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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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Ferreño Márquez DM, Dauder Gallego C, Bebea Zamorano FNG, Sebastián Pérez V, Montejo Sancho J, Martínez Martín J. Long-Term Outcomes of 496 Anatomical Cementless Modular Femoral Stems: Eleven to Twenty Years of Follow-Up. J Arthroplasty 2021; 36:2087-2099. [PMID: 33610406 DOI: 10.1016/j.arth.2021.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of the study is to assess the long-term outcomes of this specific stem (anatomical cementless modular stem ESOP), to review the survivorship, complication rate, and radiographic and clinical outcomes. METHODS Descriptive and analytical retrospective longitudinal observational study of patients was operated on total hip arthroplasty between 1998 and 2007. Four hundred ninety-six prostheses corresponding to 447 patients were reviewed, mean age was 65.8 years (standard deviation [SD] ±11.6 years), and median follow-up time was 13.4 years (range 1-20). The most used cups were cementless (75.8%). The most frequent friction pairs were metal-polyethylene (53.1%) and ceramic-polyethylene (24.2%). Main variables analyzed were stem survival, subsidence, coronal orientation, osteolysis, reintervention, and Oxford Hip Score. RESULTS From 496 implants, there were 22 lost to follow-up (4.4%). Stem revision was performed in 51 patients: 26 periprosthetic joint infections (2-stage revision), 16 periprosthetic fractures, and 8 one-stage revisions (6 real aseptic loosening with negative culture after revision). The stem survivorship at more than 15 years for any reason was 89.2% and for aseptic loosening 97.97%. No specific complications were found due to modularity. The mean subsidence and orientation was 2.06 mm (SD ±5.11 mm) and 0.41° varus (SD ±2.20°) respectively. Subsidence >5 mm or varus >5° was associated with a higher revision rate. Osteolysis was found in 110 patients (zone I = 79, VII = 57), associated with zirconium-polyethylene, without relationship to the stem revision rate or Oxford Hip Score. CONCLUSION To our knowledge, this study represents the largest series of this stem, revealing an excellent survival rate and long-term clinical outcomes similar to the best results of classical cementless stems published in the literature.
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Affiliation(s)
| | | | | | | | - Jorge Montejo Sancho
- Department of Orthopaedic Surgery, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Javier Martínez Martín
- Department of Orthopaedic Surgery, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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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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Pierce TP, Jauregui JJ, Kapadia BH, Elmallah RK, Cherian JJ, Harwin SF, Mont MA. Second-Generation Versus First-Generation Cementless Tapered Wedge Femoral Stems. Orthopedics 2015; 38:550-4. [PMID: 26375526 DOI: 10.3928/01477447-20150902-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/06/2015] [Indexed: 02/03/2023]
Abstract
Clinical outcomes of a new second-generation proximally coated, tapered wedge cementless stem were compared with those of its predecessor regarding (1) all-cause implant survivorship; (2) objective and subjective outcomes; (3) complications; and (4) radiographic features. Patients who underwent a primary total hip arthroplasty with the second-generation stem (68 hips) were compared with those who received the first-generation stem (136 hips) at a mean follow-up of 3.5 years. Although the first-generation stem was designed in the traditional manner, the second-generation stem was shortened to accommodate all surgical approaches and designed using a computed tomography scan-based database to enhance fit. The second-generation stem had survivorship, functional, and subjective outcomes similar to those of the first-generation stem.
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Nam D, Sauber TJ, Barrack T, Johnson SR, Brooks PJ, Nunley RM. Radiographic parameters associated with pain following total hip and surface arthroplasty. J Arthroplasty 2015; 30:495-501. [PMID: 25456636 DOI: 10.1016/j.arth.2014.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/01/2014] [Accepted: 10/01/2014] [Indexed: 02/01/2023] Open
Abstract
Pain following total hip arthroplasty (THA) and surface arthroplasty (SRA) remains a significant source of patient dissatisfaction. Two hundred twenty-four SRA and 196 THA patients completed a pain drawing questionnaire and postoperative radiographic measurements of component positioning were performed. In the SRA cohort, 11 of 21 patients (52%) with acetabular uncoverage of ≥5 mm versus 43 of 147 (29%) with acetabular uncoverage of ≤4.9 mm reported groin pain (P=.03). In the THA cohort, an increased distal-third canal fill ratio and a lower canal calcar ratio trended towards a higher incidence of thigh pain (P=.10 and .06), while a decreased mid-third canal fill ratio was associated with increased severity of thigh pain (P=.04). This study identifies associations between radiographic findings and pain following THA and SRA.
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Affiliation(s)
- Denis Nam
- Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | | | - Toby Barrack
- Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Staci R Johnson
- Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | | | - Ryan M Nunley
- Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
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Kolisek FR, Issa K, Harwin SF, Jaggard C, Naziri Q, Mont MA. Minimum 5-year follow-up for primary THA using a tapered, proximally coated cementless stem. Orthopedics 2013; 36:e633-6. [PMID: 23672917 DOI: 10.3928/01477447-20130426-27] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to assess the survivorship of a proximally coated, cementless femoral stem used for total hip arthroplasty at a minimum 5-year follow-up by assessing clinical outcomes and implant survival. A total of 936 primary total hip arthroplasties were performed in 854 patients by 3 high-volume surgeons between 2001 and 2007. Patients included 385 men and 469 women with a mean age of 56 years (range, 20-88 years) and a mean follow-up of 7 years (range, 5-11 years). The aseptic revision rate related to the femoral component was 0.3%. Three patients underwent revision of the femoral component. Mean postoperative Harris Hip Score improved to 91 points (range, 70-100 points). When stratified by primary cause of total hip arthroplasty, no differences were found in implant survivorship or postoperative Harris Hip Scores. With the exception of the 3 patients who underwent revision surgery, postoperative radiographic evaluation of the stems demonstrated no progressive radiolucencies, component malalignment, change in component position, or implant subsidence at most recent follow-up.These results are encouraging and indicate a 0.3% revision rate for the femoral component. The cause of primary total hip arthroplasty did not affect the clinical outcomes. These types of prostheses will provide patients with a stable implant that is expected to have excellent durability and longevity.
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Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am 2011; 93:500-9. [PMID: 21368083 DOI: 10.2106/jbjs.j.00774] [Citation(s) in RCA: 319] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A number of cementless femoral stems are associated with excellent long-term survivorship. Cementless designs differ from one another in terms of geometry and the means of obtaining initial fixation. Strict classification of stem designs is important in order to compare results among series. Loosening and thigh pain are less prevalent with modern stem designs. Stress-shielding is present in most cases, even with newer stem designs.
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Affiliation(s)
- Harpal S Khanuja
- Center for Joint Preservation and Replacement, The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
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Tannast M, Ecker TM, Murphy SB. Second-generation uncemented stems: excellent 5-13-year results. Arch Orthop Trauma Surg 2009; 129:1691-1700. [PMID: 22803191 DOI: 10.1007/s00402-009-0977-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study was to prospectively evaluate the 5-13-year results of a cementless total hip arthroplasty with a special focus on the survivorship,occurrence of osteolysis, incidence of intraoperative femoral fractures, thigh pain, and cortical hypertrophy of the femoral stem. The femoral component used in this study was titanium fluted, slotted, symmetrical component that was prepared with intraoperative machining. The proximal third of the stem had hydroxyl-apatite coating and horizontal steps. METHODS The clinical and radiographical results of a consecutive series of 157 total hip arthroplasties (124 patients)with this stem were investigated. Minimum follow-up was 5 years. The average age of the patients at the time of surgery was 47 years. Three patients died and ten patients were lost to follow-up, leaving 142 hips for evaluation. The clinical result was evaluated on the basis of the Merled’Aubigné score, complications and thigh pain. A detailed radiographic analysis was performed at each follow-up visit. Kaplan–Meier survivorship analysis was performed to evaluate stem, cup, and bearing survivorship. RESULTS The mean follow-up was 8.5 years (range 5-13 years). The average Merle d’Aubigné score improved from 10.5 points preoperatively to 17.4 points postoperatively.The cumulative 10-year survival rate was 99% for the femoral component, 99% for the acetabular component,and 69% for the bearing. Thigh pain was identified in three patients (2%). There was no distal femoral osteolysis.Seventy-nine percent of all the hips had endosteal spot welds around the coated, proximal one-third of the prosthesis.51% had radio dense lines around the distal tip of the prosthesis,and 3% had cortical hypertrophy. One undersized stem and one cup were revised for aseptic loosening, and 25 bearings were exchanged. CONCLUSIONS Uncemented, machined, fluted titanium canal-filling femoral components achieve reliable fixation in this young patient population. They have a decreased incidence of activity-related thigh pain, lower rate of intraoperative femur fractures and cortical hypertrophy with comparable bone-ingrowth in comparison to other second generation uncemented femoral components described in literature. Bearing wear and the need for bearing exchange was the only limitation of these constructs.
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Affiliation(s)
- Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Murtenstrasse, 3010 Bern, Switzerland.
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Dorr LD, Wan Z, Malik A, Zhu J, Dastane M, Deshmane P. A comparison of surgeon estimation and computed tomographic measurement of femoral component anteversion in cementless total hip arthroplasty. J Bone Joint Surg Am 2009; 91:2598-604. [PMID: 19884433 DOI: 10.2106/jbjs.h.01225] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The intraoperative estimation of the anteversion of the femoral component of a total hip arthroplasty is generally made by the surgeon's visual assessment of the stem position relative to the condylar plane of the femur. Although the generally accepted range of intended anteversion is between 10 degrees and 20 degrees, we suspected that achieving this range of anteversion consistently during cementless implantation of the femoral component was more difficult than previously thought. METHODS We prospectively evaluated the accuracy of femoral component anteversion in 109 consecutive total hip arthroplasties (ninety-nine patients), in which we implanted the femoral component without cement. In all hips, we measured femoral stem anteversion postoperatively with three-dimensional computed tomography reconstruction of the femur, using both the distal femoral epicondyles and the posterior femoral condyles to determine the femoral diaphyseal plane. The bias and precision of the measurements were calculated. RESULTS The surgeon's estimate of femoral stem anteversion was a mean (and standard deviation) of 9.6 degrees +/- 7.2 degrees (range, -8 degrees to 28 degrees). The anteversion of the stem measured by computed tomography was a mean of 10.2 degrees +/- 7.5 degrees (range, -8.6 degrees to 27.1 degrees) (p = 0.324). The correlation coefficient between the surgeon's estimate and the computed tomographic measurement was 0.688; the intraclass coefficient was 0.801. Anteversion measured by computed tomography found that forty-nine stems (45%) were between 10 degrees and 20 degrees of anteversion; forty-three stems (39%) were between 0 degree and 9 degrees of femoral anteversion; eight stems (7%) were in anteversion of >20 degrees; and nine stems (8%) were in retroversion. CONCLUSIONS The surgeon's estimation of the anteversion of the cementless femoral stem has poor precision and is often not within the intended range of 10 degrees to 20 degrees of anteversion. The implications of this finding increase the importance of achieving a safe range of motion by evaluating the combined anteversion of the stem and the cup.
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Affiliation(s)
- Lawrence D Dorr
- The Arthritis Institute at Good Samaritan Hospital, 637 South Lucas Avenue, 5th Floor, Los Angeles, CA 90017, USA.
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Lombardi AV, Berend KR, Mallory TH, Skeels MD, Adams JB. Survivorship of 2000 tapered titanium porous plasma-sprayed femoral components. Clin Orthop Relat Res 2009; 467:146-54. [PMID: 18975042 PMCID: PMC2600990 DOI: 10.1007/s11999-008-0568-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 09/26/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Tapered titanium porous plasma-sprayed components have performed well in primary THA. To confirm the literature at longer followup we retrospectively reviewed all 1639 patients who underwent 2000 THAs in which a specific porous femoral component was used. One hundred fourteen patients (134 hips) were lost to followup leaving a cohort of 1525 patients (1866 THAs). The component is a tapered titanium plasma spray-coated design that remained relatively unchanged since its first implantation except for circumferential proximal porous coating added in 1986 and an offset option added in 1999. Minimum followup was 24 months (average, 119 months; range, 24 to 275 months). To date there have been 39 femoral revisions for an implant survival of 98%. Using the Kaplan-Meier method, cumulative survival with any stem revision as the end point was 98.6% at 5 years, 98.4% at 10 years, 97.1% at 15 years, and 95.5% at 20 years. Using aseptic revision for failure of ingrowth as the endpoint, stem survival was 99.1%. Kaplan-Meier cumulative survival with aseptic revision for failure of ingrowth as the endpoint was 99.4% at 5 years, 99.3% at 10, 15 and 20 years. Harris hip pain and total scores improved. This titanium, porous plasma spray-coated femoral component continues to demonstrate high long-term survival with a low rate of component revision for any reason or aseptic failure of ingrowth. LEVEL OF EVIDENCE Level IV, therapeutic study (case series). See the Guidelines for Authors for a complete description of levels of evidence.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Arthritis, Rheumatoid/diagnostic imaging
- Arthritis, Rheumatoid/surgery
- Arthroplasty, Replacement, Hip
- Coated Materials, Biocompatible
- Female
- Femur Head/diagnostic imaging
- Femur Head/surgery
- Femur Head Necrosis/diagnostic imaging
- Femur Head Necrosis/surgery
- Follow-Up Studies
- Hip Dislocation, Congenital/diagnostic imaging
- Hip Dislocation, Congenital/surgery
- Hip Prosthesis
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Osteoarthritis, Hip/diagnostic imaging
- Osteoarthritis, Hip/surgery
- Prosthesis Failure
- Radiography
- Reoperation
- Retrospective Studies
- Titanium
- Young Adult
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Dorr LD, Malik A, Dastane M, Wan Z. Combined anteversion technique for total hip arthroplasty. Clin Orthop Relat Res 2009; 467:119-27. [PMID: 18979146 PMCID: PMC2600986 DOI: 10.1007/s11999-008-0598-4] [Citation(s) in RCA: 306] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 10/14/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Combined cup and stem anteversion in THA based on femoral anteversion has been suggested as a method to compensate for abnormal femoral anteversion. We investigated the combined anteversion technique using computer navigation. In 47 THAs, the surgeon first estimated the femoral broach anteversion and validated the position by computer navigation. The broach was then measured with navigation. The navigation screen was blocked while the surgeon estimated the anteversion of the broach. This provided two estimates of stem anteversion. The navigated stem anteversion was validated by postoperative CT scans. All cups were implanted using navigation alone. We determined precision (the reproducibility) and bias (how close the average test number is to the true value) of the stem position. Comparing the surgeon estimate to navigation anteversion, the precision of the surgeon was 16.8 degrees and bias was 0.2 degrees ; comparing the navigation of the stem to postoperative CT anteversion, the precision was 4.8 degrees and bias was 0.2 degrees , meaning navigation is accurate. Combined anteversion by postoperative CT scan was 37.6 degrees +/- 7 degrees (standard deviation) (range, 19 degrees -50 degrees ). The combined anteversion with computer navigation was within the safe zone of 25 degrees to 50 degrees for 45 of 47 (96%) hips. Femoral stem anteversion had a wide variability. LEVEL OF EVIDENCE Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lawrence D. Dorr
- The Arthritis Institute at Good Samaritan Hospital, 637 S. Lucas Avenue, 5th Floor, Los Angeles, CA 90017 USA
| | - Aamer Malik
- The Arthritis Institute at Good Samaritan Hospital, 637 S. Lucas Avenue, 5th Floor, Los Angeles, CA 90017 USA
| | - Manish Dastane
- The Arthritis Institute at Good Samaritan Hospital, 637 S. Lucas Avenue, 5th Floor, Los Angeles, CA 90017 USA
| | - Zhinian Wan
- The Arthritis Institute at Good Samaritan Hospital, 637 S. Lucas Avenue, 5th Floor, Los Angeles, CA 90017 USA
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Incavo SJ, Beynnon BD, Coughlin KM. Total hip arthroplasty with the Secur-Fit and Secur-Fit plus femoral stem design a brief follow-up report at 5 to 10 years. J Arthroplasty 2008; 23:670-6. [PMID: 18534379 DOI: 10.1016/j.arth.2007.05.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 05/28/2007] [Indexed: 02/01/2023] Open
Abstract
This report represents a 5- to 10-year follow-up of our initial 2- to 5-year data with this proximally hydroxyapatite-coated stem design (Secur-Fit, Stryker Orthopaedics, Mahwah, NJ). This is a retrospective review of a single surgeon's consecutive cases. A total of 105 cases were available for complete review. The average follow-up was 6.7 years (60-123 months). All stems achieved bony ingrowth. Harris hip score and Oxford hip score averaged to 91 and 17, respectively, with no differences seen between the 132 degrees and the 127 degrees stem designs. Leg length measurements were considered equal side-to-side differences of 7 mm or less in 87% of cases: 82% of standard- and 92% of high-offset cases (P < .05). Four cases of osteolysis were identified and occurred only in patients with an elevated rim liner, implicating neck-liner impingement. The stem design performed exceedingly well over the course of this study. Having a high-offset option aids the surgeon in proper leg length management.
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Affiliation(s)
- Stephen J Incavo
- Department of Orthopaedic Surgery, The Methodist Hospital, Houston, Texas 77030, USA
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