1
|
Herzberg R, Tracey OC, Tahvilian S, Baksh N, Zikria B, Naziri Q. Incidence of heterotopic ossification following total hip arthroplasty by approach: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2089-2098. [PMID: 38536499 DOI: 10.1007/s00590-024-03896-9] [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: 09/28/2023] [Accepted: 02/28/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Heterotopic ossification (HO) formation has been increasingly recognized as a complication of major orthopedic surgeries, particularly total hip arthroplasty (THA). Though, the overall incidence of HO following THA has been well-documented, it is often not reported by severity or by surgical approach. QUESTIONS/PURPOSES (1) What are the demographics of patients with HO? (2) What is the severity of HO following THA using the Brooker classification? (3) What is the incidence and class of HO following different THA approaches (anterior, posterior, posterolateral, anterolateral, superior, lateral, trans-gluteal)? (4) What are the number and training level of surgeons who performed each procedure? METHODS The PubMed, Embase, and Web of Science databases were queried, and PRISMA guidelines were followed. Qualitative and quantitative analyses were performed using Microsoft Excel. RESULTS We isolated 26 studies evaluating 6512 total hip arthroplasties (THA). The mean HO percentage overall was 28.8%, mostly Class I (54.2%) or Class II (29.6%). The highest percentage of HO was associated with the modified direct lateral (57.2%) and the traditional lateral (34.6%) approaches. The lowest HO percentages were identified following posterolateral (12.8%) and direct superior approaches (1%). Most studies reported a singular senior surgeon operating within the same approach for all patients. CONCLUSIONS The traditional lateral and modified direct lateral approaches to THA resulted in the highest percentage of HO postoperatively. However, most ossification cases were not clinically significant and did not strongly affect overall patient morbidity. Further studies are warranted to identify an association between severity of ossification and different arthroplasty approaches.
Collapse
Affiliation(s)
- Rex Herzberg
- Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Olivia C Tracey
- Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Shahriar Tahvilian
- Touro College of Osteopathic Medicine, 230 W 125th St 3rd Floor, New York, NY, 10027, USA
| | - Nayeem Baksh
- Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Bashir Zikria
- Department of Orthopedic Surgery, Johns Hopkins Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Qais Naziri
- Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA.
| |
Collapse
|
2
|
Formica M, Zanirato A, Bori E, Revetria TA, Ditting J, Innocenti B. Biomechanical analysis of different THA cementless femoral stem designs in physiological and osteoporotic bone during static loading conditions. Arch Orthop Trauma Surg 2024; 144:917-926. [PMID: 37796284 DOI: 10.1007/s00402-023-05080-w] [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: 06/27/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The influence of THA stem design on periprosthetic femoral fractures (PFFs) risk is subject of debate. This study aims to compare the effects of different cementless stem designs on stress-strain distributions in both physiological and osteoporotic femur under various loading conditions. MATERIALS A biomechanical study using finite-element analysis was conducted. Four models were developed: three with implanted femurs and a native one chosen as control. Each model was analyzed for both healthy and osteoporotic bone. The following stem designs were examined: short anatomical stem with femoral neck preservation, double-wedge stem, and anatomical standard stem. Three loading conditions were assessed: gait, sideways falling, and four-point bending. RESULTS During gait in physiological bone, the anatomical stem and the short anatomical stem with femoral neck preservation showed stress distribution similar to the native model. The double-wedge stem reduced stress in the proximal area but concentrated it in the meta-diaphysis. In osteoporotic bone, the double-wedge stem design increased average stress by up to 10%. During sideways falling, the double-wedge stem exhibited higher stresses in osteoporotic bone. No significant differences in average stress were found in any of the studied models during four-point bending. CONCLUSION In physiological bone, anatomical stems demonstrated stress distribution comparable to the native model. The double-wedge stem showed uneven stress distribution, which may contribute to long-term stress shielding. In the case of osteoporotic bone, the double-wedge stem design resulted in a significant increase in average stress during both gait and sideways falling, potentially indicating a higher theoretical risk of PFF.
Collapse
Affiliation(s)
- Matteo Formica
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università Degli Studi di Genova, Viale Benedetto XV N°6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, UO Clinica Ortopedica, Largo Rosanna Benzi N° 10, 16132, Genoa, Italy
| | - Andrea Zanirato
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università Degli Studi di Genova, Viale Benedetto XV N°6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, UO Clinica Ortopedica, Largo Rosanna Benzi N° 10, 16132, Genoa, Italy
| | - Edoardo Bori
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium.
| | - Tullio Andrea Revetria
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università Degli Studi di Genova, Viale Benedetto XV N°6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, UO Clinica Ortopedica, Largo Rosanna Benzi N° 10, 16132, Genoa, Italy
| | - Juljana Ditting
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
| |
Collapse
|
3
|
Thöne P, Gruber MS, Kindermann H, Gussner W, Sadoghi P, Ortmaier R. Stem Design in Total Hip Arthroplasty Influences Ipsilateral Knee Valgus: A Retrospective Comparative Analysis of 2953 Cases. J Clin Med 2023; 12:6662. [PMID: 37892800 PMCID: PMC10607773 DOI: 10.3390/jcm12206662] [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: 09/04/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) affects the biomechanics of the hip and the patient gait. The stem design influences femoral lever ratios and tissue trauma. Biomechanical changes such as these have the potential to induce knee arthritis. A varus or valgus configuration of knee arthritis is formed by asymmetric loadings. The aim of this study was to evaluate the impact of stem design in THA on knee valgus by comparing a standard implant with an implant with a short stem. METHODS A total of 2953 patients who underwent primary total knee arthroplasty for end-stage osteoarthritis between 2015 and 2021 were included in this retrospective data analysis. Patients were divided into three groups, depending on hip status (straight stem, short stem, and native joint). Leg alignment was distinguished as varus or valgus, and the degree of axial deviation was measured. Descriptive and explorative statistical analyses were performed, with a p value < 0.05 set as significant. RESULTS Ipsilateral knee valgus occurred significantly more often in patients with straight stems (57.2%) than in those with short stems (29%) and native joints (25.8%) (p < 0.001). Additionally, mean valgus deviation was significantly increased in patients with straight stems (8.9°) compared to those with short stems (6.4°) or native hip joints (6.7°). Both findings were accentuated in women. CONCLUSIONS Previous ipsilateral straight-stem THA is associated with knee valgus deformity, especially in women. Short-stem THA seems to be better suited to restoring physiological biomechanics and preventing the development of valgus osteoarthritis of the ipsilateral knee.
Collapse
Affiliation(s)
- Paul Thöne
- Medical Faculty, Johannes Kepler University Linz, 4020 Linz, Austria
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Michael Stephan Gruber
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Harald Kindermann
- Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, 4400 Steyr, Austria;
| | - Walter Gussner
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Patrick Sadoghi
- Department of Orthopedics and Trauma, Medical University of Graz, Austria Auenbruggerplatz 5, 8036 Graz, Austria
| | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| |
Collapse
|
4
|
Kinoshita S, Kinoshita K, Sakamoto T, Seo H, Suzuki M, Yamamoto T. Sequential Intraoperative Evaluation of Rotational Stability of Cementless Stem in Total Hip Arthroplasty: A Broach-Based Study. J Clin Med 2023; 12:5444. [PMID: 37685511 PMCID: PMC10487492 DOI: 10.3390/jcm12175444] [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: 06/28/2023] [Revised: 08/05/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
In cementless total hip arthroplasty, the rotational stability of the stem is generally confirmed in a one-time manual evaluation by the surgeon. This study was performed to evaluate the sequential intraoperative changes in rotational stability using a torque wrench. Primary total hip arthroplasty was performed on 52 consecutive hips using a single wedge stem design. Intraoperative evaluation of rotational stability was uniformly performed using a torque wrench. Evaluations were performed immediately after broach insertion and immediately before the final insertion of the stem (after placement of the acetabular cup). Immediately after the insertion of the broach, rotational stability was checked and confirmed to be fully stabilized using a torque wrench in all cases, and the stability was maintained in 17 of 52 (33%) hips immediately before the final insertion of the stem. Among the hips showing instability, 11 of 35 (31%) broaches were upsized, while the remaining 24 hips achieved stabilization through deeper insertion of the broach. In conclusion, the rotational stability achieved immediately after the insertion of the broach was not necessarily maintained during surgery, indicating that rotational stability may need to be checked at multiple time points intraoperatively.
Collapse
Affiliation(s)
| | | | | | | | | | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan; (S.K.); (K.K.); (T.S.); (H.S.); (M.S.)
| |
Collapse
|
5
|
Miyazaki S, Yamako G, Arakawa H, Sakamoto T, Kawaguchi T, Ito K, Chosa E. Weight-shifting-based robot control system improves the weight-bearing rate and balance ability of the static standing position in hip osteoarthritis patients: a randomized controlled trial focusing on outcomes after total hip arthroplasty. PeerJ 2023; 11:e15397. [PMID: 37214101 PMCID: PMC10199675 DOI: 10.7717/peerj.15397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Background After a total hip arthroplasty (THA), standing and walking balance are greatly affected in the early stages of recovery, so it is important to increase the weight-bearing amount (WBA) on the operated side. Sometimes, traditional treatments may not be enough to improve WBA and weight-bearing ratio (WBR) on the operated side in a satisfactory way. To solve this problem, we came up with a new weight-shifting-based robot control system called LOCOBOT. This system can control a spherical robot on a floor by changing the center of pressure (COP) on a force-sensing board in rehabilitation after THA. The goal of this study was to find out how rehabilitation with the LOCOBOT affects the WBR and balance in a static standing position in patients with unilateral hip osteoarthritis (OA) who had a primary uncemented THA. Methods This randomized controlled trial included 20 patients diagnosed with Kellgren-Lawrence (K-L) grade 3 or 4 hip OA on the operative side and K-L grade 0 normal hip on the nonoperative side. We used the minimization method for allocation and randomly assigned patients to either the LOCOBOT group or the control group. As a result, 10 patient seach were randomly assigned to the LOCOBOT and control groups. Both groups received 40 min of rehabilitation treatment. Out of the 40 min, the LOCOBOT group underwent treatment for 10 min with LOCOBOT. The control group performed COP-controlled exercises on a flat floor instead of using LOCOBOT for 10 of the 40 min. All theoutcome measures were performed pre-THA and 11.9 ± 1.6 days after THA (12 days after THA). The primary outcome measure included WBR in the static standing position. Results After12 days of THA, the LOCOBOT group exhibited significantly higher mean WBR and WBA (operated side) values than the control group. Furthermore, the LOCOBOT group exhibited significantly lower mean WBA (non-operated side) and outer diameter area (ODA) values than the control group. From pre-THA to 12 days after THA, the LOCOBOT group exhibited a significant improvement in mean WBR and WBA (operated side). Moreover, the mean WBA (non-operated side) and ODA significantly decreased. From pre-THA to 12 days after THA, the control group showed a significant increase in total trajectory length and ODA. Conclusions The most important finding of this study was that patients were able to perform the LOCOBOT exercise as early as the second day after THA, and that WBR and ODA significantly improved by the 12th day after THA. This result demonstrated that the LOCOBOT effectively improves WBR in a short period of time after THA and is a valuable system for enhancing balance ability. This expedites the acquisition of independence in activities of daily living after THA and may contribute to optimizing the effectiveness of medical care.
Collapse
Affiliation(s)
- Shigeaki Miyazaki
- Rehabilitation Unit, University of Miyazaki Hospital, Miyazaki, Japan
| | - Go Yamako
- Department of Mechanical Engineering, Faculty of Engineering, University of Miyazaki, Miyazaki, Japan
| | - Hideki Arakawa
- Rehabilitation Unit, University of Miyazaki Hospital, Miyazaki, Japan
| | - Takero Sakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tsubasa Kawaguchi
- Rehabilitation Unit, University of Miyazaki Hospital, Miyazaki, Japan
| | - Kirari Ito
- Department of Mechanical Engineering, Faculty of Engineering, University of Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| |
Collapse
|
6
|
Jacquot L, Machenaud A, Bonnin MP, Chouteau J, Vidalain JP, Ramos-Pascual S, Saffarini M, Dubreuil S. Survival and Clinical Outcomes at 30 to 35 Years Following Primary Total Hip Arthroplasty With a Cementless Femoral Stem Fully Coated With Hydroxyapatite. J Arthroplasty 2022; 38:880-885. [PMID: 36496046 DOI: 10.1016/j.arth.2022.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/28/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of the present study was to update and report clinical outcomes and survival of primary total hip arthroplasty using a cementless double-tapered titanium fully hydroxyapatite-coated stem at a follow-up > 30 years. METHODS The outcomes of this series of 347 primary total hip arthroplasties were already published at a follow-up > 25 years, during which only 12 stems were revised. Since then, there were two additional stem revisions, bringing the total to 14 stem revisions (all of which also required cup revision). Patients still living with the original stem were assessed using the modified Harris Hip Score and patient satisfaction (very satisfied, satisfied, dissatisfied, and very dissatisfied). Revision incidence was calculated using the Kaplan-Meier (KM) method and Cumulative Incidence Function (CIF) at 35 years. RESULTS At a mean follow-up of 33 years (range, 31 to 35 years), 32 patients (34 hips) were still living with the original stem. Their mean modified Harris Hip Score was 86 points (range, 46 to 100) and all patients (100%) were very satisfied or satisfied with surgery. The revision incidence at 35 years considering (a) stem revision for any reason was 9.5% using KM and 4.5% using CIF; (b) stem revision for aseptic loosening was 3.1% using KM and 2.1% using CIF; and (c) reoperation or revision of any component for any reason was 45.3% using KM and 26.3% using CIF. CONCLUSION The present study has demonstrated excellent survival at 35 years for a cementless double-tapered titanium fully hydroxyapatite-coated stem. LEVEL OF EVIDENCE Level IV, Retrospective cohort study.
Collapse
Affiliation(s)
- Laurent Jacquot
- Artro Institute, Annecy Le Vieux, France; Clinique d'Argonay, Ramsay Santé, Annecy, France
| | - Alain Machenaud
- Artro Institute, Annecy Le Vieux, France; Clinique d'Argonay, Ramsay Santé, Annecy, France
| | - Michel P Bonnin
- Artro Institute, Annecy Le Vieux, France; Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Julien Chouteau
- Artro Institute, Annecy Le Vieux, France; Clinique d'Argonay, Ramsay Santé, Annecy, France
| | -
- ReSurg SA, Nyon, Switzerland
| | - Jean-Pierre Vidalain
- Artro Institute, Annecy Le Vieux, France; Clinique d'Argonay, Ramsay Santé, Annecy, France
| | | | | | | |
Collapse
|
7
|
Fukunishi S, Takeda Y, Fukui T, Nishio S, Tachibana T, Fujihara Y. Long term results of the Bicontact D stem in dysplastic osteoarthritis: a 10-15 year follow-up study. Arch Orthop Trauma Surg 2022; 142:3987-3993. [PMID: 34817670 DOI: 10.1007/s00402-021-04262-8] [Citation(s) in RCA: 2] [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: 04/30/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the present study was to investigate the results of total hip arthroplasty (THA) using the Bicontact D stem with a minimum 10 year follow-up that focused on patients with developmental dysplasia of the hip (DDH). METHODS One hundred five patients with osteoarthritis due to DDH who underwent primary THA were included in this study. The mean final follow-up period was 12.7 ± 1.2 years (range 10-15 years). All cases were evaluated both clinically and radiographically, and Kaplan-Meier survivorship was determined as stem revision for any reason as the end point. RESULTS Modified Harris hip score averaged 89.0 ± 1.1 (range 60-98) at the final follow-up. The survivorship was 99.0% (95% confidence interval 93.4-99.9%) at 15.0 years, and only one hip with a well-fixed stem required stem revision due to recurrent dislocations. Cortical hypertrophy (CH) was observed in 40 of 105 hips (38.1%), and stress shielding (SS) progressed to grade 3 or 4 in six hips (6 of 105 hips: 5.7%) during the study period. Among the six hips with progressed SS, Dorr type C proximal femoral geometry was seen in five hips. CONCLUSION This study of 105 THAs using the Bicontact D stem that focused on DDH patients with a minimum 10 year follow-up period achieved satisfactory clinical and radiological outcomes. Dorr type C proximal femoral geometry could be considered a risk factor for progressed SS.
Collapse
Affiliation(s)
- Shigeo Fukunishi
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, 1-4, Ohama-cho, Nishinomiya, Hyogo, 662-0957, Japan.
| | - Yu Takeda
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, 1-4, Ohama-cho, Nishinomiya, Hyogo, 662-0957, Japan
| | - Tomokazu Fukui
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Shoji Nishio
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuki Fujihara
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| |
Collapse
|
8
|
Formica M, Mosconi L, Cavagnaro L, Chiarlone F, Quarto E, Lontaro-Baracchini M, Zanirato A. A 24-year single-centre experience with Collum Femoris Preserving stem: clinical and radiological results in young and elderly population. Hip Int 2022:11207000221093248. [PMID: 35465751 DOI: 10.1177/11207000221093248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The primary aim was to evaluate the long-term follow-up of Collum Femoris Preserving (CFP) stem, specifically focusing on stem survivorship, complications, as well as on clinical and radiological results. The secondary study objective is an age-based sub-analysis (<65 years vs. ⩾65 years) of long-term results. MATERIALS AND METHODS We performed a retrospective analysis of patients who underwent CFP implantation between 1997 and 2009. A total of 311 patients (342 hips) were included with a mean follow-up of 15.8 ± 2.2 (range 11-24) years. 2 age groups were analysed: Group-Y (age <65) and Group-E (age ⩾65). Group-Y included 182 hips (mean follow-up 16.3 ± 4.2 years), whereas Group-E included 160 hips (mean follow-up 15.5 ± 3.7 years). Clinical (HHS, OHS and VAS) and radiological data were obtained at final follow-up. Any complications, reoperations, prosthetic components revisions and stem revisions were analysed. RESULTS According to HSS score, 95% of patients reported excellent/good results (95.6% Group-Y vs. 94.4% Group-E) with an overall stem survival rate of 93.3% (94% Group-Y vs. 92.5% Group-E; p = 0.37). Overall, 87% of stem revisions were performed with primary stems. The rate of prosthetic components revision was 9.9 % (9.9% in Group-Y vs. 10% in Group-E; p = 1). The reoperation rate was 10.8% (11.5% in Group-Y vs. 10.0% in Group-E; p = 0.73). CONCLUSIONS The CFP stem provides good clinical and radiological long-term results with low rate of complications in both young and elderly patients. No significant difference in stem revision and reoperation rates was observed between the 2 groups. Both in elderly and young patients, CFP stem allows revisions to be performed with primary stems.
Collapse
Affiliation(s)
- Matteo Formica
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy.,DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
| | - Lorenzo Mosconi
- Joint Replacement Unit - Orthopaedics and Traumatology 2, Hospital Santa Corona, Pietra Ligure, Italy
| | - Luca Cavagnaro
- Joint Replacement Unit - Orthopaedics and Traumatology 2, Hospital Santa Corona, Pietra Ligure, Italy
| | - Francesco Chiarlone
- Joint Replacement Unit - Orthopaedics and Traumatology 2, Hospital Santa Corona, Pietra Ligure, Italy
| | - Emanuele Quarto
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy.,DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
| | - Maddalena Lontaro-Baracchini
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy.,DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
| | - Andrea Zanirato
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy.,DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
| |
Collapse
|
9
|
The Implant Proteome—The Right Surgical Glue to Fix Titanium Implants In Situ. J Funct Biomater 2022; 13:jfb13020044. [PMID: 35466226 PMCID: PMC9036294 DOI: 10.3390/jfb13020044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023] Open
Abstract
Titanium implants are frequently applied to the bone in orthopedic and trauma surgery. Although these biomaterials are characterized by excellent implant survivorship and clinical outcomes, there are almost no data available on the initial protein layer binding to the implant surface in situ. This study aims to investigate the composition of the initial protein layer on endoprosthetic surfaces as a key initiating step in osseointegration. In patients qualified for total hip arthroplasty, the implants are inserted into the femoral canal, fixed and subsequently explanted after 2 and 5 min. The proteins adsorbed to the surface (the implant proteome) are analyzed by liquid chromatography–tandem mass spectrometry (LC-MS/MS). A statistical analysis of the proteins’ alteration with longer incubation times reveals a slight change in their abundance according to the Vroman effect. The pathways involved in the extracellular matrix organization of bone, sterile inflammation and the beginning of an immunogenic response governed by neutrophils are significantly enriched based on the analysis of the implant proteome. Those are generally not changed with longer incubation times. In summary, proteins relevant for osseointegration are already adsorbed within 2 min in situ. A deeper understanding of the in situ protein–implant interactions in patients may contribute to optimizing implant surfaces in orthopedic and trauma surgery.
Collapse
|
10
|
Miyazaki S, Tsuruta K, Yoshinaga S, Yamaguchi Y, Fujii Y, Arakawa H, Ochiai M, Kawaguchi T, Unoki A, Sakamoto T, Tajima T, Nakamura Y, Funamoto T, Hiyoshi M, Chosa E. Effect of total hip arthroplasty on improving locomotive syndrome in hip disease patients: A prospective cohort study focused on total clinical decision limits stage 3. J Orthop Sci 2022; 27:408-413. [PMID: 33640221 DOI: 10.1016/j.jos.2020.12.028] [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: 11/04/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND In 2020, the Japanese Orthopaedic Association established a new stage 3 in clinical decision limits (CDL) to evaluate the stage of locomotive syndrome (LS). This study focused on total CDL stage 3 with the aim of investigating indicators related to improvements in total CDL by evaluating the improvement of LS in patients who underwent total hip arthroplasty (THA). METHODS Of the 125 patients who underwent THA at our hospital, the subjects of the analysis were 105 patients determined to be total CDL stage 3 in an evaluation performed before THA. LS was evaluated using the stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale (GLFS-25). Indicators related to improvements in total CDL were also investigated. All evaluation items were measured before THA and three months after THA. RESULTS Before THA, all subjects (n = 105) were classified as total CDL stage 3. Three months after THA, improvements in total CDL were seen in 49 subjects (46.7%). The results of stepwise multiple logistic regression analysis showed that the before THA stand-up test and GLFS-25 were significantly related to improvements in total CDL. CONCLUSIONS Three months after THA, improvements in LS were seen in approximately half of the subjects. The stand-up test and GLFS-25 can be used as indicators of improvement in total CDL. DESIGN Prospective cohort study design.
Collapse
Affiliation(s)
- Shigeaki Miyazaki
- Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Kurumi Tsuruta
- School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Saori Yoshinaga
- School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Yoichiro Yamaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Yoshinori Fujii
- Department of Mathematics Education, Faculty of Education, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki, Miyazaki, 889-2192, Japan.
| | - Hideki Arakawa
- Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Masaru Ochiai
- Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Tsubasa Kawaguchi
- Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Aya Unoki
- Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Takero Sakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Takuya Tajima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Yoshihiro Nakamura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Taro Funamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Masaru Hiyoshi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| | - Etsuo Chosa
- Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake Miyazaki, Miyazaki, 889-1692, Japan.
| |
Collapse
|
11
|
Chiba D, Yamada N, Mori Y, Oyama M, Ohtsu S, Kuwahara Y, Baba K, Tanaka H, Aizawa T, Hanada S, Itoi E. Mid-term results of a new femoral prosthesis using Ti-Nb-Sn alloy with low Young's modulus. BMC Musculoskelet Disord 2021; 22:987. [PMID: 34836525 PMCID: PMC8620944 DOI: 10.1186/s12891-021-04879-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background This study was performed to investigate the mid-term results of Ti-Nb-Sn (TNS) alloy stem with a low Young’s modulus. Methods This study was a multicenter prospective cohort study. A total of 40 primary total hip arthroplasties performed between April 2016 and September 2017 was enrolled in this study. With the unique functional gradient properties by heating treatment, the strength of the proximal portion was enhanced, while the distal portion maintained a low Young’s modulus. The surgeries were performed through the posterolateral approach using the TNS alloy stems. Radiographs were taken from immediately after surgeries until 3 years, and stress shielding and subsidence of the stems were evaluated. The incidences of the stem breakage were also assessed. Clinical assessments were performed using Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) scores. Results Among the 40 enrolled patients, 36 patients were female and 4 were male. At 3 years after surgery, there were no radiologic signs of loosening, subsidence, or breakage of the stem. Stress shielding was observed in 26 hips (65%). Of 26 hips, 16 hips (40%) were grade 1 and 10 hips (25%) were grade 2. There was no advanced stress shielding. The JOA and JHEQ scores significantly improved compared with the preoperative scores. Conclusion The current study using a new TNS alloy femoral stem showed good clinical outcomes at 3-year follow-up. Radiologically, there was no loosening or subsidence of the stem. The mild stress shielding was observed in 65% of patients. Trial registration Current Controlled Trials ISRCTN21241251. The date of registration was October 26, 2021. Retrospectively registered.
Collapse
Affiliation(s)
- Daisuke Chiba
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Norikazu Yamada
- Department of Orthopaedic Surgery, Sendai Red Cross Hospital, 2-43-3 Yagiyamahoncho, Taihaku-ku, Sendai, Miyagi, 982-8501, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Masamizu Oyama
- Department of Orthopaedic Surgery, Sendai Red Cross Hospital, 2-43-3 Yagiyamahoncho, Taihaku-ku, Sendai, Miyagi, 982-8501, Japan
| | - Susumu Ohtsu
- Department of Orthopaedic Surgery, Osaki Citizen Hospital, 3-8-1 Furukawahonami, Osaki, Miyagi, 989-6183, Japan
| | - Yoshiyuki Kuwahara
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kazuyoshi Baba
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hidetatsu Tanaka
- Department of Orthopaedic Surgery, Sendai Red Cross Hospital, 2-43-3 Yagiyamahoncho, Taihaku-ku, Sendai, Miyagi, 982-8501, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Shuji Hanada
- Institute for Materials Research, Tohoku University, 2-1-1 Katahira, Aoba-ku, Miyagi, 980-8577, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Evaluation of femoral anteversion, hip rotation, and lateral patellar tilt after total hip arthroplasty using a changeable neck system. J Artif Organs 2021; 24:492-497. [PMID: 33899127 DOI: 10.1007/s10047-021-01269-1] [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: 02/15/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
In patients with secondary osteoarthritis due to acetabular dysplasia, femoral anteversion has many variations. A changeable neck system is one useful option to adjust the femoral anteversion. Retroverted necks can effectively adjust anatomical anteversion (AA), femoral rotational angle (FRA), and functional anteversion (FA); however, effectiveness of anteverted necks for these adjustments has not been investigated. Moreover, although the lateral patellar tilt after total hip arthroplasty (THA) has been reported to externally rotate, the influence on lateral patellar tilt using a changeable neck system remains unknown. To clarify the effectiveness of anteverted necks in THA, 96 consecutive patients (111 hips) who underwent THA using anatomical short stem with a changeable neck system were retrospectively investigated using pre- and post-operative computed tomography. Patients were divided into the straight (ST) group using straight and 4-mm-high-offset neck (N = 34) and the anteverted (AV) group using 15°-anteverted and 15°-anteverted/3-mm-high-offset neck (N = 34) after age, body mass index, and surgical approach were matched using propensity scores. AA did not change in the ST group, while it increased by 14.0° in the AV group. FRA decreased after surgery in both groups. FA decreased after surgery in the ST group, while it did not change in the AV group. Lateral patella tilt did not significantly change in both groups between pre- and post-operative position. In conclusion, with a changeable neck system, straight and anteverted necks can adjust AA to achieve pre-operative planning while not influencing lateral patellar tilt.
Collapse
|
14
|
Takehashi H, Nishino T, Mishima H, Wada H, Yamazaki M, Hyodo K. Stress distribution of cementless stems with unique flanges in a rectangular cross-section: thermoelastic stress imaging study. J Rural Med 2021; 16:83-90. [PMID: 33833833 PMCID: PMC8016676 DOI: 10.2185/jrm.2020-058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022] Open
Abstract
Objective: In this study, thermoelastic stress analysis was conducted to
clarify the surface stress distribution of a femur in which a BiCONTACT E stem was
inserted. The contact sites between the stem and femur were examined to investigate the
association with the range of stress distribution. Materials and Methods: BiCONTACT E was set up using two synthetic femurs
that mimic the morphology and mechanical properties of living bone. Preoperative planning
was performed using three-dimensional imaging software. The synthetic bone was placed in a
sample holder. After the stem was implanted into the synthetic bone, computed tomography
imaging was performed. The contact sites between the stem and the cortical part of the
synthetic bone were examined using the imaging software. Subsequently, thermoelastic
stress measurements were performed on the sample. Results: The results of thermoelastic stress analysis indicated a minimum
change in the sum of principal stresses [Δ (σ1+σ2)] on the medial
side and a maximum change in the sum of principal stresses on the lateral side. Thus, no
minimum change was observed in the sum of the principal stresses at the maximum proximal
part. It is reasonable to assume that the use of a cementless stem can inevitably lead to
bone atrophy in the proximal part of the femur. The contact sites between the stem and
femur were also investigated, and the results of the study clearly and quantitatively
demonstrated the correlation of the contact sites with a range of stress
distributions. Conclusion: The surface stress distribution of a femur, in which a BiCONTACT
E stem was inserted, was clarified. The contact sites between the stem and femur were also
investigated. Furthermore, the correlation between these results and clinical bone
response was investigated in this study.
Collapse
Affiliation(s)
| | | | - Hajime Mishima
- Department of Orthopaedic Surgery, University of Tsukuba, Japan
| | - Hiroshi Wada
- Department of Orthopaedic Surgery, Ibaraki Western Medical Center, Japan
| | | | - Koji Hyodo
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Japan
| |
Collapse
|
15
|
Isshiki K, Jinno T, Aizawa J, Takada R, Sakai T, Tachibana T, Okawa A. Asymmetry of the Cross-sectional Area of the Gluteus Medius Muscle Persists Eight Years after Total Hip Arthroplasty for Osteoarthritis of the Hip. Prog Rehabil Med 2021; 6:20210052. [PMID: 35083379 PMCID: PMC8702992 DOI: 10.2490/prm.20210052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: The objective of the present study was to compare the cross-sectional areas (CSAs) of the gluteus medius on the affected and unaffected sides to assess long-term changes after total hip arthroplasty (THA). Methods : The data for 23 women who were diagnosed with unilateral hip osteoarthritis and who underwent primary THA via the posterolateral approach were retrospectively reviewed. The demographic data of the patients and the Japanese Orthopaedic Association hip scores were obtained from medical records. The CSA of the gluteus medius was measured on computed tomography images obtained at three different time points: preoperatively, 3 years postoperatively, and 8 years postoperatively. Results: The CSA of the gluteus medius on the affected side was significantly greater than the preoperative value at 3 (P<0.005) and 8 years postoperatively (P<0.001). The mean increase in the CSA relative to the preoperative value was 24.0% at 3 years and 37.5% at 8 years postoperatively. There was no significant change in the CSA of the unaffected side at any time point. The CSA of the gluteus medius was significantly smaller on the affected side than on the unaffected side preoperatively (P<0.001), 3 years postoperatively (P<0.001), and 8 years postoperatively (P<0.003). Conclusions: Because the gluteus medius is important for achieving stability when walking, it is important to maintain or increase the CSA of the gluteus medius by regular or long-term rehabilitation interventions (such as maintaining abductor muscle strength) from the early stages of osteoarthritis and to provide guidance on effective training both before and after THA.
Collapse
Affiliation(s)
- Kazuko Isshiki
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Junya Aizawa
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, Tokyo, Japan
| | - Ryohei Takada
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomoko Sakai
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Tachibana
- Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Atsushi Okawa
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
16
|
Mid-term results of 119 Taperloc Microplasty™ femoral stems after a mean 61 months (50-82) of follow-up. Orthop Traumatol Surg Res 2020; 106:1501-1506. [PMID: 33268300 DOI: 10.1016/j.otsr.2020.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Short stems are not all the same and do not meet the same objectives in terms of shape, fixation and biomechanics. The Taperloc Microplasty™ is a shortened stem. In France, no articles have been published on this subject and very few articles are available in the international literature. We therefore decided to analyse results for this stem after a mean follow-up of 61 months, asking the following questions: (1) Is the survival of the Taperloc Microplasty™ at least equivalent to the best conventional cementless prostheses on the market, i.e. with a 10-year revision rate of less than 5% according to NICE criteria? (2) Have the expected benefits of short stems been confirmed? HYPOTHESIS The Taperloc Microplasty™ prosthesis meets the NICE criteria with a revision rate of less than 5% at 10 years. MATERIALS AND METHODS This is a retrospective single-surgeon study of 119 prostheses implanted between April 2013 and December 2015. The inclusion criteria were hip arthrosis or avascular necrosis of the femoral head in patients under the age of 70 regardless of height or weight, excluding Dorr type C femurs. The series consisted of 108 patients (11 bilateral total hip arthroplasties (THA)) with a mean age of 58.8±10 years [17-70]; 81 were men and 38 were women. RESULTS The results were assessed in 110 hips (103 patients since 9 hips (7 patients) were lost to follow-up) at a mean follow-up of 61±8 months [50-82]. At follow-up the Postel-Merle d'Aubigné (PMA) score was 17.8±0.8 [12-18] and the Oxford score 13.1±3.5 [12-41] (p<0.05 versus pre operative). On X-rays, we identified 9 pedestal signs (7.5%) below the distal end of the stem, 6 calcar atrophies (5%), but no cortical hypertrophy greater than 2 mm, no stem subsidence greater than 5mm, and no radiolucent line indicating the absence of integration. The survivorship at 61 months was 100% (95% CI: 0.905; 1.095), taking femoral revision as the end-point and 98.2% (95% CI: 0.887; 1.077) considering revision for any reason. CONCLUSION The Taperloc Microplasty™ stem is equivalent to the best conventional cementless prostheses on the market in selected surgical indications after a mean follow-up of 61 months. The follow-up is still not sufficient to confirm all the benefits expected from this type of implant. LEVEL OF EVIDENCE IV, retrospective cohort study.
Collapse
|
17
|
Long-Term Survival and Results at a Mean Follow-Up Period of 24 Years of a Tapered Straight, Collarless, Grit-Blasted, Titanium Alloy Stem. J Arthroplasty 2020; 35:3644-3649. [PMID: 32660799 DOI: 10.1016/j.arth.2020.06.044] [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] [Received: 04/14/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is limited evidence on the survivorship of patients who undergo cementless stem implantation, beyond 20 years of the hip arthroplasty. We report implant survival and results of the CLS Spotorno femoral stem until 30 years from implantation. METHODS Survival analysis of 147 CLS Spotorno stems in 119 patients for an average period of 24 years (20-30) from the date of implantation was performed. During the course of the follow-up period, 33 patients (39 hips) died. The information on the survival of their hip implant at the time of death was gathered from their relatives and general practitioners. Sixty-six patients (86 hips) undertook the complete survey along with radiographic examination, while 18 subjects (20 hips) were interviewed over the telephone. The factors influencing survival, functional outcomes, and level of satisfaction with surgery were evaluated. RESULTS The overall estimated survival of the stems was 89.9% after 30 years (95% confidence interval [CI] 83.5-93.9). Survival with femoral revision for aseptic loosening as an end point was 93.1% (95% CI 87.1-96.4). In the worst-case scenario, an overall implant survival of 77.2% (95 CI% 80.3-82.7) was observed after 24 years. Patients who were older than 50 in age at the time of surgery had better survival rates (P = .026). The mean Harris Hip Score at follow-up was 83.1 (range 43-100) and the level of satisfaction was 9/10. The main determinant of postsurgical satisfaction was Harris Hip Score, whereas radiographic alterations explained little with respect to the variation in the outcomes. CONCLUSION The cementless CLS Spotorno stem displayed satisfactory results 24 years after implantation and high estimated survival until 30 years from surgery. However, patients below the age of 50 at the time of surgery have an increased risk of undergoing revision of their femoral stem.
Collapse
|
18
|
Straight stem and threaded cup in patients under 60 years of age: 28.8-30.2 years of follow-up. J Orthop Surg Res 2020; 15:563. [PMID: 33243270 PMCID: PMC7691067 DOI: 10.1186/s13018-020-02102-w] [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: 03/03/2020] [Accepted: 11/19/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose The aim of this retrospective observational study of one cohort was to evaluate the long-term outcome in patients younger than 60 years after total hip arthroplasty using a straight uncemented stem and an uncemented threaded cup. Methods Between 1986 and 1987, 75 hips of 75 patients (mean age, 53.35 ± 6.17 years) were consecutively implanted with an Alloclassic Zweymüller/Alloclassic SL stem and an Alloclassic CSF cup. Forty-four patients had died over the last 30 years. The remaining 31 patients (mean age, 82.9 ± 6.4 years) were reinvited for follow-up examinations. Clinical and radiographic evaluations were carried out. Results At a mean follow-up of 29.5 (28.8–30.2), 4 patients (5.3%) were lost to follow-up. For the endpoint aseptic loosening (defined as the removal of stem or the cup for 2 cases), the overall survival rate is 97.3%. For the endpoint revision for any reason (22 patients), the survival rate is 70.6%. Eleven patients needed an exchange of head and liner, caused by wear. The average time from implantation until change of head and liner was 21.44 years (SD 5.92). Other reasons for revision surgery were septic loosening (3 cases), aseptic loosening of stem and cup (1 case), aseptic loosening of stem (1 case), periprosthetic calcification (2 cases), implant fracture (1 case), periprosthetic fracture (1 case), intraoperative fissure of stem (1 case), and total wear of liner including cup (1 case). Conclusion The combination of a straight stem (Alloclassic) and a screw cup (CSF) shows excellent results in young patients under the age of 60 at ultra-long-term follow-up at 30 years. Revisions due to wear of the polyethylene liner are more likely than in the older patients.
Collapse
|
19
|
Homma Y, Kawakita S, Baba T, Watari T, Kaneko K. Diagnosis of and Early Revision Surgery for Biological Fixation Failure Due to Proximal-Distal Mismatch of Proximally Coated Tapered Cementless Stem. Arthroplast Today 2020; 6:914-918. [PMID: 33204788 PMCID: PMC7649110 DOI: 10.1016/j.artd.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/13/2020] [Accepted: 09/20/2020] [Indexed: 11/28/2022] Open
Abstract
The diagnosis of and decision-making for early revision surgery to treat failure of biological fixation with a proximally coated cementless stem are challenging. A 73-year-old woman was referred to our hospital with thigh pain 2 years after the initial total hip arthroplasty. Although a plain radiograph showed no signs indicating biological fixation failure, digital tomosynthesis showed a highly radiodense line along the proximal part, and bone scintigraphy showed uptake at the distal part. With the diagnosis of biological fixation failure due to the proximal-distal mismatch, the cementless stem was revised to a cemented stem, and the thigh pain was improved after the revision surgery. Digital tomosynthesis and bone scintigraphy can be helpful for the diagnosis of biological fixation failure due to proximal-distal mismatch.
Collapse
Affiliation(s)
- Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University school of medicine, Tokyo, Japan
| | - So Kawakita
- Department of Orthopaedic Surgery, Juntendo University school of medicine, Tokyo, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University school of medicine, Tokyo, Japan
| | - Taiji Watari
- Department of Orthopaedic Surgery, Juntendo University school of medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University school of medicine, Tokyo, Japan
| |
Collapse
|
20
|
Stenicka S, Hanreich C, Babeluk R, Kubista B, Giurea A, Sigmund IK, Windhager R, Kotz R, Lass R. High Revision Rates of a Cementless Beta-Titanium Alloy Stem with Contamination-Free Roughened Surface in Primary Total Hip Arthroplasty. J Clin Med 2020; 9:jcm9072138. [PMID: 32645917 PMCID: PMC7408853 DOI: 10.3390/jcm9072138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/21/2020] [Accepted: 07/03/2020] [Indexed: 12/04/2022] Open
Abstract
Optimal osseointegration of cementless total hip arthroplasty is essential for high stability and long-term survival. The purpose of this follow-up study was to evaluate the clinical and radiological outcome, the complications, and survival rates of a beta-titanium alloy stem with a specific grit-blasted-free surface. In 192 patients (mean age of 64.4 years), 202 consecutive primary total hip arthroplasties were performed using a cementless Hipstar® stem (Stryker, Duisburg, DE). The Harris Hip Score (HHS) was assessed pre-operatively and post-operatively. Radiolucent lines were evaluated and the implant survival rate was calculated using Kaplan-Meier analysis. The mean follow-up was 7.71 years (range of 5.0–14.0 years). Overall, 15 revisions were performed. Early aseptic stem loosening was observed in six cases (2.97%). Radiolucent-lines adjacent to the stem were detected in 73 cases (83.02%), especially (70.46%) in the Gruen zones 1, 7, 8, and 14. The mean postoperative HHS was 92.65 points (range 42–100). The cumulative survival probability of the stem was 94.4% (95% CI 90.3 to 98.5%). Considering aseptic failure as an endpoint, the cumulative survival rate of the stem was 95.3% (95% CI 0.914 to 0.992) at six years of follow-up. Overall, an inferior mid-term implant survival was observed in comparison to well-established cementless stem designs.
Collapse
|
21
|
Migliorini F, Driessen A, Colarossi G, El Mansy Y, Gatz M, Tingart M, Eschweiler J. Short stems for total hip replacement among middle-aged patients. INTERNATIONAL ORTHOPAEDICS 2020; 44:847-855. [PMID: 32193611 DOI: 10.1007/s00264-020-04516-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/24/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The purpose of the present study was to investigate the role of short stem implants for primary total hip arthroplasty in middle-aged patients. For this purpose, a meta-analysis of the current literature was conducted. The focus was on clinical outcomes,radiological parameters, and further complications of both components. MATERIAL AND METHODS The study was performed according to the PRISMA guidelines. All randomized and non-randomized clinical trials comparing short stem versus standard stem prostheses for THA were considered for inclusion. Only studies reporting data concerning uncemented stems for primary total hip arthroplasty were included. Only studies reporting data concerning patients with a mean age of 45 to 69 were included. RESULTS A total of 2197 procedures in 2116 patients were analysed. The mean follow-up was 30.2 months. The short stem group showed a statistically significant higher WOMAC score and a reduced total estimated blood loss compared with the standard stem group. The short stem group showed a reduced rate of femoral fractures, dislocations, and revision, but without statistical significance. CONCLUSIONS According to the main findings of this meta-analysis and current evidence, we encourage the use of the uncemented short stems during primary total hip arthroplasty in middle-aged patients.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Arne Driessen
- Department of Orthopaedic Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Giorgia Colarossi
- Department of Thoracic Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Yasser El Mansy
- Department of Orthopaedic Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.,Department of Orthopaedics and Traumatology, Alexandria University, Alexandria, Egypt
| | - Matthias Gatz
- Department of Orthopaedic Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedic Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedic Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| |
Collapse
|
22
|
Busch A, Stöckle U, Schreiner A, de Zwaart P, Schäffler A, Ochs BG. Total hip arthroplasty following acetabular fracture: a clinical and radiographic outcome analysis of 67 patients. Arch Orthop Trauma Surg 2020; 140:331-341. [PMID: 31501930 DOI: 10.1007/s00402-019-03272-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) is a challenging option for the treatment of posttraumatic arthritis due to acetabular fractures. METHODS The study aimed to determine the short- and mid-term clinical and radiographic results of THA following acetabular fracture. The fracture pattern, the extent of injury and the initial fracture treatment were considered to evaluate the influence of these factors on the clinical-radiographic outcome. RESULTS 67 patients who received THA for the treatment of posttraumatic osteoarthritis after acetabular fracture between January 2007 and December 2012 were analyzed consecutively. The group consisted of 13 female (19%) and 54 male (81%) patients with a mean age of 59 (25-87) years at the time of THA. The time between acetabular injury and arthroplasty was 107 (1-504) months on average. The all-cause 8-year survival rate was 0.87% (0.76-0.93) and there were 8 revisions, half of them were due to aseptic loosening of the cup. The Harris Hip Score achieved was 75.7 ± 21.3 (26.9-100) points. Prior to THA, heterotopic ossifications were detected in 28% and after THA implantation in 42%. CONCLUSION The decrease of the interval between injury and arthroplasty was associated with increasing patient age (p = 0.001) and surgical treatment of the acetabular fracture (p = 0.04). Complex fracture patterns were accompanied by acetabular bone defects more often than simple patterns (p = 0.03). Overall, arthroplasty due to posttraumatic osteoarthritis after acetabular fracture resulted in decreased overall survival rates and poorer clinical outcome as compared to primary arthroplasty.
Collapse
Affiliation(s)
- André Busch
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany. .,BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany.
| | - Ulrich Stöckle
- BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany
| | - Anna Schreiner
- BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany
| | - Peter de Zwaart
- BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany
| | - Aljoscha Schäffler
- BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany.,Krankenhaus Freudenstadt, Karl-von-Hahn-Straße 120, 72250, Freudenstadt, Germany
| | - Björn Gunnar Ochs
- BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany
| |
Collapse
|
23
|
García-Rey E, Carbonell-Escobar R, Cordero-Ampuero J, García-Cimbrelo E. Outcome of a hemispherical porous-coated acetabular component with a proximally hydroxyapatite-coated anatomical femoral component. Bone Joint J 2019; 101-B:378-385. [DOI: 10.1302/0301-620x.101b4.bjj-2018-1223.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims We previously reported the long-term results of the cementless Duraloc-Profile total hip arthroplasty (THA) system in a 12- to 15-year follow-up study. In this paper, we provide an update on the clinical and radiological results of a previously reported cohort of patients at 23 to 26 years´ follow-up. Patients and Methods Of the 99 original patients (111 hips), 73 patients (82 hips) with a mean age of 56.8 years (21 to 70) were available for clinical and radiological study at a minimum follow-up of 23 years. There were 40 female patients (44 hips) and 33 male patients (38 hips). Results All acetabular and femoral components were well fixed and showed signs of bone ingrowth. Nine acetabular components were revised due to wear-osteolysis-related problems and four due to late dislocation. The probability of not having component revision at 25 years was 83.2% (95% confidence interval (CI) 74.5 to 91.8; number at risk 41). Acetabular osteolysis was observed in ten hips. The mean femoral head penetration was 1.52 mm (sd 0.8) at 15 years and 1.92 mm (sd 1.2) at 25 years. Receiver operating characteristic (ROC) analysis revealed that mean femoral penetration with a value of 0.11 mm/year or more was associated with the appearance of osteolysis. The 25-year Kaplan–Meier survival with different endpoints was 89.9% for acetabular osteolysis (95% CI 83.3 to 96.5), 92.1% for proximal femoral osteolysis (95% CI 86.1 to 98.2), and 75.5% for femoral osteopenia (95% CI 66.5 to 84.5). Conclusion The Duraloc-Profile THA system showed excellent long-term bone fixation. Nevertheless, monitoring is recommended in order to detect wear and late dislocations in this population that was relatively young at the time of surgery. Cite this article: Bone Joint J 2019;101-B:378–385.
Collapse
Affiliation(s)
- E. García-Rey
- Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | | | - J. Cordero-Ampuero
- Orthopaedics Department, Hospital Universitario La Princesa, Madrid, Spain
| | - E. García-Cimbrelo
- Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| |
Collapse
|
24
|
Jäger M, Jennissen HP, Haversath M, Busch A, Grupp T, Sowislok A, Herten M. Intrasurgical Protein Layer on Titanium Arthroplasty Explants: From the Big Twelve to the Implant Proteome. Proteomics Clin Appl 2019; 13:e1800168. [PMID: 30770655 DOI: 10.1002/prca.201800168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/08/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Aseptic loosening in total joint replacement due to insufficient osteointegration is an unsolved problem in orthopaedics. The purpose of the study is to obtain a picture of the initial protein adsorption layer on femoral endoprosthetic surfaces as the key to the initiation of osseointegration. EXPERIMENTAL DESIGN The paper describes the first study of femoral stem explants from patients for proteome analysis of the primary protein layer. After 2 min in situ, the stems are explanted and frozen in liquid nitrogen. Proteins are eluted under reducing conditions and analyzed by LC-MS/MS. RESULTS After exclusion of proteins identified by a single peptide, the implant proteome is found to consist of 2802 unique proteins. Of these, 77% are of intracellular origin, 9% are derived from the plasma proteome, 8% from the bone proteome, and four proteins with highest specificity score could be assigned to the bone marrow proteome (transcriptome). The most abundant protein in the adsorbed total protein layer is hemoglobin (8-11%) followed by serum albumin (3.6-6%). CONCLUSIONS A detailed knowledge of the initial protein film deposited onto the implants, as demonstrated here for the first time, may help to understand and predict the response of the osseous microenvironment to implant surfaces.
Collapse
Affiliation(s)
- Marcus Jäger
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, 45147 Essen, Germany
| | - Herbert P Jennissen
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, 45147 Essen, Germany.,Institute of Physiological Chemistry, Work Group Biochemical Endocrinology, University of Duisburg-Essen, 45147 Essen, Germany
| | - Marcel Haversath
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, 45147 Essen, Germany
| | - André Busch
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, 45147 Essen, Germany
| | - Thomas Grupp
- Aesculap AG, Research & Development, 78532 Tuttlingen, Germany
| | - Andrea Sowislok
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, 45147 Essen, Germany.,Institute of Physiological Chemistry, Work Group Biochemical Endocrinology, University of Duisburg-Essen, 45147 Essen, Germany
| | - Monika Herten
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, 45147 Essen, Germany
| |
Collapse
|
25
|
Kim JT, Jeong HJ, Lee SJ, Kim HJ, Yoo JJ. Does Proximally Coated Single-Wedge Cementless Stem Work Well in Dorr Type C Femurs? Minimum 10-year Followup. Indian J Orthop 2019; 53:94-101. [PMID: 30905988 PMCID: PMC6394166 DOI: 10.4103/ortho.ijortho_160_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) with a proximally coated single-wedge (PSW) cementless stem had been generally considered not to be suitable for Dorr Type C femurs. This study compares the long term outcomes of PSW stem according to the type of proximal femoral geometry. MATERIALS AND METHODS 307 primary THAs in 247 patients were performed with PSW cementless stem and followed up for over 10 years in this retrospective study. According to Dorr's criteria, 89 femurs were classified as Type A, 156 as Type B, and 62 as Type C. They were followed up for an average of 13.2 years (range 10.0-17.3 years). All the hips were evaluated clinically and radiologically. RESULTS There was no significant difference in stem survivorship and clinical outcomes including the incidence of thigh pain and the mean postoperative Harris hip score (HHS) in all three groups. No significant differences were observed in osteolysis, pedestal formation, or cortical hypertrophy among the groups. Radiolucent lines <2 mm in thickness in Gruen zone 4 and 7 (P = 0.003 and P = 0.044, respectively), spot-weld (P < 0.001), and stress shielding (P = 0.010) of proximal femur were more pronounced in Dorr C type femora than in Type A or B. Fifty-six intraoperative fractures were identified among 307 hips with PSW stems. The incidence of intraoperative or postoperative femoral fractures was not significantly different among the groups. CONCLUSIONS From over a 10-year followup, the PSW stem provided a recommendable option with satisfactory outcomes and excellent stem survivorship regardless of the Dorr type.
Collapse
Affiliation(s)
- Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Yeongtong-gu, Suwon-si, Gyeonggi-do, Korea
| | - Hyung Jun Jeong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Soong Joon Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea,Medical Research Center, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea,Address for correspondence: Dr. Jeong Joon Yoo, Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. E-mail:
| |
Collapse
|
26
|
Jacquot L, Bonnin MP, Machenaud A, Chouteau J, Saffarini M, Vidalain JP. Clinical and Radiographic Outcomes at 25-30 Years of a Hip Stem Fully Coated With Hydroxylapatite. J Arthroplasty 2018; 33:482-490. [PMID: 29066107 DOI: 10.1016/j.arth.2017.09.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Little is known about the survival of total hip arthroplasty implants with bioactive coatings beyond the first 20 years. The authors aimed to report survival of a tapered hip stem fully coated with hydroxylapatite (HA) at follow-up of 25-30 years. METHODS Of the original series of 320 patients (347 hips), 12 patients (12 hips) had stem and cup revisions, 54 patients (55 hips) had cup revisions, 17 patients (17 hips) had liner exchange. A total of 207 patients (225 hips) died with stems in place and 21 patients (24 hips) could not be reached. This left a cohort of 80 patients (86 hips) with their original stem for assessment. Survival was analyzed using the Kaplan-Meier (KM) method and cumulative incidence function (CIF). RESULTS Considering stem revision as endpoint, the revision risk calculated using the KM method was 6.3%, whereas using the CIF it was 3.7%. Considering any reoperation as endpoint, the revision risk calculated using the KM method was 41.2%, whereas using the CIF it was 25.9%. The Harris Hip Score for 77 patients (18 hips) was 81.6 ± 15.2. Standard x-rays were available for 52 hips (49 patients), and 10 (19.2%) showed radiolucencies <2 mm thick. CONCLUSION This study is the first to report outcomes of an HA-coated stem beyond 25 years. The survival of stem compares favorably with long-term survival of the Charnley cemented stem, and with shorter-term registry studies. The stem achieved its intended purpose of total osteointegration in the long-term, although the proximolateral region remains susceptible to radiolucencies.
Collapse
Affiliation(s)
- Laurent Jacquot
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| | - Michel P Bonnin
- Artro Institute, Annecy Le Vieux, France; Ramsay Générale de Santé, Centre Orthopédique Santy, Hôpital PrivéJean Mermoz, Lyon, France
| | - Alain Machenaud
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| | - Julien Chouteau
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| | | | - Jean-Pierre Vidalain
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| |
Collapse
|
27
|
Krämer M, Kahrs LA, Friese KI, von Falck C, Hurschler C. Inter- and intra-operator reliability in patient-specific template positioning for total hip arthroplasty. A cadaver study. Int J Med Robot 2018; 14. [PMID: 29336121 DOI: 10.1002/rcs.1887] [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: 01/25/2017] [Revised: 10/05/2017] [Accepted: 11/19/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND The implantation of the acetabular cup essentially determines the clinical outcome of total hip arthroplasty. To address this issue, the aim of this study was to build patient-specific instruments (PSIs) with various reference surfaces, followed by in vitro investigations to examine the inter- and intra-operator reliability as well as the overall precision of these patient-specific templates. METHODS Seven human hemi-pelvis specimens were used for this study. After a CT scan, PSIs with different imprint heights were created. The overall precision of the templates and the inter- and intra-operator reliabilities were calculated. RESULTS Strong differences in precision between the PSI designs could be observed. The desired orientation of the acetabular cup could be adjusted with a precision of up to 1.55°. CONCLUSION Based on our results, we believe that the application of the PSI-based acetabular cup positioning in total hip arthroplasty procedures can potentially increase the precision of cup placement.
Collapse
Affiliation(s)
- Manuel Krämer
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Lüder A Kahrs
- Institute of Mechatronic Systems, Leibniz Universität Hannover, Hannover, Germany
| | | | - Christian von Falck
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| |
Collapse
|
28
|
Cruz-Pardos A, García-Rey E, García-Cimbrelo E. Total Hip Arthroplasty with Use of the Cementless Zweymüller Alloclassic System: A Concise Follow-up, at a Minimum of 25 Years, of a Previous Report. J Bone Joint Surg Am 2017; 99:1927-1931. [PMID: 29135666 DOI: 10.2106/jbjs.16.01109] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED We previously reported the 10 to 13-year follow-up results for 104 total hip replacements with the Zweymüller Alloclassic stem and a threaded cup in 94 patients. The present study is a clinical and radiographic outcome update after a minimum follow-up of 25 years. Four patients (4 hips) were lost and 46 patients (50 hips) died, leaving 44 patients (50 hips) available for follow-up. Since our previous report, 7 cups and 2 stems were revised. At 20 years, the probability of survival of any component was 84.1% (95% confidence interval [CI], 73.91% to 94.29%) and the cumulative probability of not having stem loosening was 95.9% (95% CI, 95.51% to 96.29%). We observed proximal femoral osteolysis in 15 hips (30%), cortical hypertrophy in 21 hips (42%), and proximal femoral osteopenia in 30 hips (60%). The Zweymüller Alloclassic stem continues to provide excellent results after extended follow-up. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
29
|
Three-Dimensional Analysis of the Contact Pattern between the Cortical Bone and Femoral Prosthesis after Cementless Total Hip Arthroplasty. Adv Orthop 2016; 2016:8052380. [PMID: 26881087 PMCID: PMC4736951 DOI: 10.1155/2016/8052380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/17/2015] [Indexed: 12/02/2022] Open
Abstract
The cementless stem Excia (B. Braun, Melsungen, Germany) implant has a rectangular cross-sectional shape with back-and-forth flanges and a plasma-sprayed, dicalcium phosphate dihydrate coating from the middle to proximal portion to increase initial fixation and early bone formation. Here, the conformity of the Excia stem to the femoral canal morphology was three-dimensionally assessed using computed tomography. Forty-three patients (45 hips) were examined after primary total hip arthroplasty with a mean follow-up of 27 ± 3 months (range: 24–36 months). Spot welds occurred at zone 2 in 16 hips and at zone 6 in 24 hips, with 83% (20/24 hips) of those occurring within 3 months after surgery. First- (n = 12 hips), second- (n = 32), and third- (n = 1) degree stress shielding were observed. The stem was typically in contact with the cortical bone in the anterolateral mid-portion (100%) and posteromedial distal portions (85%). Stress shielding did not progress, even in cases where the stems were in contact with the distal portions. The anterior flange was in contact with the bone in all cases. The stability of the mid-lateral portion with the dicalcium phosphate dihydrate coating and the anterior flange may have inhibited the progression of stress shielding beyond the second degree.
Collapse
|
30
|
A Case Series of Total Hip Arthroplasty Using Cementless Hip Stem Customized for Patients of a Specific Race: 10- to 15-Year Results. J Arthroplasty 2016; 31:190-3. [PMID: 26321076 DOI: 10.1016/j.arth.2015.07.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/08/2015] [Accepted: 07/27/2015] [Indexed: 02/01/2023] Open
Abstract
We report a minimum of 10-year results of patients undergoing total hip arthroplasty (THA) using the cementless BiCONTACT N stem, which was developed to fit the femur in a specific race in which the predominant etiology of hip diseases was developmental dysplasia. A total of 108 hips were evaluated with a mean follow-up of 11.9 ± 1.4 years. The etiology for THA was secondary osteoarthritis due to developmental dysplasia in 90.3% of patients. No evidence of aseptic loosening of the BiCONTACT N stem was observed. The survivorship with the end point as revision surgery for any reason was 94.4% (95% confidence interval 88.7%-97.3%) at 15.0 years postoperatively. BiCONTACT N stem may be an effective alternative for patients with developmental dysplasia of the hip.
Collapse
|