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Meyer M, Leiß F, Götz JS, Holzapfel DE, Grifka J, Weber M. Bone Mineral Density is Associated With Adverse Events but not Patient-Reported Outcomes in Total Hip and Knee Arthroplasty. J Arthroplasty 2024; 39:320-325. [PMID: 37607640 DOI: 10.1016/j.arth.2023.08.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Although osteoporosis is common in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA), its impact on postoperative outcomes has been inadequately studied. The purpose of this study was to evaluate the impact of bone mineral density (BMD) on adverse events and patient-reported outcomes in THA and TKA. METHODS A series of 1,306 THA and 1,046 TKA patients who had received osteodensitometry were analyzed retrospectively. Rates of readmission, complication, transfusion, and patient-reported outcome were correlated with BMD. Multivariable logistic regression models were used to assess the relationship between osteoporosis and adverse events. RESULTS Osteoporosis patients showed higher rates of 90-day readmission (THA: 8.5% versus 4.0%, P = .02; TKA: 8.9% versus 4.4%, P = .04) and transfusion (THA: 6.8% versus 1.2%, P < .001; TKA: 5.4% versus 1.5%, P = .005). After THA, rates of complications requiring intensive care management (5.1% versus 0.7%, P < .001) and rates of medical complications (3.5% versus 0.6%, P = .001) were increased. After TKA, rates of surgical complications (2.8% versus 0.8%, P = .04) were increased. Postoperatively, osteoporosis patients improved to comparable patient-reported outcomes as patients who had normal BMD. Multivariable logistic regression analyses revealed osteoporosis as an independent risk factor for readmissions, complications, and transfusions. CONCLUSION Osteoporosis is a risk factor for adverse events after THA and TKA. Affected patients show similar improvement of patient-reported outcome compared to patients who have normal BMD. As osteoporosis is modifiable, a systematic screening of patients scheduled for THA or TKA should be discussed.
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Affiliation(s)
- Matthias Meyer
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Franziska Leiß
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Julia S Götz
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Dominik E Holzapfel
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Markus Weber
- Department of Orthopaedic Surgery, Hospital of the Order of Merciful Brothers, Regensburg, Germany
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Fiedler B, Patel V, Lygrisse KA, Kelly ME, Turcotte JJ, MacDonald J, Schwarzkopf R. The effect of reduced bone mineral density on elective total hip arthroplasty outcomes. Arch Orthop Trauma Surg 2023; 143:5993-5999. [PMID: 36920526 DOI: 10.1007/s00402-023-04830-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Reduced bone mineral density (BMD) and disruption of normal bony architecture are the characteristics of osteopenia and osteoporosis and in patients undergoing total hip arthroplasty (THA) may cause failure of trabecular ingrowth. The purpose of this study is to evaluate the impact of reduced BMD on outcomes following primary elective THA. METHODS A retrospective chart review of 650 elective THAs with a DEXA scan in their electronic health record (EHR) from 2011 to 2020 was conducted at an urban, academic center and a regional, health center. Patients were separated into three cohorts based on their t-score and the World Health Organizations definitions: normal (t-score ≥ - 1), osteopenia (t-score < - 1.0 and > - 2.5), and osteoporosis (t-score ≤ - 2.5). Demographic and outcome data were assessed. Subsidence was assessed for patients with non-cemented THAs. Regression models were used to account for demographic differences. RESULTS 650 elective THAs, of which only 11 were cemented, were included in the study. Patients with osteopenia and osteoporosis were significantly older than those without (p = 0.002 and p < 0.0001, respectively) and had a lower BMI (p < 0.0001 and p < 0.0001, respectively). PFx was significantly greater in patients with osteoporosis when compared to those with normal BMD (6.5% vs. 1.0%; p = 0.04). No such difference was found between osteoporotic and osteopenic patients. The revision rate was significantly higher for osteoporotic patients than osteopenic patients (7.5% vs. 1.5%; p = 0.04). No such difference was found between the other comparison groups. CONCLUSION Patients with osteoporosis were older with reduced BMI and had increased PFx after non-cemented elective THA. Understanding this can help surgeons formulate an appropriate preoperative plan for the treatment of patients with osteoporotic bone undergoing elective THA.
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Affiliation(s)
- Benjamin Fiedler
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA
| | - Vaidehi Patel
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA
| | - Katherine A Lygrisse
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA
| | - McKayla E Kelly
- Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Justin J Turcotte
- Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - James MacDonald
- Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA.
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Behforootan S, Thorniley M, Minonzio JG, Boughton O, Karia M, Bhattacharya R, Hansen U, Cobb J, Abel R. Can guided wave ultrasound predict bone mechanical properties at the femoral neck in patients undergoing hip arthroplasty? J Mech Behav Biomed Mater 2022; 136:105468. [PMID: 36244325 DOI: 10.1016/j.jmbbm.2022.105468] [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: 06/26/2022] [Revised: 08/30/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022]
Abstract
The bone quality of patients undergoing hip replacement surgery is poorly predicted by radiographs alone. With better bone quality information available to a surgeon, the operation can be performed more safely. The aim of this study was to investigate whether ultrasound signals of cortical bone at peripheral sites such as the tibia and radius can be used to predict the compressive mechanical properties of cortical bone at the femoral neck. We recruited 19 patients undergoing elective hip arthroplasty and assessed the radius and tibia of these patients with the Azalée guided wave ultrasound to estimate the porosity and thickness of the cortex. Excess bone tissues were collected from the femoral neck and the compressive mechanical properties of the cortex were characterised under a mechanical loading rig to determine stiffness, ultimate strength, and density. The correlations between the ultrasound measurements and mechanical properties were analysed using linear regression, Pearson correlation statistics, and multiple regression analysis. Cortical mechanical properties were weakly to moderately correlated with the ultrasound measurements at various sites (R2 = 0.00-0.36). The significant correlations found were not consistent across all 4 peripheral measurement sites. Additionally, weak to moderate ability of the ultrasound to predict mechanical properties at the neck of femur with multiple regression analysis was found (R2 = 0.00-0.48). Again, this was inconsistent across the different anatomical sites. Overall, the results demonstrate the need for ultrasound scans to be collected directly from clinically relevant sites such as the femoral neck due to the inconsistency of mechanical properties across various sites.
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Affiliation(s)
- Sara Behforootan
- MSK Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK.
| | - Madelaine Thorniley
- MSK Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - Jean-Gabriel Minonzio
- Escuela de Ingeniería Informática, Centro de Investigación y Desarrollo en Ingeniería en Salud, Universidad de Valparaíso, Valparaíso, Chile & Sorbonne Université, INSERM UMR S 1146, CNRS UMR 7371, Laboratoire d'Imagerie Biomédicale, Paris, France
| | - Oliver Boughton
- MSK Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - Monil Karia
- MSK Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | | | - Ulrich Hansen
- Department of Mechanical Engineering, Faculty of Engineering, Imperial College London, UK
| | - Justin Cobb
- MSK Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - Richard Abel
- MSK Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
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Jain S, Parashar V. Analytical review on the biocompatibility of surface-treated Ti-alloys for joint replacement applications. Expert Rev Med Devices 2022; 19:699-719. [PMID: 36240236 DOI: 10.1080/17434440.2022.2132146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION With the advancement of joint replacements such as total hip replacement (THR), Titanium (Ti) and its alloys are widely used as implant materials. The bearing surface of Ti improves the longevity of implants. In this perception, researchers design a Ti-alloy that increases the wear and corrosion resistance to enhance osteogenesis and mechanical stability. AREAS COVERED : This paper is dedicated to finding the major causes of the failure of THR. Further, this paper provides an overview of the application of metallic alloys and their influencing factors that influence biocompatibility. The most contributing part of this paper focuses on the post-treatment impact on Ti-alloys biocompatibility. EXPERT OPINION This paper revealed and discussed that Ti alloys' biocompatibility for orthopedic applications mainly depends on antibacterial activities that decide tissue-implant compatibility. Therefore, performing surface treatment enhances the biocompatibility of Ti alloys. It was also observed that more water contact angle (WCA) induces bacterial growth and enhances cell adhesion. In contrast, the treated surface increases the antibacterial activities at lower WCA. Surface heat treatment with sintering or micro-arc oxidation achieves suitable antibacterial or antimicrobial activities.
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Affiliation(s)
- Shubham Jain
- Department of Mechanical Engineering, MANIT, Bhopal,462003, India
| | - Vishal Parashar
- Department of Mechanical Engineering, MANIT, Bhopal,462003, India
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Artificial Neural Networks Can Predict Early Failure of Cementless Total Hip Arthroplasty in Patients With Osteoporosis. J Am Acad Orthop Surg 2022; 30:467-475. [PMID: 35202042 DOI: 10.5435/jaaos-d-21-00775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/18/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) done in the aging population is associated with osteoporosis-related complications. The altered bone density in osteoporotic patients is a risk factor for revision surgery. This study aimed to develop and validate machine learning (ML) models to predict revision surgery in patients with osteoporosis after primary noncemented THA. METHODS We retrospectively reviewed a consecutive series of 350 patients with osteoporosis (T-score less than or equal to -2.5) who underwent primary noncemented THA at a tertiary referral center. All patients had a minimum 2-year follow-up (range: 2.1 to 5.6). Four ML algorithms were developed to predict the probability of revision surgery, and these were assessed by discrimination, calibration, and decision curve analysis. RESULTS The overall incidence of revision surgery was 5.2% at a mean follow-up of 3.7 years after primary noncemented THA in osteoporotic patients. Revision THA was done because of periprosthetic fracture in nine patients (50%), aseptic loosening/subsidence in five patients (28%), periprosthetic joint infection in two patients (11%) and dislocation in two patients (11%). The strongest predictors for revision surgery in patients after primary noncemented THA were female sex, BMI (>35 kg/m2), age (>70 years), American Society of Anesthesiology score (≥3), and T-score. All four ML models demonstrated good model performance across discrimination (AUC range: 0.78 to 0.81), calibration, and decision curve analysis. CONCLUSION The ML models presented in this study demonstrated high accuracy for the prediction of revision surgery in osteoporotic patients after primary noncemented THA. The presented ML models have the potential to be used by orthopaedic surgeons for preoperative patient counseling and optimization to improve the outcomes of primary noncemented THA in osteoporotic patients.
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Abstract
There is a high prevalence of osteoporosis in patients undergoing total hip arthroplasty. There are several clinically relevant questions related to the management of such cases: the effect of ageing; the initial osseointegration of implants, especially when cementless THA is used; the effect of medical osteoporosis treatment on bone-implant interface; the incidence of intraoperative and late periprosthetic fractures, and the long-term survival of both cemented and cementless total hip arthroplasty performed for proximal femoral fractures and hip osteoarthritis. A critical review of the literature is presented in an attempt to draw practical conclusions.
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Affiliation(s)
- Theofilos S Karachalios
- Orthopaedic Department, University General Hospital of Larissa, Larissa, Hellenic Republic (Greece).,School of Health Sciences, Faculty of Medicine, University of Thessalia, Biopolis Mezourlo Region, Larissa, Hellenic Republic (Greece)
| | - Antonios A Koutalos
- Orthopaedic Department, University General Hospital of Larissa, Larissa, Hellenic Republic (Greece)
| | - George A Komnos
- Orthopaedic Department, University General Hospital of Larissa, Larissa, Hellenic Republic (Greece)
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Lee SJ, Yoon KS. Favorable Functional Recovery and Stem Stability after Hip Arthroplasty with a Short Metaphyseal Stem in Elderly Patients with Osteoporotic Femoral Neck Fractures. Hip Pelvis 2019; 31:11-17. [PMID: 30899710 PMCID: PMC6414405 DOI: 10.5371/hp.2019.31.1.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/06/2019] [Accepted: 01/28/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Short stems have recently become widely used; however, concerns about the initial secure fixation of a short stem in osteoporotic bone remain. The aim of this study was to evaluate the short-term clinical and radiological results of using a short cementless metaphyseal stabilizing tapered stem for senile osteoporotic femoral neck fractures. Materials and Methods Thirty-eight arthroplasties (31 bipolar hemiarthroplasties and 7 total hip arthroplasties) were performed for osteoporotic femoral neck fractures in patients older than 65 years (10 males and 28 females). The mean age was 76.1 years and the mean follow-up was 2.9 years. We retrospectively evaluated clinical results, focusing on walking performance, thigh pain, and radiologic results, with special regard to signs of stem stability and osteointegration. Results Mean Harris hip score was 84.3 points and 68.4% of patients regained their preoperative walking performance. No patients complained about thigh pain. No osteolysis or loosening was observed during the follow-up, and all but 1 stem showed signs of stable bone ingrowth. Conclusion Short, metaphyseal stabilizing tapered stems could be a reliable treatment option for osteoporotic femoral neck fractures.
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Affiliation(s)
- Soong Joon Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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8
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Boymans TA, Heyligers IC, Grimm B. Discrepancy and contradiction regarding fixation of hip stems with or without cement: survey among 765 hip arthroplasty specialists. Hip Int 2018; 28:514-521. [PMID: 29808731 DOI: 10.1177/1120700018778963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The growing use of cementless stems is associated with an increase in implant-related complications. This global survey study investigates which parameters orthopaedic surgeons currently consider for either cemented or cementless stem fixation in primary total hip arthroplasty (THA). METHODS A survey regarding current practice patterns was distributed among hip arthroplasty specialists. Key questions concerned: (i) frequency of using cemented/cementless stems; (ii) frequency of using parameters which influence a choice between both; (iii) usage of specific cut-off values for parameters. RESULTS 507 (out of 765) respondents, having at least 5 years' experience and performing at least 50 cases a year, were selected for analysis. Respondents using both fixation techniques ( n = 413; 81%) use a cementless stem in 69% and a cemented stem in 31%. The choice is most frequently based on: (i) patient age; (ii) cortical thickness; (iii) femoral canal shape; (iv) bone mineral density; and (v) stem fit on preoperative templating. 57% using both fixation techniques do not use a specific cut-off value for age. 92% of the respondents that do use a cut-off value for age use exclusively cemented stems in patients being ⩾72.7 years (median 75; range 50-90 years). Considerable discrepancy and even contradictory responses were present regarding the other parameters and the use of specific cut-off values. CONCLUSIONS Current practice patterns regarding stem fixation in primary THA vary substantially among orthopaedic surgeons. Evidence-based guidelines are needed to define which parameters and threshold values support the best individual choice for hip stem fixation.
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Affiliation(s)
- Tim Aej Boymans
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Ide C Heyligers
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Bernd Grimm
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
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The Importance of Bone Mineral Density in Hip Arthroplasty: Results of a Survey Asking Orthopaedic Surgeons about Their Opinions and Attitudes Concerning Osteoporosis and Hip Arthroplasty. Adv Orthop 2016; 2016:8079354. [PMID: 27999686 PMCID: PMC5141559 DOI: 10.1155/2016/8079354] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/02/2016] [Indexed: 01/25/2023] Open
Abstract
Objective. In patients scheduled to undergo total joint arthroplasty of the hip, the bone quality around the joint affects the safety of prosthetic implantation. Bone strength is clinically assessed by measuring bone mineral density (BMD); therefore we asked if BMD is important to orthopaedic surgeons performing hip arthroplasty. Methods. In a 14-question survey, we asked about treatment patterns with respect to BMD, osteoporosis work-up, and treatment for patients with low BMD scheduled to undergo hip arthroplasty. Results. 72% of all asked orthopaedics reported to use cementless implants as a standard in hip arthroplasty. Over 60% reported that low BMD is a reason to reconsider operation strategies, but only 4% performed BMD measurement preoperatively. 26% would change their treatment strategy in case of a BMD (T-Score) between −1.5 and −2 and 40% in case of a T-score between −2 and −2.5, and 29% would change their intraoperative strategy if a T-score smaller than −2.5 was measured. Conclusion. The majority of orthopaedic surgeons who responded to the survey reported that they do not perform routine measurement of BMD before arthroplasty. However, most surgeons commented that low bone mineral density will influence their surgical plan and the implant design.
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Seo JS, Shin SK, Jun SH, Cho CH, Lim BH. The Early Result of Cementless Arthroplasty for Femur Neck Fracture in Elderly Patients with Severe Osteoporosis. Hip Pelvis 2014; 26:256-62. [PMID: 27536590 PMCID: PMC4971402 DOI: 10.5371/hp.2014.26.4.256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose The purposes of the current study were to assess the early results of cementless hip arthroplasty (HA) for femoral neck fractures in elderly patients with severe osteoporosis and to compare the clinical outcomes between those who underwent total HA (THA) or bipolar hemiarthroplasty (BHA). Materials and Methods From April 2011 to May 2012, we performed 87 cementless HAs for displaced femoral neck fractures in elderly patients (≥65 years) with severe osteoporosis. Among them, we studied 70 hips that were able to be followed-up for >24 months. Of these, 34 underwent THA and 36 underwent BHA. Clinical results were evaluated using the Harris hip score (HHS), Koval classification, and radiographs. Results Only one instance of femoral stem loosening was observed. Additionally, no dislocations were observed and no revision surgeries were required. The mean changes in the functional items of the HHS scores were 2.8 and 5.2 for those who underwent THA and BHA, respectively (P<0.05). According to the Koval classification used for the ambulatory status analysis, the mean perioperative change in the grade was 0.8 (0-4), with no significant differences noted between the THA and BHA groups. Conclusion The early results of cementless HA for femur neck fractures in elderly patients with osteoporosis were satisfactory, and THA was found to have a functional advantage over BHA.
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Affiliation(s)
- Jae-Seong Seo
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
| | - Seong-Kee Shin
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
| | - Sung-Han Jun
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
| | - Chang-Ho Cho
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
| | - Byung Ho Lim
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
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Lee YK, Joung HY, Kim SH, Ha YC, Koo KH. Cementless bipolar hemiarthroplasty using a micro-arc oxidation coated stem in patients with displaced femoral neck fractures. J Arthroplasty 2014; 29:2388-92. [PMID: 24851787 DOI: 10.1016/j.arth.2014.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/17/2014] [Accepted: 04/16/2014] [Indexed: 02/01/2023] Open
Abstract
Femoral stem fixation for displaced femoral neck fractures in osteoporotic patients is an ongoing debate. We evaluated the outcome of 136 cementless bipolar hemiarthroplasty using a Micro-arc oxidation (MAO) coated stem. All patients survived the procedure and were discharged from the hospital. Thirty- and 90-day mortality rates were 0.7% and 2.2%, respectively. Ninety-eight hips were followed for a minimum of 2years (mean, 44months) postoperatively. Three stems were revised because of a periprosthetic fracture. Although cortical stress shielding around the stem was observed in 3 hips, there was no loosening or osteolysis. Cementless bipolar hemiarthroplasty using a MAO-coated stem is a useful and safe option to treat displaced femoral neck fractures.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam 463-707, South Korea
| | - Ho-Yun Joung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam 463-707, South Korea
| | - Sang-Hwan Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam 463-707, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam 463-707, South Korea
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12
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High early failure rate after cementless hip replacement in the octogenarian. Clin Orthop Relat Res 2014; 472:2779-89. [PMID: 24771260 PMCID: PMC4117887 DOI: 10.1007/s11999-014-3641-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 04/09/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Use of cementless hip replacements is increasing in many countries, but the best method for fixation for octogenarian patients remains unknown. QUESTIONS/PURPOSES We studied how fixation method (cemented, cementless, hybrid) affects the survival of primary hip replacements and mortality in patients 80 years or older. Specifically, we asked if fixation method affects (1) the risk of revision; (2) the reasons for revision; and (3) the mortality after contemporary primary hip replacement in octogenarian patients. METHODS A total of 4777 primary total hip replacements were performed in 4509 octogenarian patients with primary osteoarthritis in Finland between 1998 and 2009 and were registered in the Finnish Arthroplasty Register. Comorbidity data were collected from a nationwide quality register. Survival of hip replacements, using any revision as the end point, and mortality were analyzed using competing risks survival analysis and Cox regression analysis. The average followup was 4 years (range, 1-13 years). RESULTS Cementless hip replacements were associated with a higher rate of early (within 1 year) revision compared with cemented hip replacements (hazard ratio, 2.9; 95% CI, 1.7-5.1), particularly in women. The difference was not explained by comorbidity or provider-related factors. Periprosthetic fracture was the leading mode of failure of cementless hip replacements. After 1 year, there were no differences in the survival rates although 10-year survival was slightly lower for cementless than cemented and hybrid hip replacements (93.9% [95% CI, 91.1%-96.7%] versus 97.4% [95% CI, 96.9%-98.0%] and 98.1% [95% CI, 96.9%-99.4%], respectively). Fixation method was not associated with mortality. CONCLUSIONS Cementless fixation was associated with an increased risk of revision and did not provide any benefit in terms of lower mortality in octogenarian patients. LEVEL OF EVIDENCE Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Berstock JR, Whitehouse MR, Piper DC, Eastaugh-Waring SJ, Blom AW. A 5-8 year retrospective follow-up of the C-stem AMT femoral component: patient reported outcomes and survivorship analysis. J Arthroplasty 2014; 29:1753-7. [PMID: 24891001 DOI: 10.1016/j.arth.2014.04.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/06/2014] [Accepted: 04/27/2014] [Indexed: 02/01/2023] Open
Abstract
We report midterm functional, radiographic and survivorship data for the cemented, triple taper C-stem AMT femoral component from a consecutive cohort of 415 hip arthroplasties in 386 patients at a non-developer centre. Follow-up ranges were from 60 to 99 months, with a mean of 76 months. 32 hips were lost to follow-up. The median OHS was 40, median SF-12 mental component score (MCS) was 50, and median SF-12 physical component score (PCS) was 39. At 99 months follow up, stem survivorship is 96.9% (95% confidence interval (CI) 82.5-99.5), and construct survivorship is 96.0% (95% CI 84.2-99.0). Adverse events such as calcar fracture, greater trochanter fracture and dislocation were rare at <1%. There have been no revisions for aseptic loosening.
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Affiliation(s)
- James R Berstock
- University of Bristol Musculoskeletal Research Unit, AOC (Lower Level), Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Michael R Whitehouse
- University of Bristol Musculoskeletal Research Unit, AOC (Lower Level), Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Danielle C Piper
- University of Bristol Musculoskeletal Research Unit, AOC (Lower Level), Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Stephen J Eastaugh-Waring
- University of Bristol Musculoskeletal Research Unit, AOC (Lower Level), Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Ashley W Blom
- University of Bristol Musculoskeletal Research Unit, AOC (Lower Level), Southmead Hospital, Westbury-on-Trym, Bristol, UK
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Oh KJ, Mishra A, Yang JH. Radiologic bone remodeling pattern around DCPD-coated, metaphyseal-loading cementless short stems in elderly patients. Orthopedics 2014; 37:e649-55. [PMID: 24992060 DOI: 10.3928/01477447-20140626-57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/27/2013] [Indexed: 02/03/2023]
Abstract
Concerns exist regarding using short stems during total hip arthroplasties performed in elderly patients. For this study, the authors assessed sequential bone remodeling findings in metaphyseal-loading short stems using serial radiography. A total of 100 consecutive primary THAs using short stems were performed in patients with an average age of 78.3 years. The presence and patterns of radiolucent lines, radiopaque lines, calcar rounding, proximal bone resorption, spot welds, cortical hypertrophy, and intramedullary bone formation around the distal tip were assessed. The final study group comprised 92 hips, and mean follow-up was 60±3 months (range, 48-72 months). At final follow-up, condensations of spot welds were noted in 84 (91.3%) hips. Spot weld formation occurred in all zones except 1 and 4. Calcar rounding was observed in 90 (97.8%) hips. Atrophy of the calcar was noted in 19 (20.6%) hips. Analysis of the proximal zones revealed reactive radiodense lines in zones 1 and 2 (tensile area/shoulder of stem) in 22 (23.9%) hips. A prominent reactive line around the tip of the stem was recorded in 32 (34.8%) hips on radiographs at final follow-up. However, there was no increase in space between the tip of the stem and the radiopaque line. No acetabular or femoral component migrated by more than 1 mm at final follow-up. No acetabular or femoral osteolysis was identified. The radiographic findings of metaphyseal-loading short stems in elderly patients suggest that 91.3% of implants were osseointegrated. No patient required stem revision. Metaphyseal-loading short stems in elderly patients provide continued fixation with adaptive bone remodeling.
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