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Tsukada S, Wakui M. Total hip arthroplasty using an alkali- and heat-treated titanium Zweymüller stem with no trochanteric shoulder: results at 5-year follow-up. Hip Int 2023; 33:845-849. [PMID: 35815396 DOI: 10.1177/11207000221111739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A trochanteric shoulder is 1 of the characteristics of the original Zweymüller femoral stem for total hip arthroplasty (THA). There have been few clinical reports of THA using recently available versions of Zweymüller-type stems with eliminated trochanteric shoulder. METHODS 82 consecutive THAs with a Zweymüller-type stem without trochanteric shoulder were analyzed. The stem was made of alkali- and heat-treated titanium, straight, tapered, with rectangular cross-section. Survivorship was estimated with the Kaplan-Meier method. RESULTS 76 of 82 hips (92.7%) were followed for more than 5 years or until revision. 35 of 82 hips (42.7%), were revised and the predominant reason for revision was aseptic loosening of the femoral stem (34 of 35 hips, 97.1%). Survival with revision for any reason as the endpoint was 71.3% (95% CI, 51.8% to 80.1%) at 5 years. CONCLUSIONS The survival of the modified Zweymüller-type stem with no trochanteric shoulder was unacceptably low.
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Affiliation(s)
| | - Motohiro Wakui
- Orthopaedic Surgery, Nekoyama Miyao Hospital, Niigata, Japan
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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.
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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
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Tsukada S, Wakui M, Kizaki K, Iseki T, Miyao M, Tasaki A. Uncemented total hip arthroplasty using alumina ceramic bearings at a minimum of 14 years of follow-up. Arch Orthop Trauma Surg 2022; 142:1689-1695. [PMID: 34269893 DOI: 10.1007/s00402-021-04055-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/02/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The effectiveness of modern ceramic bearings has been well established in reducing the osteolysis associated with wear of the bearing surfaces in total hip arthroplasty (THA). However, there are limited mid- to long-term follow-up data for complications associated with ceramic bearings. MATERIALS AND METHODS This case series analyzed 124 consecutive primary uncemented THAs in 108 patients with a mean age of 61 years using alumina ceramic-on-alumina ceramic bearing couples. Seventy THAs (56%) were evaluated at a minimum 14 years of follow-up; the mean follow-up period was 16 ± 1 years (14-20 years). Kaplan-Meier survivorship was determined with revision surgery for any reason as the end point. Complications were recorded focusing on osteolysis, ceramic fracture, and abnormal sounds until the final follow-up. Clinical data were scored according to the Merle d'Aubigne and Postel hip score at 14 years after THA. RESULTS The survivorship was 93.5% (95% CI 86.7-97.0%) at 14-years postoperatively. Five patients (4.0%) underwent revision surgery due to instability or infection before 1-year postoperatively. Two patients (1.6%) underwent revision surgery due to ceramic liner fracture at 9- and 12-years postoperatively, respectively. There was no radiographic evidence of osteolysis. A total of 27 complications occurred: dislocations (n = 7/124), squeaking sounds (n = 3/124), clicking sounds (n = 6/124), ceramic liner fractures (n = 2/124), periprosthetic fractures (n = 4/124), deep infections (n = 2/124), transient sciatic nerve palsy (n = 2/124), and femoral stem breakage (n = 1/124). The Merle d'Aubigne and Postel hip score was 16.8 ± 1.4 points. CONCLUSIONS The survivorship analysis demonstrates the uncemented THA using alumina ceramic bearings may provide favorable clinical outcome and can offer minimal wear at a minimum 14-year follow-up. Revision surgery was mostly required due to instability and infection in the short-term, and implant breakage in the mid- to long-term.
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Affiliation(s)
- Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo City, Niigata, 950-1151, Japan. .,Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan.
| | - Motohiro Wakui
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo City, Niigata, 950-1151, Japan
| | - Kazuha Kizaki
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo City, Niigata, 950-1151, Japan
| | - Takuya Iseki
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo City, Niigata, 950-1151, Japan
| | - Masunao Miyao
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo City, Niigata, 950-1151, Japan
| | - Atsushi Tasaki
- Department of Orthopaedic Surgery, St. Luke's International Hospital, 9-1 Akashi Cho, Chuo City, Tokyo, 104-8560, Japan
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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.
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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
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Nishino T, Mishima H, Kawamura H, Yoshizawa T, Miyakawa S, Yamazaki M. Ten-year results of 55 dysplasia hips of hip offset and leg length reconstruction in total hip arthroplasty with cementless tapered stems having a high offset option designed for dysplastic femur. J Orthop Surg (Hong Kong) 2020; 28:2309499020909499. [PMID: 32186225 DOI: 10.1177/2309499020909499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In developmental dysplasia of the hip (DDH), the centers of hip rotation move in the superior and lateral direction. In total hip arthroplasty for such cases, movement of the center of hip rotation is in the inferior and medial direction. It causes an increase in leg length and a decrease in acetabular offset. We therefore evaluated the change of hip offset and leg length before and after surgery with two stems having a high offset option. PATIENTS AND METHODS The preoperative diagnosis was secondary osteoarthritis due to DDH excluded Crowe IV. A stem selection was decided based on preoperative two-dimensional templating. Total 55 hips in 50 patients were followed up for minimum 10 years. Pre- and postoperative clinical evaluations were performed using a hip joint function scoring system. Radiographic evaluations were used for offset and leg length measurements and other associated factors. RESULTS Both stems showed excellent clinical results. A high offset option was used in 60% of all cases. No postoperative dislocations were observed. The biological fixation was stable in all cases. The hip offset was restored without excessive leg lengthening in most cases. CONCLUSION Anatomical consistency could be maintained by using a stem which matched geometry of the proximal part and had offset option. These cementless tapered stems having a high offset option are suitable for Crowe I to III hip dysplasia if two-dimensional X-ray templates fit the shape of the proximal femurs. They were associated with excellent clinical results and biological fixation. The offset option may be useful to adjust leg length and offset in DDH patients.
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Affiliation(s)
- Tomofumi Nishino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hajime Mishima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Haruo Kawamura
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tomohiro Yoshizawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shumpei Miyakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Kanto M, Fukunishi S, Fukui T, Nishio S, Fujihara Y, Okahisa S, Takeda Y, Yoshiya S, Tachibana T. Radiological Evaluation of the Relationship Between Cortical Hypertrophy and Stress Shielding After Total Hip Arthroplasty Using a Cementless Stem. Arthroplast Today 2020; 6:894-900. [PMID: 33204784 PMCID: PMC7649111 DOI: 10.1016/j.artd.2020.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 01/03/2023] Open
Abstract
Background Unloading of the proximal medial femoral cortex is usually associated with an increased bone strain at the distal part of the prosthesis, which may cause distal femoral cortical hypertrophy (CH). The objective of this study was to determine the factors that may be considered a predisposition to distal femoral CH and its effect on the stress shielding (SS) or durability of the fixation of the stem. Methods A total of 240 total hip arthroplasties were performed between January 2006 and December 2016, with all hips implanted with a Bicontact stem. The minimum follow-up period was more than 2 years, and the mean follow-up period was 7.2 years. The radiographic outcome was assessed on an anteroposterior hip radiograph. CH and SS were assessed on postoperative radiographs in the Gruen zone. We defined CH that appeared in zone 3 or 5 as ‘the focal type’ and defined CH that appeared in zones 2, 3, 4, 5, and 6 as ‘the diffuse type.’ SS followed the procedures from the Engh classification. Results CH was found in 72 hips (30% of the 240 hips), the focal type was found in 23 hips (9.6% of the 240 hips), and the diffuse type was found in 49 hips (20.4% of the 240 hips). SS was found in 41 hips (17.1% of 240 hips), including 32 hips with SS, which was found after the development of CH. One hip was from the focal-type CH and 31 hips were from the diffuse-type CH. SS, which is typically found in Engh classification types 1 and 2 developed in 13 hips, and SS, which is widely seen in Engh classification types 3 and 4 developed in 19 hips. All 19 hips with progressed SS were found after the diffuse-type CH had developed. In addition, among the 19 hips with progressed SS, Dorr type A was found in 0 hips, Dorr type B in 8 hips, and Dorr type C in 11 hips. Conclusions According to the results of our radiological evaluation, development of the diffuse-type CH after total hip arthroplasty using Bicontact stems is one of the critical causes of the later development of SS and could be predicted to progress to SS. To prevent the development of the diffuse-type CH, the indication to choose a Bicontact stem for a Dorr type C with osteoporotic bone should be considered.
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Affiliation(s)
- Makoto Kanto
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | | | - Tomokazu Fukui
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Shoji Nishio
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Yuki Fujihara
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Shohei Okahisa
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Yu Takeda
- Nishinomiya Kaisei Hospital, Nishinomiya City, Hyogo, Japan
| | | | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
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Chatterjee S, Roy S, Majumder S, RoyChowdhury A. Biomechanical Analysis to Probe Role of Bone Condition and Subject Weight in Stiffness Customization of Femoral Stem for Improved Periprosthetic Biomechanical Response. J Biomech Eng 2020; 142:101002. [PMID: 32320044 DOI: 10.1115/1.4046973] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Indexed: 11/08/2022]
Abstract
Stress shielding due to difference in stiffness of bone and implant material is one among the foremost causes of loosening and failure of load-bearing implants. Thus far, femoral geometry has been given priority for the customization of total hip joint replacement (THR) implant design. This study, for the first time, demonstrates the key role of bone condition and subject-weight on the customization of stiffness and design of the femoral stem. In particular, internal hollowness was incorporated to reduce the implant stiffness and such designed structure has been customized based on subject parameters, including bone condition and bodyweight. The primary aim was to tailor these parameters to achieve close to natural strain distribution at periprosthetic bone and to reduce interfacial bone loss over time. The maintenance of interfacial bone density over time has been studied here through analysis of bone remodeling (BR). For normal bodyweight, the highest hollowness exhibited clinically relevant biomechanical response, for all bone conditions. However, for heavier subjects, consideration of bone quality was found to be essential as higher hollowness induced bone failure in weaker bones and implant failure in stronger bones. Moreover, for stronger bone, thinner medial wall was found to reduce bone resorption over time on the proximo-lateral zone of stress shielding, while lateral thinning was found advantageous for weaker bones. The findings of this study are likely to facilitate designing of femoral stems for achieving better physiological outcomes and enhancement of the quality of life of patients undergoing THR surgery.
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Affiliation(s)
- Subhomoy Chatterjee
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Howrah, West Bengal 711103, India; Materials Research Centre, Indian Institute of Science, Bangalore, Karnataka 560012, India
| | - Sandipan Roy
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Howrah, West Bengal 711103, India; Department of Mechanical Engineering, SRM Institute of Science & Technology, Kattankulathur, Kancheepuram, Chennai, Tamil Nadu 603203, India
| | - Santanu Majumder
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal 711103, India
| | - Amit RoyChowdhury
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal 711103, India
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Al Thaher Y, Perni S, Prokopovich P. Nano-carrier based drug delivery systems for sustained antimicrobial agent release from orthopaedic cementous material. Adv Colloid Interface Sci 2017; 249:234-247. [PMID: 28477865 DOI: 10.1016/j.cis.2017.04.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 12/22/2022]
Abstract
Total joint replacement (TJR), such as hip and knee replacement, is a popular procedure worldwide. Prosthetic joint infections (PJI) after this procedure have been widely reported, where treatment of such infections is complex with high cost and prolonged hospital stay. In cemented arthroplasties, the use of antibiotic loaded bone cement (ALBC) is a standard practice for the prophylaxis and treatment of PJI. Recently, the development of bacterial resistance by pathogenic microorganisms against most commonly used antibiotics increased the interest in alternative approaches for antimicrobial delivery systems such as nanotechnology. This review summarizes the efforts made to improve the antimicrobial properties of PMMA bone cements using nanotechnology based antibiotic and non-antibiotic delivery systems to overcome drawbacks of ALBC in the prophylaxis and treatment of PJIs after hip and knee replacement.
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Affiliation(s)
- Yazan Al Thaher
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, UK
| | - Stefano Perni
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, UK
| | - Polina Prokopovich
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, UK.
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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.
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