA
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30
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Yasuda T, Matsunaga K, Hashimura T, Tsukamoto Y, Sueyoshi T, Ota S, Fujita S, Onishi E. Bone turnover markers in the early stage of rapidly progressive osteoarthritis of the hip. Eur J Rheumatol 2021; 8:57-61. [PMID: 32910766 PMCID: PMC8133882 DOI: 10.5152/eurjrheum.2020.20046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/10/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Previous reports have demonstrated that patients with end-stage rapidly progressive osteoarthritis of the hip (RPOH) show significantly higher serum levels of bone turnover markers than those with osteoarthritis (OA). However, the characteristics of bone turnover markers in the early stage of RPOH remain unclear. This study aimed to elucidate the association of bone turnover markers with disease progression in the early stage of RPOH. METHODS This study included 29 postmenopausal female patients with joint space narrowing >2 mm demonstrated on a series of radiographs and computed tomography within 1 year following the onset of hip pain. The study also included 9 postmenopausal female patients with hip OA secondary to developmental dysplasia showing femoral head destruction. Cortical thickness index (CTI) associated with bone mineral density of the hip was analyzed. Serum concentrations of tartrate-resistant acid phosphatase-5b (TRACP-5b) and bone alkaline phosphatase (BAP) were evaluated. RESULTS RPOH was classified into two types on the basis of the absence (type 1, n=13) or presence (type 2, n=16) of subsequent destruction of the femoral head within 1 year following disease onset. TRACP-5b and BAP significantly increased in RPOH type 2 compared with type 1 and OA. Receiver operating characteristic curve analyses indicated that TRACP-5b and BAP could differentiate RPOH type 2 from type 1 within 1 year following the onset. CTI showed no difference among the RPOH types 1 and 2 and OA. CONCLUSION High serum levels of bone turnover markers may be associated with destruction of the femoral head in the early stage of RPOH.
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Affiliation(s)
- Tadashi Yasuda
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuhiro Matsunaga
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takumi Hashimura
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yoshihiro Tsukamoto
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tatsuya Sueyoshi
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Satoshi Ota
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Satoshi Fujita
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Eijiro Onishi
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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31
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Ishii S, Homma Y, Baba T, Shirogane Y, Kaneko K, Ishijima M. Does increased diameter of metal femoral head associated with highly cross-linked polyethylene augment stress on the femoral stem and cortical hypertrophy? INTERNATIONAL ORTHOPAEDICS 2021; 45:1169-1177. [PMID: 33619587 DOI: 10.1007/s00264-021-04994-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Cortical hypertrophy (CH) after total hip arthroplasty (THA) is thought as a process of femoral cortical functional adaptation against the stem. However, no study has been performed to investigate the association between CH and femoral head size. The purpose of this study is to investigate the factors related to femoral CH around the cementless stem after THA. METHODS THAs in 31 patients using 36-mm metal head and as a control, age-matched 62 THAs with 32-mm metal head have been analyzed. Radiographs were reviewed at four years to determine cortical thickness change from immediate post-operative one. Pre-operative and immediate post-operative radiographs were used to calculate the femoral morphology, canal fill ratio, stem alignment, and femoral and acetabular offset. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for CH. RESULTS Patients with a 36-mm metal head had a significantly higher rate of severe CH (P = 0.001) than those with a 32-mm metal head. The multivariate logistic regression analysis with dependent variables of CH showed that the use of a 36-mm metal head had a significantly positive effect on CH. The odds ratio of a 36-mm metal head in mild CH was 2.517 (95% confidence interval, 1.032-6.143; P = 0.043), and that in severe CH was 8.273 (95% confidence interval, 2.679-25.551; P = 0.000). Age and the canal flare index were weakly and negatively influenced by mild CH. CONCLUSIONS The use of a 36-mm metal head was the dominant risk factor for CH.
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Affiliation(s)
- Seiya Ishii
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuichi Shirogane
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Toro G, Di Fino C, De Cicco A, Toro G, Paoletta M, Toro A, Tarantino U, Iolascon G, Panni AS. Atypical periprosthetic femoral fractures of the hip: characterisation of three cases. Hip Int 2020; 30:77-85. [PMID: 33267685 DOI: 10.1177/1120700020971726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Long-term use of bisphosphonates (BPs) has been associated with a specific type of tensile side femoral stress fracture known as Atypical Femoral Fracture (AFF). Theoretically periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, emerging evidence correlates prolonged BPs use with the occurrence of a type of PFF with an atypical pattern (atypical PFF, APFF). The aim of the present study is to report 3 cases of APFF treated at a single centre. METHODS Clinical and radiographic records of PFF that occurred between January 2016 and August 2018 were retrospectively reviewed. All patients meeting the American Society for Bone and Mineral Research (ASBMR) criteria for definition of PFF were included. Management strategies for APFF and patient outcomes, including fracture healing and hip function (assessed by the Oxford Hip Score [OHS]) were collected. RESULTS 3 patients in the study period were identified as APFF (1 incomplete, 2 complete). All patients were females with a mean age of 83.3 years. All patients were treated with lateral plating. The application of a contralateral strut allograft resulted in fracture healing in cases of complete fractures. Mean OHS at final follow-up was 34.3. CONCLUSIONS Despite occurring around a hip stem like PFF, APFF had peculiar clinical and radiographic features, making them more similar to AFF. Therefore, the orthopaedic surgeon should also consider the natural history and healing problems associated with AFF prior in order to choose the most appropriate management for APFF.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ciro Di Fino
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Toro
- Unit of Orthopaedics and Traumatology, "Martiri del Villa Malta" Hospital, Sarno, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Yamamoto N, Sukegawa S, Kitamura A, Goto R, Noda T, Nakano K, Takabatake K, Kawai H, Nagatsuka H, Kawasaki K, Furuki Y, Ozaki T. Deep Learning for Osteoporosis Classification Using Hip Radiographs and Patient Clinical Covariates. Biomolecules 2020; 10:biom10111534. [PMID: 33182778 PMCID: PMC7697189 DOI: 10.3390/biom10111534] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/08/2020] [Accepted: 11/08/2020] [Indexed: 01/10/2023] Open
Abstract
This study considers the use of deep learning to diagnose osteoporosis from hip radiographs, and whether adding clinical data improves diagnostic performance over the image mode alone. For objective labeling, we collected a dataset containing 1131 images from patients who underwent both skeletal bone mineral density measurement and hip radiography at a single general hospital between 2014 and 2019. Osteoporosis was assessed from the hip radiographs using five convolutional neural network (CNN) models. We also investigated ensemble models with clinical covariates added to each CNN. The accuracy, precision, recall, specificity, negative predictive value (npv), F1 score, and area under the curve (AUC) score were calculated for each network. In the evaluation of the five CNN models using only hip radiographs, GoogleNet and EfficientNet b3 exhibited the best accuracy, precision, and specificity. Among the five ensemble models, EfficientNet b3 exhibited the best accuracy, recall, npv, F1 score, and AUC score when patient variables were included. The CNN models diagnosed osteoporosis from hip radiographs with high accuracy, and their performance improved further with the addition of clinical covariates from patient records.
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Affiliation(s)
- Norio Yamamoto
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan; (N.Y.); (K.K.)
| | - Shintaro Sukegawa
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan;
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
- Correspondence: ; Tel.: +81-87-811-3333; Fax: +81-87-835-8363
| | - Akira Kitamura
- Search Space Inc., Tokyo 151-0072, Japan; (A.K.); (R.G.)
| | - Ryosuke Goto
- Search Space Inc., Tokyo 151-0072, Japan; (A.K.); (R.G.)
| | - Tomoyuki Noda
- Department of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;
| | - Keisuke Nakano
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Kiyofumi Takabatake
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Hotaka Kawai
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Keisuke Kawasaki
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan; (N.Y.); (K.K.)
| | - Yoshihiko Furuki
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan;
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;
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Zhang JZ, Zhao K, Li JY, Zhu YB, Zhang YZ. Age-related dynamic deformation of the femoral shaft and associated osteoporotic factors: a retrospective study in Chinese adults. Arch Osteoporos 2020; 15:157. [PMID: 33026533 DOI: 10.1007/s11657-020-00834-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/22/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Dynamic skeletal deformation with ageing showed important signs of degenerative and osteoporotic diseases. We found that both femoral bowing and cortical thickness were correlated with ageing in a Chinese population. Further, femoral cortical index, an osteoporotic indicator, was negatively correlated with femoral bowing angle. Hence, more attention should be paid to these femoral morphological changes to avoid fragility fractures and failed internal fixation. PURPOSE The purpose of this study was to determine whether morphological parameters of the femoral shaft are in age-related deformation and identify correlations between parameters of femoral cortical thickness and femoral shaft bowing. METHODS One hundred twenty patients (mean 50 years, range 18~104 years) who had received standard long-standing anteroposterior and femoral lateral radiographs from October 2016 to October 2019 were included in this retrospective study. The sagittal femoral bowing angle (sFBA), sagittal femoral cortical index (sFCI), coronal femoral bowing angle (cFBA), and coronal femoral cortical index (cFCI) were measured by two orthopaedists separately. All the participants' demographic data, including age, sex, body laterality, height, and weight, were collected. The Student's t test, Mann-Whitney U test, two-way ANOVA, Pearson correlation, and multiple linear regression were used in the statistical analysis. RESULTS The mean age of the male and female participants was 46.95 ± 15.25 and 52.22 ± 15.61 years, respectively. Two-way ANOVA revealed that females had a significantly lower sFCI than males at the right side (P < 0.05). There were no significant interactions between sex or body laterality and the sFBA, cFBA, sFCI, and cFCI groups (P > 0.05). Pearson correlation revealed that sFCI was strongly correlated with sFBA (r = - 0.535, P < 0.05) and cFBA (r = - 0.535, P < 0.05). Multiple linear regression analysis demonstrated that both age (β = 0.304 and 0.308 respectively) and sFCI (β = - 0.322 and - 0.414 respectively) were two independent predictors associated with sFBA and cFBA respectively. CONCLUSIONS The femoral shaft bowing of the Chinese population was positively correlated with ageing, whereas the sagittal femoral cortical thickness negatively correlated with ageing. A high FBA occurred in femoral shafts with a low sFCI, which revealed that femoral shaft bowing was associated with femoral cortical thickness. During femur-related surgery in older patients, more attention should be paid to these femoral morphological changes.
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Affiliation(s)
- Jun-Zhe Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Jun-Yong Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Yan-Bin Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Ying-Ze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China. .,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
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35
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Spina M, Scalvi A. Periprosthetic fractures of the proximal femur within first year of the index hip prosthesis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91. [PMID: 32921757 PMCID: PMC7717019 DOI: 10.23750/abm.v91i3.9683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/19/2020] [Indexed: 11/23/2022]
Abstract
Introduction: Periprosthetic fractures are a serious complication of implants prosthetic. The aim of this review is to analyze incidence and predisposing factors of periprosthetic fractures of the proximal femur within first year of the index hip prosthesis. Materials and methods: Between 1998 and 2017 we have performed 4240 hip replacements (F 2661, M 1579): 2877 total hip arthroplasties (67,9%) and 1363 hemiartrhoplasties (32,1%). Hip replacements with cemented stem were 2173 (51,2%), while cementless ones were 2067 (48,8%). In the same period we admitted 121 hip periprosthetic fractures, 26 of which (0,6%) within the first year of the index surgery. We examined the medical and radiographic records of this last cohort of patients (F 19, M 7) following the Vancouver System, Dorr Classification and Stem Size Index. Results: The cause was a low-energy trauma in 25 cases (96.1%); the primary diagnosis was hip fracture in 20 patients (76.9%); 8 patients were taking chronic osteoporosis medication (30.7%); 14 patients were affected by neuropsychiatric disease (53.8%); cementless stems were found in 18 cases, 12 of which were oversized (SSI < 0,8). According to Vancouver System, fractures were classified as follows: 10 type B1, 14 type B2 and 2 type C. As far as the proximal femoral shape, 2 cases were Dorr type A, 7 Dorr type B and 17 Dorr type C. Conclusions: The incidence of periprosthetic fractures in the aftermath of stem implant is twice as high with uncemented stems. The Vancouver type B1/B2 is the most common. Predisposing factors are: female sex, hip fracture, chronic osteoporosis medication, neuropsychiatric disease and oversized uncemented stem (SSI < 0.8).The evidence level is IV. (www.actabiomedica.it)
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Affiliation(s)
- Mauro Spina
- Azienda Ospedaliera Universitaria Integrata di Verona.
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36
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Bigart KC, Nahhas CR, Ruzich GP, Culvern CN, Salzano MB, Della Valle CJ, Nam D. Does Femoral Morphology Predict the Risk of Periprosthetic Fracture After Cementless Total Hip Arthroplasty? J Arthroplasty 2020; 35:S359-S363. [PMID: 32209287 DOI: 10.1016/j.arth.2020.02.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/28/2020] [Accepted: 02/22/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periprosthetic femur fracture remains a leading mode of early failure following cementless total hip arthroplasty (THA). The purpose of this study is to determine if a specific femoral morphology is associated with an increased risk of acute, periprosthetic fracture after cementless THA. METHODS An institutional arthroplasty registry was used to identify 32 primary, cementless THAs revised for acute, postoperative periprosthetic fracture ("fracture" cohort) within 3 months of the index procedure. Patients were matched 1:2 to 64 THAs without fracture ("control" cohort) for age, body mass index, gender, and stem design. Preoperative radiographic measurements performed on anteroposterior pelvis and femur radiographs included the neck-shaft angle, endosteal width at 4 locations, and external cortical diameter at 2 locations. These measurements were used to calculate the morphological cortical index, canal flare index, canal calcar ratio, and canal bone ratio. Postoperative measurements included canal fill and stem alignment. Statistical analyses included clustered regressions, Fisher's exact test, and Student's t-test. RESULTS The mean endosteal width at 10 cm distal to the lesser trochanter was greater in fracture patients, although not statistically significant (P = .1). However, this resulted in differences in the canal flare index (P = .03), canal calcar ratio (P = .03), and canal bone ratio (P = .03) between the 2 cohorts. These ratios indicate decreased meta-diaphyseal taper in fracture patients. Preoperative femoral neck-shaft angle was more varus in fracture patients (P = .04). CONCLUSION Patients sustaining an acute, periprosthetic fracture with cementless femoral fixation after THA had thinner distal cortices and a decreased meta-diaphyseal taper.
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Affiliation(s)
- Kevin C Bigart
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Cindy R Nahhas
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Gregory P Ruzich
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Chris N Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Michael B Salzano
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Denis Nam
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Tootsi K, Lees L, Geiko B, Märtson A. Intraoperative complications in total hip arthroplasty using a new cementless femoral implant (SP-CL ®). J Orthop Traumatol 2020; 21:8. [PMID: 32451636 PMCID: PMC7248161 DOI: 10.1186/s10195-020-00548-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Considering the excellent results already achieved in total hip arthroplasty (THA), new implants must be at least as safe as currently used implants and lead to longer survival. A new cementless femoral stem, SP-CL®, has been introduced. The aim of this study is to evaluate intraoperative complications and assess the risk factors of THA with the SP-CL® implant. MATERIALS AND METHODS All THA patients who were operated on using the SP-CL® (LINK, Hamburg, Germany) implant between 2015 and 2018 were included in the analysis. Data were collected from medical records from national and hospital electronic databases. Radiological measurements were made from standard pre- and postoperative radiographs. RESULTS A total of 222 THA were performed using the SP-CL® implant. The average age of the patients was 56 years (14-77 years). There were 1 transient sciatic nerve injury, 1 acetabular fracture, and 11 (5.0%) intraoperative femoral fractures (IFF), of which 7 were treated with cerclage wire or titanium band during the operation while the other fractures were treated conservatively. None of the IFF patients were revised due to fracture during the follow-up period (one revision due to infection). The radiographic morphology of proximal femur was associated with increased risk of IFF (p = 0.02). CONCLUSIONS The results of the current study demonstrate a 5% incidence of IFF when using the LINK SP-CL® femoral stem in THA. The radiographic morphology of the proximal femur was an important predictor of IFF and should be assessed when using SP-CL®. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Kaspar Tootsi
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, Tartu, 51014, Estonia. .,Traumatology and Orthopaedics Clinic, Tartu University Hospital, Puusepa 8, Tartu, 51014, Estonia.
| | - Loviisa Lees
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, Tartu, 51014, Estonia
| | - Boris Geiko
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, Tartu, 51014, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, Tartu, 51014, Estonia.,Traumatology and Orthopaedics Clinic, Tartu University Hospital, Puusepa 8, Tartu, 51014, Estonia
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38
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D'Ambrosio A, Peduzzi L, Roche O, Bothorel H, Saffarini M, Bonnomet F. Influence of femoral morphology and canal fill ratio on early radiological and clinical outcomes of uncemented total hip arthroplasty using a fully coated stem. Bone Joint Res 2020; 9:182-191. [PMID: 32431809 PMCID: PMC7229336 DOI: 10.1302/2046-3758.94.bjr-2019-0149.r2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims The diversity of femoral morphology renders femoral component sizing in total hip arthroplasty (THA) challenging. We aimed to determine whether femoral morphology and femoral component filling influence early clinical and radiological outcomes following THA using fully hydroxyapatite (HA)-coated femoral components. Methods We retrospectively reviewed records of 183 primary uncemented THAs. Femoral morphology, including Dorr classification, canal bone ratio (CBR), canal flare index (CFI), and canal-calcar ratio (CCR), were calculated on preoperative radiographs. The canal fill ratio (CFR) was calculated at different levels relative to the lesser trochanter (LT) using immediate postoperative radiographs: P1, 2 cm above LT; P2, at LT; P3, 2 cm below LT; and D1, 7 cm below LT. At two years, radiological femoral component osseointegration was evaluated using the Engh score, and hip function using the Postel Merle d’Aubigné (PMA) and Oxford Hip Score (OHS). Results CFR was moderately correlated with CCR at P1 (r = 0.44; p < 0.001), P2 (r = 0.53; p < 0.001), and CFI at P1 (r = − 0.56; p < 0.001). Absence of spot welds (n = 3, 2%) was associated with lower CCR (p = 0.049), greater CFI (p = 0.017), and lower CFR at P3 (p = 0.015). Migration (n = 9, 7%) was associated with lower CFR at P2 (p = 0.028) and P3 (p = 0.007). Varus malalignment (n = 7, 5%), predominantly in Dorr A femurs (p = 0.028), was associated with lower CFR at all levels (p < 0.05). Absence of spot welds was associated with lower PMA gait (p = 0.012) and migration with worse OHS (p = 0.032). Conclusion This study revealed that femurs with insufficient proximal filling tend to have less favourable radiological outcomes following uncemented THA using a fully HA-coated double-tapered femoral component. Cite this article: Bone Joint Res. 2020;9(4):182–191.
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Affiliation(s)
- Adrien D'Ambrosio
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospitals, Strasbourg, France
| | | | - Olivier Roche
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospitals, Strasbourg, France
| | | | | | - François Bonnomet
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospitals, Strasbourg, France
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Yasuda T, Matsunaga K, Hashimura T, Tsukamoto Y, Sueyoshi T, Ota S, Fujita S, Onishi E. Characterization of rapidly progressive osteoarthritis of the hip in its early stage. Eur J Rheumatol 2020; 7:130-134. [PMID: 32384049 DOI: 10.5152/eurjrheum.2020.19159] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/16/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aimed to characterize the process of disease progression in the early stage of rapidly progressive osteoarthritis of the hip (RPOH) and clarify its association with potential pathological factors of RPOH. METHODS This monocentric retrospective study included 41 female patients who met the criteria for RPOH, chondrolysis >2 mm during 12 months from the onset of hip pain based on a series of radiographs and computed tomography. This study also included 9 female patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH) who demonstrated chondrolysis >2 mm during 12 months from the onset of hip pain. Cortical thickness index (CTI) correlated with bone mineral density of the hip, pelvic tilt, and serum concentrations of matrix metalloproteinase (MMP)-3 were analyzed. RESULTS RPOH was classified into two types based on the absence (type 1, n=17) and presence (type 2, n=24) of subsequent femoral head destruction within 12 months after the onset of hip pain. MMP-3 significantly increased in RPOH type 2 compared with type 1 and DDH. Increased posterior pelvic tilt was found in RPOH type 2 compared with DDH. Logistic regression and receiver operating characteristic curve analyses indicated that MMP-3 may be associated with differentiation between RPOH types 1 and 2. No difference was found in the CTI between the RPOH types and DDH. CONCLUSION Disease progression of RPOH during 12 months after the onset of hip pain could be classified into two distinct types based on the absence (type 1) and presence (type 2) of femoral head destruction in association with MMP-3 and pelvic tilt as biological and mechanical factors, respectively. MMP-3 may be helpful to differentiate these two types in the early stage of RPOH.
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Affiliation(s)
- Tadashi Yasuda
- Department of Orthopaedic Surgery, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Kazuhiro Matsunaga
- Department of Orthopaedic Surgery, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Takumi Hashimura
- Department of Orthopaedic Surgery, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Yoshihiro Tsukamoto
- Department of Orthopaedic Surgery, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Tatsuya Sueyoshi
- Department of Orthopaedic Surgery, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Satoshi Ota
- Department of Orthopaedic Surgery, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Satoshi Fujita
- Department of Orthopaedic Surgery, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Eijiro Onishi
- Department of Orthopaedic Surgery, Kobe City Medical Centre General Hospital, Kobe, Japan
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Watanabe K, Mitsui K, Usuda Y, Nemoto K. An increase in the risk of excessive femoral anteversion for relatively younger age and types of femoral morphology in total hip arthroplasty with direct anterior approach. J Orthop Surg (Hong Kong) 2020; 27:2309499019836816. [PMID: 30913961 DOI: 10.1177/2309499019836816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Direct anterior approach (DAA) is known to diminish a dislocation risk and widely used for total hip arthroplasty (THA). On the other hand, anterior dislocation due to increasing stem anteversion and cup anteversion is an important complication. METHODS A retrospective analysis of 140 (male/female: 10/130) consecutive patients with 149 hips who had undergone primary THA in the period between 2011 and 2015 was conducted. Factors including age, gender, body mass index (BMI), and primary diagnosis were examined. Radiographic parameters including the Dorr proximal femoral types, cortical thickness index (CTI), canal flare index (CFI), and canal to calcar index were measured. To investigate relationships of combined anteversion (CA) with other factors, a stepwise regression analysis was performed. RESULTS The mean age, BMI, and the follow-up period were 69.5 ± 10.3 years old, 23.4 ± 3.4 kg/m2, and 48.2 ± 13.6 months, respectively. The proximal femurs of the 149 hips were categorized as Dorr type A ( n = 33), type B ( n = 110), and type C ( n = 6). The mean CTI, CFI, and canal to calcar index were 0.56 ± 0.08, 4.15 ± 0.83, and 0.46 ± 0.09, respectively. The mean stem varus angle, radiographic inclination, and radiographic anteversion of the cup were 0.19 ± 1.63, 40.9 ± 6.0°, and 12.7 ± 3.5°, respectively. Stem anteversion measured by computed tomography (CT) axial image was 17.7 ± 12.0°. The mean radiographic inclination, radiographic anteversion (CTRA), and anatomical anteversion analyzed by Kyocera 3-D template were 40.8 ± 7.2°, 19.8 ± 6.6°, and 28.8 ± 10.0°, respectively. Mean CA defined as the sum of stem anteversion and CTRA was 37.5 ± 14.5°. To investigate relationships of CA with other factors, a stepwise regression analysis was performed and resulted in a model with age ( p < 0.001). In the same way, stem anteversion and CTRA were analyzed; only for the stem anteversion, the stepwise selection process resulted in a model with age ( p < 0.001) and the Dorr types ( p = 0.047). CONCLUSION The risk of excessive femoral anteversion increases for relatively younger age and for types of femoral morphology according to the Dorr classification, moreover with an increase of CA in DAA-THA with cementless tapered-wedge stem.
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Affiliation(s)
- Kenya Watanabe
- Department of Orthopedic Surgery, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
| | - Katsuhiro Mitsui
- Department of Orthopedic Surgery, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
| | - Yu Usuda
- Department of Orthopedic Surgery, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
| | - Kazuaki Nemoto
- Department of Orthopedic Surgery, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
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Anderson PA, Morgan SL, Krueger D, Zapalowski C, Tanner B, Jeray KJ, Krohn KD, Lane JP, Yeap SS, Shuhart CR, Shepherd J. Use of Bone Health Evaluation in Orthopedic Surgery: 2019 ISCD Official Position. J Clin Densitom 2019; 22:517-543. [PMID: 31519473 DOI: 10.1016/j.jocd.2019.07.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023]
Abstract
This position development conference (PDC) Task Force examined the assessment of bone status in orthopedic surgery patients. Key questions included which orthopedic surgery patients should be evaluated for poor bone health prior to surgery and which subsets of patients are at high risk for poor bone health and adverse outcomes. Second, the reliability and validity of using bone densitometry techniques and measurement of specific geometries around the hip and knee before and after arthroplasty was determined. Finally, the use of computed tomography (CT) attenuation coefficients (Hounsfield units) to estimate bone quality at anatomic locations where orthopedic surgery is performed including femur, tibia, shoulder, wrist, and ankle were reviewed. The literature review identified 665 articles of which 198 met inclusion exclusion criteria and were selected based on reporting of methodology, reliability, or validity results. We recommend that the orthopedic surgeon be aware of established ISCD guidelines for determining who should have additional screening for osteoporosis. Patients with inflammatory arthritis, chronic corticosteroid use, chronic renal disease, and those with history of fracture after age 50 are at high risk of osteoporosis and adverse events from surgery and should have dual energy X-ray absorptiometry (DXA) screening before surgery. In addition to standard DXA, bone mineral density (BMD) measurement along the femur and proximal tibia is reliable and valid around implants and can provide valuable information regarding bone remodeling and identification of loosening. Attention to positioning, selection of regions of interest, and use of special techniques and software is required. Plain radiographs and CT provide simple, reliable methods to classify the shape of the proximal femur and to predict osteoporosis; these include the Dorr Classification, Cortical Index, and critical thickness. Correlation of these indices to central BMD is moderate to good. Many patients undergoing orthopedic surgery have had preoperative CT which can be utilized to assess regional quality of bone. The simplest method available on most picture archiving and communications systems is to simply measure a regions of interest and determine the mean Hounsfield units. This method has excellent reliability throughout the skeleton and has moderate correlation to DXA based on BMD. The prediction of outcome and correlation to mechanical strength of fixation of a screw or implant is unknown.
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Affiliation(s)
- Paul A Anderson
- Department of Orthopedics Surgery & Rehabilitation, University of Wisconsin UWMF Centennial Building, Madison, WI, USA.
| | - Sarah L Morgan
- UAB Osteoporosis Prevention and Treatment Clinic, University of Alabama Birmingham, Birmingham, AL, USA
| | - Diane Krueger
- University of Wisconsin, Osteoporosis Clinical Research Program, Madison, WI, USA
| | | | - Bobo Tanner
- Division Rheumatology, Vanderbilt University, Nashville, TN, USA
| | - Kyle J Jeray
- Greenville Health System, Deparment of Orthopaedic Surgery, Greenville, SC, USA
| | | | - Joseph P Lane
- Department of Orthopedic Surgery, Hospital for Special surgery, New York, USA
| | | | | | - John Shepherd
- University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI, USA
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Yun HH, Lim JT, Yang SH, Park PS. Occult periprosthetic femoral fractures occur frequently during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA. PLoS One 2019; 14:e0221731. [PMID: 31536499 PMCID: PMC6752856 DOI: 10.1371/journal.pone.0221731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/13/2019] [Indexed: 11/19/2022] Open
Abstract
The present study aimed to investigate the prevalence and clinical consequences of occult intra-operative periprosthetic femoral fractures in total hip arthroplasty (THA). Between 2012 and 2017, a total of 113 primary THAs were enrolled. The mean age of the patients was 66.4 ± 7.6 years. We assessed occult intra-operative periprosthetic femoral fractures with the use of computed tomography (CT) and risk factors, including age, sex, body mass index, diagnosis, stem size, and radiographic parameters of proximal femoral geometry were analyzed. We also assessed the differences in thigh pain and stem subsidence and alignment between the patients with and without occult periprosthetic femoral fracture. Occult intra-operative periprosthetic femoral fractures were found in 13 of 113 hips (11.5%). In 9/13 (69.2%) of occult fractures, fracture lines were started from the region below the tip of the lesser trochanter. Six periprosthetic femoral fractures (5.3%) were found during the operation. Out of the five hips that had detected femoral fractures around the lesser trochanter intra-operatively, four hips (80%) showed concurrent occult fractures on different levels. The female sex (P = .01) and canal filling ratio at 7 cm below the tip of the lesser trochanter (P = .01) were significantly different between the patients with and without occult periprosthetic femoral fracture. The sex was significantly associated with an increased risk in predicting an occult intra-operative periprosthetic femoral fracture (odds ratio of male, 0.25 compared with the female; 95% CI, 0.08-0.85; p = .02). There was a significant difference in the incidence of thigh pain between occult fracture group and non-occult fracture group (P < .05). There were no significant differences in stem subsidence and alignment between the patients with and without occult periprosthetic femoral fracture. All 13 cases of occult intra-operative periprosthetic femoral fractures were healed at the final follow-up. Occult periprosthetic femoral fractures are common during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA, that CT scans are helpful to identify them, and that these fractures do not adversely affect the implant's survival if a rigid fixation of the implants has been achieved.
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Affiliation(s)
- Ho Hyun Yun
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
- * E-mail:
| | - Jung Taek Lim
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
| | - Se-Hyun Yang
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
| | - Phil Sun Park
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
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Lim YW, Huddleston JI, Goodman SB, Maloney WJ, Amanatullah DF. Proximal Femoral Shape Changes the Risk of a Leg Length Discrepancy After Primary Total Hip Arthroplasty. J Arthroplasty 2018; 33:3699-3703. [PMID: 30173942 DOI: 10.1016/j.arth.2018.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To evaluate how canal morphology affects the technical aspects of total hip arthroplasty, we investigated the effects of femoral cortical index (FCI) on the re-establishment of leg length at the conclusion of surgery. METHODS We retrospectively reviewed age, gender, body mass index, and radiographs of 516 patients with osteoarthritis or osteonecrosis who underwent unilateral cementless primary total hip arthroplasty between 2008 and 2015. Patients were divided into level of FCI and leg length discrepancy (LLD). Each cohort was compared in terms of demographics and LLD. One-way analysis of variance and Kruskal-Wallis test were used. RESULTS The mean FCI and LLD were 0.6 ± 0.1 and 3.5 ± 6.3 mm, respectively. Utilization of an extended offset stem was highest with Dorr type A and B hips (P = .001). High FCI increased the risk of lengthening (P = .017) and low FCI increased the risk of shortening (P = .005). CONCLUSION A high FCI increases the probability of a leg length increase and a low FCI increases the probability of a leg length decrease. Surgeons might consider informing patients in advance of possible variation in leg length depending on the patients' proximal femoral shape and bony quality.
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Affiliation(s)
- Young Wook Lim
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - William J Maloney
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
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Siddiqi N, Valdevit A, Chao EYS. Differences in femoral morphology among the Orientals and Caucasians: a comparative study using plain radiographs. Anat Sci Int 2018; 94:58-66. [PMID: 29951777 DOI: 10.1007/s12565-018-0450-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
The purpose of this study was to identify the differences in femoral dimensions among Caucasian and Oriental populations. A total of 268 femora were collected from China, Japan, Korea, Taiwan and the United States. Firstly, the dimensional parameters for measuring femur were identified. These were initially measured on bone specimens to determine the methodology, followed by measuring the same parameter on plane radiographs of the same bone specimen using a board, and digitized with the aim of verifying the repeatability and reliability of the data. Data were analyzed using ANOVA, paired students t test and Pearson's correlation analysis. The results revealed that Caucasian femora are significantly larger in maximum bone length (BL), head-neck length (HNL), lesser trochanter width and the total width of the distal epiphysis (Wdf). The Beijing femora were found to be the longest and the Japanese femora constituted the shortest bone lengths and smallest angle alpha among the Oriental populations. A strong correlation was observed between Wdf and HD, HNL, Wmc and Wlc in all the populations; however, correlation between Wdf and BL was mild. The angle alpha showed no correlation with BL. This study generated a large database of femoral geometry, which may help pharmaceutical companies to design orthopedic implants for Oriental populations.
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Affiliation(s)
- Najam Siddiqi
- Biomechanics Laboratory, School of Medicine, Johns Hopkins University, 720 Rutland Avenue, Baltimore, MD, 21205, USA. .,Department of Anatomy, National University of Science and Technology, College of Medicine and Health Sciences, Al-Tareef, PO Box 391, Zip Code: 321, Sohar, Sultanate of Oman.
| | - Antonio Valdevit
- Biomechanics Laboratory, School of Medicine, Johns Hopkins University, 720 Rutland Avenue, Baltimore, MD, 21205, USA.,SEA Limited, 7001 Buffalo Parkway, Columbus, OH, 43229, USA
| | - E Y S Chao
- Biomechanics Laboratory, School of Medicine, Johns Hopkins University, 720 Rutland Avenue, Baltimore, MD, 21205, USA.,, Southern California, USA
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Toro G, Bothorel H, Saffarini M, Jacquot L, Chouteau J, Rollier JC. Uncemented total hip arthroplasty in octogenarian and nonagenarian patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:103-110. [DOI: 10.1007/s00590-018-2242-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/24/2018] [Indexed: 01/21/2023]
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Preoperative Canal Bone Ratio is Related to High-Degree Stress Shielding: A Minimum 5-Year Follow-Up Study of a Proximally Hydroxyapatite-Coated Straight Tapered Titanium Femoral Component. J Arthroplasty 2018; 33:1764-1769. [PMID: 29366730 DOI: 10.1016/j.arth.2017.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/04/2017] [Accepted: 12/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few studies have reported risk factors for stress shielding. We sought to evaluate clinical and radiographic outcomes of a proximally hydroxyapatite-coated straight tapered titanium femoral component stem during a minimum 5-year follow-up and identify factors associated with high-degree stress shielding. METHODS A total of 156 total hip arthroplasties (n = 124; 98 women and 26 men; mean age, 56.5 years) with a minimum follow-up period of 5 years were included in the study. Clinical and radiologic measurements at follow-up (range, 5-16.3 years; mean, 10.2 years) were analyzed. RESULTS The mean preoperative Harris Hip Score (HHS) was 56.6, and the mean HHS at the latest follow-up was considerably improved at 86.8. Stress shielding at the latest follow-up was low degree in 136 (87%) hips and high degree in 20 (13%) hips. On average, high-degree stress shielding occurred 9.9 years (5-14 years) after surgery. The results of Cox proportional hazard analysis showed that a canal bone ratio ≥ 0.49 was an independent risk factor for high-degree stress shielding (P = .0075; hazard ratio, 3.981). HHS at the latest follow-up was significantly lower in high-degree stress shielding than in low-degree stress shielding (80.7 and 87.7, respectively; P = .0030). CONCLUSION Preoperative canal bone ratio ≥ 0.49 is independently associated with high-degree stress shielding. In addition, the number of cases with high-degree stress shielding significantly increased over time during a mean 10-year follow-up.
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Nguyen BNT, Hoshino H, Togawa D, Matsuyama Y. Cortical Thickness Index of the Proximal Femur: A Radiographic Parameter for Preliminary Assessment of Bone Mineral Density and Osteoporosis Status in the Age 50 Years and Over Population. Clin Orthop Surg 2018; 10:149-156. [PMID: 29854337 PMCID: PMC5964262 DOI: 10.4055/cios.2018.10.2.149] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/02/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Bone mineral density (BMD) is the indicator of bone quality in at-risk individuals. Along with the fracture risk assessment tool (FRAX), a quick assessment of BMD from routine radiographs may be useful in the case of lacking X-ray absorptiometry data. This study aimed to investigate the correlation of cortical thickness index (CTI) and canal flare index (CFI) with BMD and FRAX and to evaluate their ability to predict femoral neck BMD (nBMD) and FRAX in the general elderly population. METHODS A total of 560 volunteers (age ≥ 50 years) who underwent hip-spine X-ray, BMD scanning and FRAX calculation were retrospectively reviewed. CTI and CFI were measured on anteroposterior radiographs and analyzed for their correlation with BMD and FRAX and for their ability to predict nBMD. The ability of CTI to predict osteoporosis status (OPS) and fracture risk status (FRS) was also investigated and the threshold values were calculated. All the analyses were performed separately on male and female subjects. RESULTS Significant differences in CTI, CFI, nBMD and FRAX between males and females were observed. CTI and CFI demonstrated significant positive correlation with nBMD and FRAX (all p < 0.001) in both males and females. CTI, height, and weight significantly predicted nBMD. CTI statistically predicted OPS and FRS, and the values of 0.56 and 0.62 were computed as CTI thresholds for males and females, respectively. CONCLUSIONS CTI was significantly correlated with nBMD and it predicted nBMD at good prediction levels. Therefore, CTI may be used as a supportive tool in the assessment of OPS and FRS besides BMD and FRAX in clinical practice.
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Affiliation(s)
- Bao NT Nguyen
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironobu Hoshino
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Togawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Uozumi Y, Nagamune K, Oe K. Automated Femoral Stem Canal Fill Ratio Evaluation for Bipolar Hip Arthroplasty in 2D X-Ray Image. JOURNAL OF ADVANCED COMPUTATIONAL INTELLIGENCE AND INTELLIGENT INFORMATICS 2018. [DOI: 10.20965/jaciii.2018.p0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A stem loosening is one of the significant problem in the bipolar hip arthroplasty (BHA), causes a pain and instability of a patient’s hip, and requires a further surgery of BHA. A stem canal fill ratio (SCFR), a general evaluation of the stem loosening, have been clinically studied many; however, a determination of the optimal SCFR evaluation has not been still understood well. A purpose of this study is to propose an automatic and quantitative evaluation of SCFR from BHA hip X-ray image. A proposed method segmented the femoral canal and stem, and evaluated SCFR. In experiments, a proposed method’s accuracy was validated, and six BHA patients’ SCFRs were clinically evaluated (age 88±7 (74–93), one male / five females). In result of the proposed method’s accuracy, the femur canal was 90.60±3.65%, and the stem was 97.83±0.46%; therefore, the proposed method had the accuracy to well evaluate SCFR. Result of six BHA patients’ SCFRs was 63.70±5.62%. In conclusion, the proposed method was able to automatically evaluate SCFR from the hip X-ray image with BHA.
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Scott T, Salvatore A, Woo P, Lee YY, Salvati EA, Gonzalez Della Valle A. Polished, Collarless, Tapered, Cemented Stems for Primary Hip Arthroplasty May Exhibit High Rate of Periprosthetic Fracture at Short-Term Follow-Up. J Arthroplasty 2018; 33:1120-1125. [PMID: 29223405 DOI: 10.1016/j.arth.2017.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/29/2017] [Accepted: 11/05/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cemented stems are designed to follow 1 of 2 principles of fixation: composite beams or slide taper. Stems in the latter category have a collarless, polished, tapered (CPT) design and subside into the cement mantle, creating hoop stresses. We compared the rate of periprosthetic fracture (PPF) of stem designed with these 2 principles of fixation. In addition, we examined radiographic factors that may predispose to the development of PPF. METHODS We retrospectively reviewed all patients who underwent primary THA by a single surgeon using highly polished cemented stems. PPF rates were compared between CPT stems (follow-up, 21 months; standard deviation [SD], 22) and composite beam stems (follow-up, 21.7 months; SD, 26). Demographic data were compared between patients with and without a PPF. Three preoperative radiographic parameters (canal bone ratio [CBR], canal-calcar ratio, and canal flare index), stem alignment, and cement mantle were compared in match-paired patients with and without a PPF (1:34). RESULTS Seven of 1460 THA patients developed a PPF (0.479%); 4 hips of 185 with a CPT stem (2.2%); and 3 of 1275 hips with a composite beam stem (0.23%; P = .0064). Three of the 4 PPFs in the CPT group and none in the composite beam group were classified as Vancouver B2. The CBR in patients with a PPF was 0.50 (SD, 0.07) and 0.43 (SD, 0.07) in the match cohort of hips without PPF (P = .013). CONCLUSION CPT stems may be associated with a higher risk of PPF that often require reoperation. An increased CBR may be a risk factor for postoperative PPF.
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Affiliation(s)
- Trevor Scott
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Anthony Salvatore
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Pauline Woo
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Yuo-Yu Lee
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Eduardo A Salvati
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
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Aslam-Pervez N, Riaz O, Gopal S, Hossain F. Predictors of Intraoperative Fractures during Hemiarthroplasty for the Treatment of Fragility Hip Fractures. Clin Orthop Surg 2018; 10:14-19. [PMID: 29564042 PMCID: PMC5851849 DOI: 10.4055/cios.2018.10.1.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 01/02/2018] [Indexed: 11/07/2022] Open
Abstract
Background The aim of our study was to determine the rate and preoperative predictors of intraoperative fracture (IOF) during hip hemiarthroplasty (HA) in patients who have sustained a fragility hip fracture injury. Methods We reviewed 626 patients who underwent HA at our institution using the National Hip Fracture Database. Various patient- and surgery-related data including demographic information, cement usage, surgeon grade, time to surgery, and operative duration were collected. The metaphyseal diaphyseal index and modified canal bone ratio were measured on preoperative radiographs. We compared patients with and without IOF with respect to all variables collected. Multivariate regression modeling was used to identify significant preoperative risk factors for IOF. Results There was a 7% incidence of IOF in our cohort exclusively comprising of Vancouver A fractures. The majority of these complications were treated nonoperatively (52%). There was no statistically significant difference with respect to cement usage, surgeon grade, operative duration, time to surgery, and radiographic parameters collected. Increasing age was found to be the most significant preoperative risk factor for predicting IOF (p = 0.024, overall relative risk = 1.06). Conclusions Our identified predictor of increasing age is nonmodifiable and illustrates the importance of meticulous surgical technique in older patients. Furthermore, its independence from fixation methods or prosthesis design as a predictor of IOF may support using an uncemented prosthesis in patients at risk from cement implantation.
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Affiliation(s)
- Nayef Aslam-Pervez
- Department of Orthopaedics and Trauma Surgery, Hull Royal Infirmary, Hull, UK
| | - Osman Riaz
- Department of Orthopaedics and Trauma Surgery, Leeds General Infirmary, Leeds, UK
| | - Shivkumar Gopal
- Department of Orthopaedics and Trauma Surgery, Hull Royal Infirmary, Hull, UK
| | - Fahad Hossain
- Department of Orthopaedics and Trauma Surgery, University College London, London, UK
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