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Staunton P, Alhojailan K, Desgagne C, Epure L, Zukor D, Huk O, Antoniou J. Acute Periprosthetic Hip Fractures With Short, Uncemented Femoral Stems. J Arthroplasty 2024; 39:S248-S253. [PMID: 38851408 DOI: 10.1016/j.arth.2024.05.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Uncemented femoral stems in hip arthroplasty have shown excellent long-term results, and several systematic studies indicate satisfactory performance of short stems. However, biomechanical and finite element analysis studies have suggested that shorter stems allow greater micromotion, producing greater strain at the implant-bone interface, which potentially increases the risk for periprosthetic fracture (PPF). We sought to assess this risk within our unit. METHODS Our institution's arthroplasty database was searched for all primary total hip arthroplasties using short femoral stems performed between July 14, 2009 and August 29, 2022. The overall PPF rate and the PPF rate for individual femoral stems were established. Preoperative X-rays for each case were analyzed to characterize individual proximal femoral geometry. A data analysis was performed to identify risk factors for PPF. RESULTS For the time period assessed, 3,192 short femoral stems were implanted. This included 1,561 of stem A and 1,631 of stem B. Women constituted 55.37% of the cohort. The average patient age was 66 years (range, 22 to 95). The PPF rate was 0.6%, with 19 PPFs identified at a follow-up of 3 months. There was a significantly higher fracture rate in stem A (0.96%) compared to stem B (0.25%) (P ≤ .01). Proximal femoral geometry, age, and sex were not determined to be risk factors for PPF in our cohort. Individual surgeons and surgical approaches appeared to confer no increased risk. There was no significant difference in average stem length, but multivariate analysis identified stem type and stem length as an independent risk factor for PPF. CONCLUSIONS Our study identified individual stem and stem length as independent risk factors for PPF within our cohort. PPF is a multifactorial issue, and consensus on emerging risk factors such as implant design will hopefully inform decisions that can provide further risk reduction for individual patients.
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Affiliation(s)
- Peter Staunton
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | - Khalifa Alhojailan
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | | | - Laura Epure
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada
| | - David Zukor
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | - Olga Huk
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | - John Antoniou
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
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Ishii S, Baba T, Shirogane Y, Hayashi K, Homma Y, Muto O, Kaneko K, Ishijima M. Callus formation after total hip arthroplasty using a short tapered-wedge stem. Skeletal Radiol 2024:10.1007/s00256-024-04756-7. [PMID: 39052073 DOI: 10.1007/s00256-024-04756-7] [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: 03/04/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE The incidence of periprosthetic fractures after total hip arthroplasty using a short tapered-wedge stem is high. Callus formation preceding this fracture, which indicates postoperative stress fracture around the stem, has been reported. However, previous studies on postoperative callus are limited. Hence, the current study aimed to evaluate the prevalence and risk factors of postoperative callus after total hip arthroplasty with a short tapered-wedge stem. MATERIALS AND METHODS This retrospective study included 127 patients who underwent total hip arthroplasty using a cementless short tapered-wedge stem. The depth of stem insertion was measured as the distance from the lateral corner of the stem to the most medial point of the lesser trochanter along the body axis. Postoperative callus was defined as a bridging callus on the lateral femoral cortex at the distal end of the porous coating of the stem. Plain radiography was performed before surgery and immediately and at 1, 3, and 6 months after surgery to assess postoperative callus. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PC. RESULTS In total, 60 (47.2%) of 127 patients presented with postoperative callus. Multivariate logistic regression analysis with postoperative callus as the dependent variable revealed that the stem depth at 1 month after total hip arthroplasty (odds ratio, 1.14; 95% confidence interval, 1.04-1.24, p = 0.002) was a significant and independent risk factor of postoperative callus. CONCLUSION Deep insertion of a short tapered-wedge stem is a risk factor for postoperative callus.
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Affiliation(s)
- Seiya Ishii
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan.
- Department of Orthopaedic Surgery, Yokohama Tsurugamine Hospital, Kanagawa, Japan.
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yuichi Shirogane
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Koju Hayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Osamu Muto
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
- Department of Orthopaedic Surgery, Yokohama Tsurugamine Hospital, Kanagawa, Japan
| | - Kazuo Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Su MW, Groot OQ, Werenski JO, Sodhi A, Merchan N, Anderson ME, Heincelman C, Chang CY, Lozano-Calderon SA. Cemented and Press-fit Femoral Stems for the Management of Oncologic Femoral Tumors. J Am Acad Orthop Surg 2024; 32:e695-e705. [PMID: 38773833 DOI: 10.5435/jaaos-d-23-01043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/17/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Stem fixation in reconstruction after resection of femoral tumors is debated. Cemented stems offer immediate stability but risk aseptic loosening, while press-fit stems allow bone ingrowth but risk stress shielding and subsidence. Our retrospective review aimed to determine implant failure rates and their associated factors, as well as the rates of infection, debridement, and mortality for both fixation groups (cemented or press-fit stems) used in patients undergoing resection of femoral tumor disease and subsequent arthroplasty. METHODS We retrospectively studied 252 patients who underwent resection of femoral tumors and subsequent arthroplasty using cemented (n = 173; 69%) or press-fit (noncemented) (n = 79; 31%) stems between 1999 and 2020. Implant failure was the primary outcome, with secondary outcomes including rates of implant infection, debridement, and mortality. Multivariable regression was done to assess risk factors for implant failures. RESULTS The study found implant failure rates of 11% and 18% for cemented stems and press-fit stems, respectively. Lower stem to diaphyseal ratios ( P = 0.024) and younger patients ( P = 0.008) were associated with a higher risk of implant failure in cemented stems. The infection rates were 14% and 10% for cemented and press-fit stems, respectively. Debridement rates were 16% and 13% for cemented and press-fit stems, respectively, while the 1-year mortality rate was 16% for cemented stems and 1.5% for press-fit stems. CONCLUSIONS This study is the largest of its kind, providing patient characteristics and outcomes in both cemented and press-fit stems in the setting of reconstruction for femoral tumors. Both methods can be effective, with outcomes dependent on patient-specific factors, such as life expectancy, activity level, and body habitus, as well as proper implant fit. Additional studies of both implants and longer follow-up are required to elucidate the optimal fixation method for each individual patient. LEVEL OF EVIDENCE Level III, retrospective noncomparative study.
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Affiliation(s)
- Marie W Su
- From the Department of Orthopaedic Surgery, Massachusetts General Hospital, Musculoskeletal Oncology Service, Harvard Medical School, Boston, MA (Su, Groot, Werenski, Sodhi, Merchan, and Lozano-Calderon), Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Merchan, Anderson, Heincelman, Chang), Department of Orthopaedic Surgery, Musculoskeletal Oncology Service (Dr. Merchan, Dr. Anderson, Dr. Heincelman), Boston Children's Hospital, Harvard Medical School, Boston, MA (Dr. Merchan, Dr. Anderson, Dr. Heincelman)
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Ohashi Y, Fukushima K, Tsuchiya M, Saito H, Uchida K, Uchiyama K, Takahira N, Takaso M. Influence of broach surface design of a fully hydroxyapatite coated, double tapered stem on periprosthetic bone mineral density after total hip arthroplasty: a study based on the morphology of the proximal femur. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05430-2. [PMID: 38987502 DOI: 10.1007/s00402-024-05430-2] [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: 09/26/2023] [Accepted: 06/27/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION This study aimed to compare the impact of different broach surface designs on post-operative clinical outcomes, bone reactions and changes in bone mineral density (BMD) in patients who underwent total hip arthroplasty (THA) using a fully hydroxyapatite coated and double tapered stem with either compaction shape (COM) or hybrid shape (HYB) broaches. MATERIALS AND METHODS A retrospective analysis was conducted on 76 patients (100 hips) who underwent primary THA using the Avenir complete stem®. Patients were divided into two groups: the COM broach group (50 hips) and HYB broach group (50 hips). We evaluated clinical outcomes using the Japanese Orthopaedic Association hip scores one month before the surgery, and 12 and 24 months after the surgery. Radiographic findings, including stem alignment angles, radiolucent lines, spot welds, and cortical hypertrophy, were assessed. BMD around the stem in Gruen zones 1-7 was evaluated using dual-energy X-ray absorptiometry (DEXA) at 7 days, 12, and 24 months post-operatively. The Dorr classification was used to assess femoral morphology. RESULTS There were no significant differences in clinical outcomes, radiographic findings, or BMD changes between the COM and HYB broach groups in the overall patient cohort. However, in Dorr type A femurs, the COM broach group demonstrated superior BMD superior preservation in zones 1 and 7 after 12 months and in zones 1, 6 and 7 after 24 months. Additionally, in Dorr type B femurs, significant BMD preservation was observed in zone 3 at 24 months in the COM broach group. CONCLUSIONS This study suggests that the broach surface design of fully hydroxyapatite coated stems may influence periprosthetic BMD changes, especially in Dorr type A and B femurs. Surgeons should consider broach selection based on patient-specific femoral morphology to optimize BMD preservation in THA procedures using fully hydroxyapatite coated stems.
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Affiliation(s)
- Yoshihisa Ohashi
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Kensuke Fukushima
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan.
| | - Maho Tsuchiya
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Hiroki Saito
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Kentaro Uchida
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Katsufumi Uchiyama
- Department of Patient Safety and Healthcare Administration, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Masashi Takaso
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
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Maeda T, Obayashi O, Ishijima M, Sato T, Musha Y, Ikegami H. Finite element analysis of mechanical stress in a cementless tapered-wedge short stem in the varus position. J Orthop Surg Res 2024; 19:385. [PMID: 38951850 PMCID: PMC11218374 DOI: 10.1186/s13018-024-04856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/15/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND In recent years, the use of tapered-wedge short stems has increased due to their ability to preserve bones and tendons. Surgical techniques occasionally result in a varus position of the stem, which is particularly pronounced in short stems. Although the varus position is not clinically problematic, there are reports of an increased incidence of stress shielding and cortical hypertrophy. Thus, we evaluated and examined the acceptable range of varus angles using finite element analysis. METHODS Patients diagnosed with osteoarthritis of the hip joint who had undergone arthroplasty were selected and classified into three types [champagne-flute (type A), intermediate (type B), and stovepipe (type C)]. Finite element analysis was performed using Mechanical Finder. The model was created using a Taperloc microplasty stem with the varus angle increased by 1° from 0° to 5° from the bone axis and classified into seven zones based on Gruen's zone classification under loading conditions in a one-leg standing position. The volume of interest was set, the mean equivalent stress for each zone was calculated. RESULTS A significant decrease in stress was observed in zone 2, and increased stress was observed in zones 3 and 4, suggesting the emergence of a distal periosteal reaction, similar to the results of previous studies. In zone 2, there was a significant decrease in stress in all groups at a varus angle ≥ 3°. In zone 3, stress increased from ≥ 3° in type B and ≥ 4° in type C. In zone 4, there was a significant increase in stress at varus angles of ≥ 2° in types A and B and at ≥ 3° in type C. CONCLUSION In zone 2, the varus angle at which stress shielding above Engh classification grade 3 may appear is expected to be ≥ 3°. Distal cortical hypertrophy may appear in zones 3 and 4; the narrower the medullary cavity shape, the smaller the allowable angle of internal recession, and the wider the medullary cavity shape, the wider the allowable range. Long-term follow-up is required in patients with varus angles > 3°.
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Affiliation(s)
- Takahiro Maeda
- Department of Orthopedic Surgery, Toho University Graduate School of Medicine, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan
- Department of Orthopedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Osamu Obayashi
- Department of Orthopedic Surgery, Juntendo Shizuoka Hospital, Nagaoka 1129, Izunokuni 410-2295, Shizuoka, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopedic and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Taichi Sato
- Department of Advanced Machinery Engineering, School of Engineering, Tokyo Denki University, 5 Senju Asahi-cho, Adachi-ku, Tokyo, 120-8551, Japan
| | - Yoshiro Musha
- Department of Orthopedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Hiroyasu Ikegami
- Department of Orthopedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
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Freitag T, Fuchs M, Friedrich D, Bieger R, Reichel H, Oltmanns M. The Migration Pattern of a Short-Tapered Femoral Stem Correlates with the Occurrence of Cortical Hypertrophies: A 10-Year Longitudinal Study Using Ein Bild Röntgen Analyse-Femoral Component Analysis. J Clin Med 2024; 13:3616. [PMID: 38930145 PMCID: PMC11205188 DOI: 10.3390/jcm13123616] [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: 05/28/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Shorter hip stems have shown promising mid-term results but lack long-term data. High rates of distal cortical hypertrophy (CH) have been described, suggesting a more diaphyseal load transmission. This study aimed to determine patient-specific and surgery-related factors influencing CH and their impact on 10-year outcomes. Methods: It included 100 consecutive total hip arthroplasties (THAs) using the Fitmore stem (Zimmer, Warsaw, Indiana), with clinical and radiographic follow-ups at 1, 2, 5, and at least 10 years post-surgery. Results: No revisions were performed due to aseptic loosening after a mean of 11.6 years (range: 10-13.5 years). CH was observed in 26% of hips, primarily in Gruen zones 3 and 5. There was no significant difference in the Harris Hip Score between patients with and without CH. Larger stem sizes and greater axial subsidence significantly correlated with CH occurrence (OD 1.80, (1.13-1.92), p = 0.004; OD 1.47, (1.04-2.08), p = 0.028). The Fitmore stem demonstrated excellent survival rates and favorable outcomes over 10 years. Conclusions: Despite a lower CH rate compared to other studies, significant correlations with stem size and subsidence were identified. This study underscores the importance of patient selection and achieving high primary stability to maintain the metaphyseal anchoring concept.
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Affiliation(s)
- Tobias Freitag
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
| | - Michael Fuchs
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
| | - David Friedrich
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
| | - Ralf Bieger
- Center for Knee, Hip and Shoulder Surgery, Schoen Clinic München Harlaching, Harlachinger Strasse 51, 81547 Munich, Germany;
| | - Heiko Reichel
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
| | - Moritz Oltmanns
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
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Lee KH, Hung YT, Chang CY, Wang JC, Tsai SW, Chen CF, Wu PK, Chen WM. The cementless taper wedge vs. fit-and-fill stem in primary total hip arthroplasty: risk of stem-related complication differs across Dorr types. Arch Orthop Trauma Surg 2024; 144:2839-2847. [PMID: 38739153 DOI: 10.1007/s00402-024-05361-y] [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: 03/02/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION The choice between a cementless taper wedge stem and a fit-and-fill stem in total Hip arthroplasty (THA) for various proximal femoral morphological types has not been thoroughly evaluated. This study aimed to compare the risk of stem-related complications between these two stem types in Dorr type A, B, and C femurs. MATERIALS AND METHODS From January 2015 through April 2021, we retrospectively reviewed 1995 cementless THA procedures. We stratified all procedures into three groups: Dorr type A (N = 360, 18.0%), B (N = 1489, 74.7%) and C (N = 146, 7.3%). The primary outcome domain was stem-related complications, including stem subsidence ≥ 3 mm, intraoperative fracture, periprosthetic fracture and aseptic stem loosening. We performed multivariate regression analysis to compare the risk of stem-related complication between the two stem types. Other factors included age, sex, body mass index, diagnosis, age-adjusted Charlson comorbidity index, stem alignment and canal fill ratio. RESULTS The incidence of stem-related complications in the taper wedge and fit-and-fill stem groups was 4.4% (N = 15) and 6.5% (N = 107), respectively. Fit-and-fill stems showed an increased risk of stem-related complications (aOR: 9.903, 95% CI: 1.567-62.597) only in Dorr type C femurs. No significant difference in risk was observed in Dorr type A and B femurs. Furthermore, the canal fill ratio at the lesser trochanter, 2 cm and 7 cm below the lesser trochanter, did not exhibit an association with stem-related complications in any Dorr type. CONCLUSIONS Concerning the risk of stem-related complications, the taper wedge stem was a better choice in Dorr type C femurs. However, there was no difference in risk between the taper wedge stem and fit-and-fill stem in Dorr type A and B femurs.
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Affiliation(s)
- Kun-Han Lee
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 11217, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yueh-Ting Hung
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 11217, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Yang Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 11217, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jui-Chien Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 11217, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 11217, Taiwan.
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 11217, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 11217, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 11217, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Lee CY, Jin SY, Choi JH, Yoon TR, Park KS. Comparison of Short Curved Stems and Standard-length Single Wedged Stems for Cementless Total Hip Arthroplasty. Hip Pelvis 2024; 36:120-128. [PMID: 38825821 PMCID: PMC11162871 DOI: 10.5371/hp.2024.36.2.120] [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: 03/16/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 06/04/2024] Open
Abstract
Purpose The purpose of this study was to compare the clinical and radiographic outcomes with use of short-curved stems versus standard-length single wedged stems over a minimum follow-up period of five years. Materials and Methods A retrospective study of primary total hip arthroplasties performed using the Fitmore® stem (127 hips, 122 patients) and the M/L taper® stem (195 hips, 187 patients) between October 2012 and June 2014 was conducted. The clinical and radiographic outcomes were obtained for evaluation over a minimum follow-up period of five years. Results In both the Fitmore® and M/L taper® groups, the mean Harris hip score improved from 52.4 and 48.9 preoperatively to 93.3 and 94.5 at the final follow-up, respectively (P=0.980). The mean Western Ontario and McMaster Universities Osteoarthritis Index scores also improved from 73.3 and 76.8 preoperatively to 22.9 and 25.6 at the final follow-up, respectively (P=0.465). Fifteen hips (Fitmore®: 14 hips; M/L taper®: one hip, P<0.001) developed intraoperative cracks and were treated simultaneously with cerclage wiring. Radiography showed a radiolucent line in 24 hips in the Fitmore® group and 12 hips in the M/L taper® group (P=0.125). Cortical hypertrophy was detected in 29 hips (Fitmore® group: 28 hips; M/L taper® group: one hip, P<0.001). Conclusion Similarly favorable clinical and radiographic outcomes were achieved with use of both short-curved stems and standard-length single wedged stems. However, higher cortical hypertrophy and a higher rate of femoral crack were observed with use of Fitmore® stems.
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Affiliation(s)
- Chan Young Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Sheng-Yu Jin
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Ji Hoon Choi
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Taek-Rim Yoon
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Kyung-Soon Park
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
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Ashkenazi I, Benady A, Ben Zaken S, Factor S, Abadi M, Shichman I, Morgan S, Gold A, Snir N, Warschawski Y. Radiological Comparison of Canal Fill between Collared and Non-Collared Femoral Stems: A Two-Year Follow-Up after Total Hip Arthroplasty. J Imaging 2024; 10:99. [PMID: 38786553 PMCID: PMC11121886 DOI: 10.3390/jimaging10050099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Collared femoral stems in total hip arthroplasty (THA) offer reduced subsidence and periprosthetic fractures but raise concerns about fit accuracy and stem sizing. This study compares collared and non-collared stems to assess the stem-canal fill ratio (CFR) and fixation indicators, aiming to guide implant selection and enhance THA outcomes. This retrospective single-center study examined primary THA patients who received Corail cementless stems between August 2015 and October 2020, with a minimum of two years of radiological follow-up. The study compared preoperative bone quality assessments, including the Dorr classification, the canal flare index (CFI), the morphological cortical index (MCI), and the canal bone ratio (CBR), as well as postoperative radiographic evaluations, such as the CFR and component fixation, between patients who received a collared or a non-collared femoral stem. The study analyzed 202 THAs, with 103 in the collared cohort and 99 in the non-collared cohort. Patients' demographics showed differences in age (p = 0.02) and ASA classification (p = 0.01) but similar preoperative bone quality between groups, as suggested by the Dorr classification (p = 0.15), CFI (p = 0.12), MCI (p = 0.26), and CBR (p = 0.50). At the two-year follow-up, femoral stem CFRs (p = 0.59 and p = 0.27) were comparable between collared and non-collared cohorts. Subsidence rates were almost doubled for non-collared patients (19.2 vs. 11.7%, p = 0.17), however, not to a level of clinical significance. The findings of this study show that both collared and non-collared Corail stems produce comparable outcomes in terms of the CFR and radiographic indicators for stem fixation. These findings reduce concerns about stem under-sizing and micro-motion in collared stems. While this study provides insights into the collar design debate in THA, further research remains necessary.
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Affiliation(s)
| | | | | | - Shai Factor
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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10
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Kirsch M, Kremer H, Fabbri C, Capdevielle P, Collignon F, Mainard D. Osseointegration of a hydroxyapatite-coated stem in femoral neck fractures in the over-80 s. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1535-1541. [PMID: 38267791 DOI: 10.1007/s00590-024-03835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE In the over-80 s, femoral bone is often osteoporotic and unlikely to be conducive to periprosthetic bone rehabitation. This observation often leads to cemented fixation for hemiarthroplasty in femoral neck fracture. Hydroxyapatite is a bioactive coating that has already demonstrated its osteoinductive properties. Our hypothesis is that hydroxyapatite enables prosthetic osseointegration in patients over 80, as well as periprosthetic cortical thickening. The objective was to evaluate the osseointegration of a hydroxyapatite-coated femoral stem in femoral neck fractures in the over-80 s, and the evaluation of the periprosthetic bone regeneration permitted by hydroxyapatite. METHODS This was a retrospective study. Osseointegration and periprosthetic bone regeneration were assessed on pre-operative, immediate post-operative and last follow-up radiographs with Engh score, O-SS score, cortical index, Canal Bone Ration (CBR) and Canal Fill Ratio (CFR). RESULTS One hundred and forty-six patients were included. At last follow-up, 99.3% (n = 145) of stems were osseointegrated. The mean Engh score was 19.9 [SD 3.1]. The mean O-SS score was 19.1 [SD 2.4], corresponding to very good osseointegration. The mean CBR at last follow-up was 0.48 [SD 0.07], corresponding to a non-osteoporotic femur. There was a significant difference with pre-operative CBR (p < 0,001). The pre-operative cortical index and the index at the last follow-up were significantly different for all levels of measurement (p < 0,001). The CFR at last follow-up was also significantly different with the post-operative CFR (p < 0,001). CONCLUSION This study shows the value of using a hydroxyapatite-coated stem on senile, osteoporotic bone to improve cortical thickness along the entire length of femoral bone.
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Affiliation(s)
- Mathias Kirsch
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France.
| | - Hugo Kremer
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
| | - Camille Fabbri
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
| | - Pierre Capdevielle
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
| | - Florian Collignon
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
| | - Didier Mainard
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
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Rolvien T, Thiessen ML, Boese CK, Bechler U, Strahl A, Beil FT, Ries C. Areal bone mineral density is not associated with femoral stem subsidence in patients younger than 70 years undergoing total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:1415-1422. [PMID: 38062273 PMCID: PMC10896811 DOI: 10.1007/s00402-023-05137-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: 03/17/2023] [Accepted: 11/11/2023] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Femoral stem subsidence is a known complication after uncemented total hip arthroplasty (THA). The purpose of this study was to determine the frequency of osteoporosis and to investigate the relationship between areal bone mineral density (aBMD) and subsidence in a cohort of patients younger than 70 years. METHODS One hundred consecutive patients (age 60 ± 6 years; 52 female, 48 male) undergoing uncemented THA using a collarless press fit femoral stem were retrospectively reviewed. Dual-energy X-ray absorptiometry (DXA) was performed preoperatively at the proximal femur and lumbar spine, and if not feasible at these sites, at the distal radius. DXA results were compared to a cohort of 100 patients ≥ 70 years scheduled for cemented THA. Age, sex, and body mass index (BMI), canal flare index (CFI), and canal fill ratio (CFR) were assessed. Analysis of stem subsidence and migration was performed on standardized, calibrated radiographs obtained postoperatively and at follow-up. RESULTS The frequency of osteoporosis was considerably lower in the study cohort compared to patients ≥ 70 years (7% vs. 19%, p = 0.02). Illustrated by the high CFR (mean 96 ± 4%) in the mid-stem region, a sufficient press fit was achieved. After a mean follow-up of 7.4 months, the mean stem subsidence was 0.9 ± 0.9 mm. Only two patients had subsidence greater than 3 mm, one of whom was morbidly obese and the other diagnosed with severe osteoporosis. There were no correlations between any of the parameters (CFI, CFR, age, sex, BMI) and femoral stem subsidence. In addition, aBMD T-scores showed no correlations with subsidence. CONCLUSION aBMD by DXA does not appear to be associated with stem subsidence in patients younger than 70 years and with adequate press fit.
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Affiliation(s)
- Tim Rolvien
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Maximilian Lenard Thiessen
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christoph Kolja Boese
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ulrich Bechler
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - André Strahl
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Frank Timo Beil
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian Ries
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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12
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Lee HJ, Kim HS, Yoo JJ. Novel radiologic indices for stem type decision in total hip arthroplasty in patients with metaphyseo-diaphyseal mismatched Dorr A proximal femur. BMC Musculoskelet Disord 2024; 25:124. [PMID: 38336653 PMCID: PMC10854119 DOI: 10.1186/s12891-024-07223-5] [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: 08/16/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND In metaphyseo-diaphyseal (M-D) mismatched Dorr A femurs, it is difficult to achieve proper fixation with a type 1 stem. Proper interpretation of the geometry of the femur is integral at the preoperative stage in an M-D mismatched femur, but there has been a scarcity of studies on the radiologic indices. Therefore, we analyze the previous radiologic indices and suggest the novel ones for M-D mismatched femurs. METHODS Our study was a retrospective review of preoperative radiographs of patients who underwent total hip arthroplasty with the smallest type 1 stem or with type 3 C stem at a single institution from July 2014 to March 2022. A Type 3 C stem was used when the smallest type 1 stem failed to achieve metaphyseal fixation. One hundred twenty-six patients were categorized into two main groups. Canal-flare index, canal-calcar ratio, modified morphological cortical index, and two novel indices (lesser trochanter-to-distal ratio-α and -β [LDR-α and -β]) were assessed on preoperative pelvic radiographs. RESULTS Multivariate and ROC analysis demonstrated that high LDR-β (Exp[B]: 485.51, CI: 36.67-6427.97, p < 0.001) was associated with a more mismatched tendency group and had clinically acceptable discriminatory power (AUC: 0.765, CI: 0.675-0.855, p < 0.001) between the two cohorts. CONCLUSION Correct assessment of preoperative femoral morphology would be fundamental in the selection of a suitable stem. The ratio based on 3 cm below the lesser trochanter of the femur seemed crucial. We recommend evaluating the newly described radiological index preoperatively in M-D mismatched Dorr A femur for planning precisely and selecting a proper stem.
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Affiliation(s)
- Han Jin Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Orthopaedic Surgery, Hanil General Hospital, Seoul, Korea
| | - Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jeong Joon Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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Berliner ZP, Jawad MU, Matzko C, Cooper HJ, Rodriguez JA, Hepinstall MS. Proximal radiolucent lines around fully hydroxyapatite-coated tapered femoral stems: should we be concerned? Hip Int 2024; 34:49-56. [PMID: 37306146 DOI: 10.1177/11207000231178269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Radiolucent lines occasionally develop around the proximal aspect of fully hydroxyapatite (HA)-coated tapered femoral stems after total hip arthroplasty (THA). It was hypothesised that distal wedging of stems may predispose to proximal radiolucent line formation, which may negatively impact clinical outcome. METHODS All primary THA performed with a collarless fully HA-coated stem that had a minimum of 1 year of radiographic follow-up were identified in a surgical database (n = 244). Radiographic measures of proximal femoral morphology and femoral canal fill at the middle and distal thirds of the stem were analysed for association with the presence of proximal radiolucent lines. Linear regression was used to explore any association between radiolucent lines and patient reported outcome measures (PROMs), available in 61% of patients. RESULTS Proximal radiolucent lines developed in 31 cases (12.7%) at final follow-up. Dorr A femoral morphology and increased canal-fill at the distal ⅓ of the stem correlated with the development of radiolucent lines (p < 0.001). No correlation was observed between pain or PROMs and the presence of proximal radiolucent lines. DISCUSSION We observed an unexpectedly high incidence of proximal femoral radiolucent lines about collarless fully HA coated stems. Distal-only implant wedging in Dorr A bone may compromise proximal fixation. Although this finding did not correlate with short-term outcomes, the long-term clinical impact requires further study.
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Affiliation(s)
- Zachary P Berliner
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Muhammad Umar Jawad
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Chelsea Matzko
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - H John Cooper
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jose A Rodriguez
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Shichman I, Lawrence KW, Berzolla E, Hernandez CS, Man-El R, Warschawski Y, Snir N, Schwarzkopf R, Hepinstall MS. Comparison of canal fill and radiolucent line formation between two fully coated, hydroxyapatite tapered stems: a 2-year follow-up after total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:6945-6954. [PMID: 37428271 DOI: 10.1007/s00402-023-04944-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 06/04/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Comparison between fully hydroxyapatite (HA)-coated stems with differing geometry are lacking in the total hip arthroplasty (THA) literature. This study aimed to compare femoral canal fill, radiolucency formation, and 2-year implant survivorship between two commonly used, HA-coated stems. METHODS All primary THAs performed with two fully HA-coated stems (Polar stem, Smith&Nephew, Memphis, TN and Corail stem, DePuy-Synthes, Warsaw, IN) with a minimum 2-year radiographic follow-up were identified. Radiographic measures of proximal femoral morphology based on the Dorr classification and femoral canal fill were analyzed. Radiolucent lines were identified by Gruen zone. Perioperative characteristics and 2-year survivorship were compared between stem types. RESULTS A total of 233 patients were identified with 132 (56.7%) receiving the Polar stem (P) and 101 (43.3%) receiving the Corail stem (C). No differences were observed with respect to proximal femoral morphology. Femoral stem canal fill at the middle third of the stem was greater for P stem patients than for C stem patients (P stem; 0.80 ± 0.08 vs. C stem; 0.77 ± 0.08, p = 0.002), while femoral stem canal fill at the distal third of the stem and presence of subsidence were comparable between groups. A total of six and nine radiolucencies were observed in P stem and C stem patients, respectively. Revision rate at 2-year (P stem; 1.5% vs C stem; 0.0%, p = 0.51) and latest follow-up (P stem; 1.5% vs C stem; 1.0%, p = 0.72) did not differ between groups. CONCLUSION Greater canal fill at the middle third of the stem was observed for the P stem compared to the C stem, however, both stems demonstrated robust and comparable freedom from revision at 2-year and latest follow-up, with low incidences of radiolucent line formation. Mid-term clinical and radiographic outcomes for these commonly used, fully HA-coated stems remain equally promising in THA despite variations in canal fill.
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Affiliation(s)
- Ittai Shichman
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA.
- Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel.
| | - Kyle W Lawrence
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
| | - Emily Berzolla
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
| | - Carlos Sandoval Hernandez
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
| | - Rani Man-El
- Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel
| | - Nimrod Snir
- Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
| | - Matthew S Hepinstall
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
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Huang Z, Zhang Z, Lu X, Liu Y, Zhang H. The influence of prosthetic positioning and proximal femoral morphology on leg length discrepancy and early clinical outcomes of cementless total hip arthroplasty. J Orthop Surg Res 2023; 18:408. [PMID: 37277763 DOI: 10.1186/s13018-023-03847-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Leg length discrepancy (LLD) is a common complication of total hip arthroplasty (THA). However, the relationship between femoral prosthesis filling, proximal femoral morphology, and acetabular prosthesis positioning with postoperative LLD and clinical outcomes is unclear. The aims of this study were to investigate the influence of canal flare index (CFI), canal fill ratio (CFR), center of rotation (COR), and femoral offset (FO) on (1) postoperative LLD; and (2) clinical outcomes in the two stem designs with different coating distribution. METHODS The study cohort included 161 patients who underwent primary cementless THA between January 2021 and March 2022 with either proximal coating or full coating stems. Multivariate logistic regression was used to assess the effect of CFI, CFR, COR, and FO on postoperative LLD, and linear regression to assess their effect on clinical outcomes. RESULTS No statistical difference was found in clinical outcomes or postoperative LLD between the two groups. High CFI (p = 0.014), low ΔVCOR (p = 0.012), and Gender (p = 0.028) were found independent risk factors for LLD one day postoperative. High CFI was also an independent risk factor for postoperative subjectively perceived LLD (p = 0.013). CFR at the level of 2 cm below the LT (p = 0.017) was an independent risk factor for Harris Hip Score. CONCLUSIONS Proximal femoral morphology and acetabular prosthesis positioning but not femoral prosthesis filling affected the LLD. High CFI was an independent risk factor for postoperative LLD and subjectively perceived LLD, and low ΔVCOR was also an independent risk factor for postoperative LLD. Women were susceptible to postoperative LLD.
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Affiliation(s)
- Zhenchao Huang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Zian Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Xinzhe Lu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Yikai Liu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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Yun HH, Lee WS, Shin YB, Yoon TH. Periprosthetic Occult Femoral Fracture: An Unknown Side Effect of Press-Fit Fixation in Primary Cementless Total Hip Arthroplasty. Hip Pelvis 2023; 35:88-98. [PMID: 37323549 PMCID: PMC10264232 DOI: 10.5371/hp.2023.35.2.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose The objectives of this study were to examine the prevalence and risk factors for development of periprosthetic occult femoral fractures during primary cementless total hip arthroplasty (THA) and to assess the clinical consequences of these fractures. Materials and Methods A total of 199 hips were examined. Periprosthetic occult femoral fractures were defined as fractures not detected intraoperatively and on postoperative radiographs, but only observed on postoperative computed tomography (CT). Clinical, surgical, and radiographic analysis of variables was performed for identification of risk factors for periprosthetic occult femoral fractures. A comparison of stem subsidence, stem alignment, and thigh pain between the occult fracture group and the non-fracture group was also performed. Results Periprosthetic occult femoral fractures were detected during the operation in 21 (10.6%) of 199 hips. Of eight hips with periprosthetic occult femoral fractures that were detected around the lesser trochanter, concurrent periprosthetic occult femoral fractures located at different levels were detected in six hips (75.0%). Only the female sex showed significant association with an increased risk of periprosthetic occult femoral fractures (odds ratio for males, 0.38; 95% confidence interval, 0.15-1.01; P=0.04). A significant difference in the incidence of thigh pain was observed between the occult fracture group and the non-fracture group (P<0.05). Conclusion Occurrence of periprosthetic occult femoral fractures is relatively common during primary THA using tapered wedge stems. We recommend CT referral for female patients who report unexplained early postoperative thigh pain or developed periprosthetic intraoperative femoral fractures around the lesser trochanter during primary THA using tapered wedge stems.
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Affiliation(s)
- Ho Hyun Yun
- Department of Orthopaedic Surgery, VHS Medical Center, Seoul, Korea
| | - Woo Seung Lee
- Department of Orthopaedic Surgery, VHS Medical Center, Seoul, Korea
| | - Young Bin Shin
- Department of Orthopaedic Surgery, VHS Medical Center, Seoul, Korea
| | - Tae Hyuck Yoon
- Department of Orthopaedic Surgery, VHS Medical Center, Seoul, Korea
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Homma Y, Zhuang X, Yanagisawa N, Ishii S, Baba T, Ishijima M. Patients With Shorter Stature Exhibit Minimal Hammering Sound Changes During Cementless Stem Insertion in Total Hip Arthroplasty. Arthroplast Today 2023; 21:101136. [PMID: 37193539 PMCID: PMC10182171 DOI: 10.1016/j.artd.2023.101136] [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: 02/09/2023] [Accepted: 03/19/2023] [Indexed: 05/18/2023] Open
Abstract
Background Listening to the change in the hammering sound is 1 of the elements used to assess the cementless stem stability. This study aimed to quantitatively investigate the change in the acoustic characteristics between the early and late phases of cementless stem insertion in total hip arthroplasty and to identify which patient characteristics contribute to the change in the hammering sound. Methods The acoustic parameters of the hammering sounds in the early and late phases of cementless taper-wedged stem insertion for 51 hips in 45 patients who underwent total hip arthroplasty (mean age = 68 years, height = 1.56 m, weight = 55.0 kg) were analyzed. Parameters including patient's basic characteristics, radiographical femoral morphology, and canal fill ratio were assessed as potential contributors to the change in the hammering sound. Results The low-frequency bands (0.5-1.0 kHz and 1.0-1.5 kHz) showed the largest changes during stem insertion and were therefore considered key bands for the analysis of sound alterations. Multivariate linear regression analysis showed that height (β = 8.312, P = .013) and proximal canal fill ratio (β = -3.8568, P = .038) were independently associated with the sound alterations. The decision tree analysis identified height (≥1.66 m or <1.66 m) as the best single discriminator for the sound alteration. Conclusions Patients with smaller stature showed the least change in the hammering sound during stem insertion. Understanding the acoustic characteristics of hammering sound alteration during cementless stem insertion may aid in the achievement of optimal stem insertion.
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Affiliation(s)
- Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Juntendo University, Bunkyo-ku, Tokyo, Japan
- Corresponding author. Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan. Tel.: +3 3813 3111.
| | - Xu Zhuang
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Naotake Yanagisawa
- Clinical Research and Trial Center, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Seiya Ishii
- Department of Orthopaedics, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Juntendo University, Bunkyo-ku, Tokyo, Japan
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18
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Radaelli M, Buchalter DB, Mont MA, Schwarzkopf R, Hepinstall MS. A New Classification System for Cementless Femoral Stems in Total Hip Arthroplasty. J Arthroplasty 2023; 38:502-510. [PMID: 36122690 DOI: 10.1016/j.arth.2022.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/18/2022] [Accepted: 09/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The growing variety of total hip arthroplasty implants necessitates a standardized, simple, and brand-neutral language to precisely classify femoral components. Although previous classifications have been useful, they need updating to include stems that have current surface treatment technologies, modularity, collar features, and other geometric characteristics. METHODS To accomplish this, we propose a new classification system for stems based on 3 distinguishing stem features: (1) geometry, (2) location of modularity, and (3) length. RESULTS Our system allows for the easy classification of all currently used stem types. CONCLUSIONS One goal of this endeavor is to improve clinical record keeping to facilitate study comparisons as well as literature reviews.
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Affiliation(s)
- Marco Radaelli
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Daniel B Buchalter
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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McGoldrick NP, Cochran MJ, Biniam B, Bhullar RS, Beaulé PE, Kim PR, Gofton WT, Grammatopoulos G. Can We Predict Fracture When Using a Short Cementless Femoral Stem in the Anterior Approach? J Arthroplasty 2022; 37:S901-S907. [PMID: 35314289 DOI: 10.1016/j.arth.2022.03.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/10/2022] [Accepted: 03/13/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Short cementless femoral stems may allow for easier insertion with less dissection. The use of short stems with the anterior approach (AA) may be associated with a considerable perioperative fracture risk. Our aim was to evaluate whether patient-specific femoral and pelvic morphology and surgical technique, influence the perioperative fracture risk. Furthermore, we sought to describe important anatomical thresholds alerting surgeons. METHODS A single-center, multi-surgeon retrospective, case-control matched study was performed. Thirty nine periprosthetic fractures (3.4%) in 1,145 primary AA THAs using short cementless stems were identified. These were matched with 78 THA nonfracture controls for factors known to increase the fracture risk. A radiographic analysis using validated software measured femoral (canal flare index [CFI], morphological cortical index [MCI], and calcar-calcar ratio [CCR]) and pelvic (Ilium-ischial ratio [IIR], ilium overhang, and anterior superior iliac spine [ASIS] to greater trochanter distance) morphologies and surgical techniques (% canal fill). A multivariate and Receiver-Operator Curve (ROC) analysis was used to identify fracture predictors. RESULTS CFI (3.7 ± 0.6 vs 2.9 ± 0.4, P < .001) and CCR (0.5 ± 0.1 vs 0.4 ± 0.1, P = .006) differed. The mean IIR was higher in fracture cases (3.3 ± 0.6 vs 3.0 ± 0.5, P < .001). Percent canal fill was reduced in fracture cases (82.8 ± 7.6 vs 86.7 ± 6.8, P = .007). Multivariate and ROC analyses revealed a threshold CFI of 3.17 which was predictive of fracture (sensitivity: 84.6%/specificity: 75.6%). The fracture risk was 29 times higher when patients had CFI >3.17 and II ratio >3 (OR: 29.2 95% CI: 9.5-89.9, P < .001). CONCLUSION Patient-specific anatomical parameters are important predictors of a fracture-risk. A careful radiographic analysis would help identify those at a risk of early fracture using short stems, and alternative stem options should be considered.
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Affiliation(s)
- Niall P McGoldrick
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michael J Cochran
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Brook Biniam
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Raman S Bhullar
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul R Kim
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Wade T Gofton
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Berliner Z, Yau C, Jahng K, Bas MA, Cooper HJ, Rodriguez JA. Risk Factors for Periprosthetic Femoral Fracture in Non-cemented Total Hip Arthroplasty Through the Direct Anterior Approach. HSS J 2022; 18:368-375. [PMID: 35846257 PMCID: PMC9247592 DOI: 10.1177/15563316211050884] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023]
Abstract
Background: Although total hip arthroplasty (THA) performed through the direct anterior (DA) approach is frequently marketed as superior to other approaches, there are concerns about increased risks of intraoperative and early postoperative femoral fracture. Purpose: We sought to assess patient-specific and radiographic risk factors for intraoperative and early postoperative (90-day) periprosthetic femoral fracture (PPFx) following DA approach THA. Methods: We retrospectively reviewed 1107 consecutive, primary, non-cemented DA THAs, performed between April 2009 and January 2015, for intraoperative and early postoperative PPFx. Patients lost to follow-up before 90 days (63), cemented or hybrid THA (52), or early femoral failure for another indication (3) were excluded, yielding 989 hips for analysis. Demographic variables and patient comorbidities were analyzed as risk factors for PPFx. Continuous variables were initially compared with 1-way analysis of variance (ANOVA) and categorical variables with chi-square test. A demographic matched-paired radiographic analysis was performed for femoral stem canal fill and compared using univariate logistic regression. Results: The incidence of perioperative PPFx was 2.02%, including 10 intraoperative and 10 early postoperative fractures. Sustaining a postoperative PPFx was associated with being 70 years old or older with a body mass index (BMI) of less than 25, or with having either osteoporosis or Parkinson disease. Radiographs demonstrated that intraoperative PPFx was associated with stems that filled greater proximally rather than distally. Conclusion: Our cohort study found older age, age over 70 with BMI of less than 25, osteoporosis, and Parkinson disease were associated with increased risk for early postoperative PPFx following DA approach THA. Intraoperative fractures may occur with disproportionate proximal femoral canal fill. Further study can evaluate whether cemented femoral components may mitigate risk in these patient populations.
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Affiliation(s)
- Zachary Berliner
- Department of Orthopaedic Surgery,
Boston Medical Center, Boston, MA, USA,Lenox Hill Hospital, Northwell Health,
New York, NY, USA,Adult Reconstruction and Joint
Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Cameron Yau
- Lenox Hill Hospital, Northwell Health,
New York, NY, USA
| | - Kenneth Jahng
- Lenox Hill Hospital, Northwell Health,
New York, NY, USA
| | - Marcel A. Bas
- Lenox Hill Hospital, Northwell Health,
New York, NY, USA
| | - H. John Cooper
- Lenox Hill Hospital, Northwell Health,
New York, NY, USA,Columbia University Medical Center, New
York, NY, USA
| | - José A. Rodriguez
- Lenox Hill Hospital, Northwell Health,
New York, NY, USA,Adult Reconstruction and Joint
Replacement Service, Hospital for Special Surgery, New York, NY, USA,José A. Rodriguez, MD, Adult Reconstruction
and Joint Replacement Service, Hospital for Special Surgery, 541 East 71st
Street, 3rd Floor, New York, NY 10021, USA.
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21
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Alpaugh K, Chiu YF, Zlotnicki JP, Bendich I, Valle AGD, Bostrom MPG, Gausden EB. Femoral Component Undersizing and Alignment are Risk Factors for Early Periprosthetic Femur Fracture. J Arthroplasty 2022; 37:S604-S610. [PMID: 35283234 DOI: 10.1016/j.arth.2022.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Known risk factors for early periprosthetic femur fracture (PFF) following total hip arthroplasty (THA) include poor bone quality and the use of cementless implants. The association between femoral component size and alignment and the risk of early PFF is not well described. We evaluated radiographic parameters of femoral component sizing and alignment as risk factors for early PFF. METHODS From 16,065 primary cementless THAs, we identified 66 cases (0.41%) of early PFFs (<90 days from index THA) at a single institution between 2016 and 2020. Sixty early PFFs were (1:2) matched to 120 controls based on the femoral component model, offset, surgical approach, age, body mass index (BMI), and gender. Radiographic assessment of preoperative bone morphology and postoperative femoral component orientation included stem alignment, metaphyseal fill, and implant congruence with medial cortical bone. A multivariable logistic regression was built to identify radiographic risk factors associated with early PFF. RESULTS Markers of preoperative bone quality including canal calcar ratio (P = .003), canal flare index (P < .001), anteroposterior canal bone ratio (CBR) (P < .001), and lateral CBR (P < .001) were statistically associated with PFF. Distance between the medial cortical bone and implant was greater in cases of PFF (2.5 mm vs 1.4 mm) (P < .001). A multivariate analysis demonstrated that a larger lateral metaphyseal CBR (Odds Ratio [OR] 5), valgus implant alignment (OR 5), and medial implant-bone incongruity (OR 2) increased the risk of early PFF. CONCLUSION A larger lateral metaphyseal CBR, valgus component alignment, and implant incongruity with medial cortical bone posed the greatest radiographic risk for early PFF following cementless THA.
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Affiliation(s)
- Kyle Alpaugh
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York; Department of Orthopaedic Surgery, Arthroplasty Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Yu-Fen Chiu
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jason P Zlotnicki
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Ilya Bendich
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York
| | | | - Mathias P G Bostrom
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Elizabeth B Gausden
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York
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22
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Li M, Zeng Y, Wu Y, Liu Y, Wu L, Shen B. Cementless femoral stems with lower canal fill ratio have similar mid-term to long-term outcomes to those with adequate fill ratio in Dorr type C femurs. Arch Orthop Trauma Surg 2022; 142:1265-1273. [PMID: 34117900 DOI: 10.1007/s00402-021-03916-x] [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: 12/15/2020] [Accepted: 04/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lower canal fill ratio was reported to correlate with aseptic loosening in many studies. However, the most widely used standard of fill ratio seemed inapplicable to Dorr type C femurs. We aimed to adapt the method of measuring the fill ratio in Dorr type C femurs and compare the outcomes among patients with different fill ratios. METHODS Twenty patients with Corail stems implanted in their Dorr type C femurs received spectrum CT to evaluate the whole-stem's fill ratio. Pearson Correlation Coefficient was calculated to assess the correlation between the fill ratio in X-ray film and spectrum CT. Then 87 THAs were involved in this study, divided into the fill ratio ≤ 80% group and the fill ratio > 80% group. Clinical and radiological outcomes were evaluated with a mean follow-up of 8.2 years. RESULTS Fill ratio at 2 cm below the lesser trochanter in anterior-posterior X-ray film correlated with the whole-stem's fill ratio (r = 0.50, P = 0.02). Survival rate of stem, function scores, and radiological outcomes between the two groups showed no significant difference. In the fill ratio > 80% group, intraoperative fracture was significantly higher (19% VS 5%, P < 0.05). CONCLUSION Patients with lower fill ratios at 2 cm below the lesser trochanter did not have poorer functional scores or more subsidence, but had a lower intraoperative fracture rate. The revision rates of the two groups presented no significant difference, but this result need to be confirmed in larger cohort in the future. In Dorr type C femurs, risk of fracture and the special morphology of the femur should be noted, and high fill ratio is not the most decisive factor for stem size selecting.
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Affiliation(s)
- Mingyang Li
- Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Yuan Liu
- Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Limin Wu
- Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.
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23
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Macheras GA, Lepetsos P, Galanakos SP, Papadakis SA, Poultsides LA, Karachalios TS. Early failure of an uncemented femoral stem, as compared to two other stems with similar design, following primary total hip arthroplasty performed with direct anterior approach. Hip Int 2022; 32:166-173. [PMID: 32662662 DOI: 10.1177/1120700020940671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION An increased risk of early femoral component loosening has been reported using the direct anterior approach (DAA) compared with other common surgical approaches. However, long-term data are scarce. The purpose of this study is: (1) to determine the incidence of early femoral loosening in a high volume, single surgeon's practice utilising the DAA approach; and (2) to examine the effect of stem design and type of coating on aseptic loosening in the early and mid-term postoperative period. METHODS A retrospective review of 1650 consecutive patients (1800 hips) who underwent total hip arthroplasty (THA) using the DAA between August 2011 and December 2017 was conducted at our institution. 3 types of uncemented femoral stems (Quadra-S, Avenir, TwinSys), with similar design, but different coating, were implanted. Patients were evaluated clinically and radiologically at 4 weeks, 3 months, 1 year, and annually thereafter. RESULTS After a mean follow-up of 46.4 months, the total incidence of revision for aseptic loosening was 0.44% (n = 8). All loose stems were Quadra-S, failing to achieve osseointegration, for an overall incidence of 0.96% (p = 0.002). None of the other stems were loose. Radiolucent lines around the proximal stem portion were visible in 75 Quadra-S stems (4.1%) on radiographs taken at 1 year postoperatively and continued to deteriorate at the latest follow-up. CONCLUSIONS In this specific cohort of patients, the increased rate of femoral stem aseptic loosening was implant-related and was attributed only to a specific type of femoral stem (Quadra-S). No relation to other factors was proven suggesting that the surface characteristics of this femoral stem and the lack of bioactive coating are responsible for the observed early femoral failures. These findings should be confirmed by additional registry work and larger population sample sizes are needed to evaluate the prosthesis performance after implantation through the DAA.
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Affiliation(s)
- George A Macheras
- 4th Department of Trauma and Orthopaedics, KAT Hospital, Athens, Greece
| | | | | | | | - Lazaros A Poultsides
- 3rd Academic Department of Orthopaedics and Trauma, Aristotle University Medical School, Thessaloniki, Greece
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Tsai MH, Chen CC, Chang CH, Chang Y, Hsieh PH, Hu CC. Revision Total Hip Arthroplasty with Primary Stem or Full-Porous-Coated Long Stem for Aseptic Femoral Component Loosening: A Matched-Pair Study. Orthop Res Rev 2022; 14:25-33. [PMID: 35210872 PMCID: PMC8857999 DOI: 10.2147/orr.s346891] [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: 11/26/2021] [Accepted: 01/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background Revision total hip arthroplasty (RTHA) for loosening the femoral stem is a technical challenge. Distally fixed, full-porous-coated long stems are widely accepted as the standard selection for these revisions. However, the success of primary stems in RTHA is not well known. Methods This study enrolled 24 patients with aseptic loosening of the femoral stem who underwent RTHA using primary stems. Another 72 patients with aseptic loosening who underwent RTHA using full-porous-coated long stems were matched in terms of operation date, proximal femoral bone stock (Paprosky classification), sex, and age. The primary and secondary outcomes of failure were the need for revision for any reason and the radiographic change in the stem respectively. Results In the primary stem group, one patient had a periprosthetic fracture and received a second RTHA 2 years after the previous one. The primary outcome’s 5-and 10-year survival rates were both 95.8%. For the matched comparison group, one patient had an immediate periprosthetic fracture of the femoral shaft requiring further open reduction internal fixation surgery. Another patient had a full-porous-coated long stem breakage 6 years postoperatively, which required a second RTHA. The primary outcome’s 5-and 10-year survival rates were 98.6% and 97.2%, respectively. Conclusion Primary stems can achieve non-inferior clinical success compared to a full-porous-coated long stem for aseptic stem loosening RTHA in patients with adequate proximal femoral bone stock.
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Affiliation(s)
- Meng-Huan Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
| | - Chun-Chieh Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 33305, Taiwan
| | - Chih-Hsiang Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 33305, Taiwan
| | - Yuhan Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 33305, Taiwan
| | - Pang-Hsin Hsieh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 33305, Taiwan
| | - Chih-Chien Hu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 33305, Taiwan
- Correspondence: Chih-Chien Hu, Bone and Joint Research Center, Chang Gung Memorial Hospital, Kweishan, Taoyuan, 33305, Taiwan, Tel +886-3-3281200, ext. 2420, Email
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Acoustic characteristics of broaching procedure for post-operative stem subsidence in cementless total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2022; 46:741-748. [PMID: 34977970 DOI: 10.1007/s00264-021-05278-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Avoiding stem subsidence is crucial for achieving better outcome for cementless total hip arthroplasty (THA). The aim of this study was to develop a prediction model for the incidence of post-operative stem subsidence using full quantitative acoustic parameters in hammering sound during the broaching procedure and to assess the accuracy of this prediction model. METHODS The acoustic parameters of the hammering sounds during a broaching procedure for 55 hips in 49 patients who underwent THAs with cementless taper-wedged stem were analysed. The stem subsidence was assessed at one month post-operatively, and the relationship between the acoustic parameters and the value of stem subsidence was investigated. RESULTS The average stem subsidence was 2.15 ± 2.91 mm. The subsidence 3 mm or more was observed in eleven hips (20%), and 5 mm or more was observed in seven hips (12.7%). Basic patient's characteristics, preoperative femoral morphology and immediate post-operative canal fill ratio and stem alignment were not significantly related to the volume of stem subsidence. Nine acoustic parameters were significantly correlated with the value of subsidence. The prediction model for post-operative subsidence using only acoustic parameters during broaching procedure was established, and this model showed a positive prediction value of 100% and a negative prediction value of 90.6% for post-operative stem subsidence at 5 mm or more. CONCLUSION Post-operative stem subsidence can be predicted by using acoustic parameters of the hammering sound during the broaching procedure. Our results suggest that we are at the start of a new era in which novel and innovative smart technologies can be used to assist in orthopaedic surgery.
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Leiss F, Götz JS, Meyer M, Maderbacher G, Reinhard J, Parik L, Grifka J, Greimel F. Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing. Arch Orthop Trauma Surg 2022; 142:673-680. [PMID: 34019145 PMCID: PMC8924083 DOI: 10.1007/s00402-021-03913-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. METHODS One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior-posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. RESULTS Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. CONCLUSION In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.
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Affiliation(s)
- Franziska Leiss
- grid.7727.50000 0001 2190 5763Department of Orthopedic Surgery, Medical Center, Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077 Bad Abbach, Germany
| | - Julia Sabrina Götz
- grid.7727.50000 0001 2190 5763Department of Orthopedic Surgery, Medical Center, Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077 Bad Abbach, Germany
| | - Matthias Meyer
- grid.7727.50000 0001 2190 5763Department of Orthopedic Surgery, Medical Center, Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077 Bad Abbach, Germany
| | - Günther Maderbacher
- grid.7727.50000 0001 2190 5763Department of Orthopedic Surgery, Medical Center, Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077 Bad Abbach, Germany
| | - Jan Reinhard
- grid.7727.50000 0001 2190 5763Department of Orthopedic Surgery, Medical Center, Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077 Bad Abbach, Germany
| | - Lukas Parik
- grid.7727.50000 0001 2190 5763Department of Orthopedic Surgery, Medical Center, Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077 Bad Abbach, Germany
| | - Joachim Grifka
- grid.7727.50000 0001 2190 5763Department of Orthopedic Surgery, Medical Center, Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077 Bad Abbach, Germany
| | - Felix Greimel
- grid.7727.50000 0001 2190 5763Department of Orthopedic Surgery, Medical Center, Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077 Bad Abbach, Germany
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27
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Uçan V, Ezici V, Aliyev O, Uzer G, Tuncay İ, Yıldız F. Comparison of tapered-wedge short and standard-length femoral stems in single-stage bilateral direct anterior total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:3119-3127. [PMID: 34347131 DOI: 10.1007/s00264-021-05152-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/17/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was performed to compare short and standard-length tapered-wedge-type femoral stems in single-stage bilateral total hip arthroplasty (THA) through a direct anterior approach (DAA). MATERIALS AND METHODS The patients were divided into two groups according to their femoral stem types as short tapered-wedge stem and standard-length tapered-wedge stem groups. Outcome parameters were the surgical time, estimated blood loss (EBL), length of stay (LOS), thigh pain, Harris Hip Score (HHS), and visual analog scale (VAS) score clinically, and canal fill ratio (CFR), coronal plan alignment of the stems, subsidence, and postoperative leg length difference (LLD), radiologically. RESULTS The short-stem group and standard-length-stem group consisted of 20 patients (40 hips, mean age 52.0 ± 14.1) and 22 patients (44 hips, mean age 49.4 ± 11.9), respectively. There were no significant differences between the groups in terms of mean surgical times (p = 0.6), EBL (p = 0.2), LOS (p = 0.2), the rate of thigh pain (p = 0.4), improvements in HHS (p = 0.4) and VAS scores (p = 0.6), LLD (p = 0.3), amount of subsidence (p = 0.9), and varus or valgus misalignment (p = 0.7). The CFR at the level of the lesser trochanter was significantly higher in the short-stem group (0.79 ± 0.1) than the standard-length-stem group (0.73 ± 0.1) (p < 0.01). CONCLUSION In single-stage bilateral THA through DAA, short, tapered-wedge femoral stems provide similar radiographic and functional results to standard stems at short-term follow-up.
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Affiliation(s)
- Vahdet Uçan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - Volkan Ezici
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - Orkhan Aliyev
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - Gökçer Uzer
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - İbrahim Tuncay
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - Fatih Yıldız
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey.
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Oishi K, Inoue R, Yamamoto Y, Harada Y, Sasaki E, Ishibashi Y. Assessment of Early Biological Fixation of Cementless Tapered-Wedge Stems Using Digital Tomosynthesis. J Arthroplasty 2021; 36:3209-3213. [PMID: 34024692 DOI: 10.1016/j.arth.2021.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/28/2021] [Accepted: 04/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We aimed to compare radiographic and digital tomosynthesis assessments of early biological fixation of a cementless stem in primary total hip arthroplasty and to investigate the factors associated with early biological fixation. METHODS Seventy-three patients underwent total hip arthroplasty using cementless short tapered-wedge stems. Both radiography and digital tomosynthesis were performed at 6 weeks and 3, 6, 12, and 24 months after surgery. The presence of spot welds (SW) was evaluated at each postoperative period to assess biological fixation between the stem and the femur. The area of contact between the femur and the stem was divided into seven zones based on Gruen's zone classification. RESULTS All 73 patients had no SW 6 weeks after surgery on radiography and digital tomosynthesis. Three months postoperatively, there was no SW on radiography; however, digital tomosynthesis revealed SW in 31 (42%) patients. Six months postoperatively, radiography showed 22 SW in 18 (24.7%) patients and digital tomosynthesis showed 94 SW in 48 patients (65.8%). CONCLUSION Digital tomosynthesis detected biological fixation between the stem and femur earlier than radiography; biological fixation may appear within 3 months after surgery.
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Affiliation(s)
- Kazuki Oishi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ryo Inoue
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshifumi Harada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Fujii M, Kitamura K, Ikemura S, Hamai S, Motomura G, Nakashima Y. Pneumatic femoral broaching decreases post-operative subsidence of a cementless taper-wedge stem. INTERNATIONAL ORTHOPAEDICS 2021; 46:233-240. [PMID: 34448924 DOI: 10.1007/s00264-021-05196-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Stem subsidence is a known cause of early failure in cementless total hip arthroplasty (THA). The aim of this study was to determine the usefulness of pneumatic femoral broaching in preventing post-operative subsidence of a proximally porous-coated, taper-wedge stem. METHODS We reviewed 169 cases of primary THA with a single taper-wedge stem. Eighty THAs performed using pneumatic broaching were compared with 89 THAs performed using manual broaching in terms of postoperative canal fill ratio (CFR) at three levels, stem subsidence at one year post-operation, and stem fixation at latest follow-up (median, 24 months). RESULTS The median CFRs were higher in the pneumatic group than in the manual group at all levels (p < 0.05). The median stem subsidence at one year after THA was lower in the pneumatic group than in the manual group (0.2 mm vs. 0.6 mm, p = 0.007). A multivariate analysis determined a decreased CFR at 60 mm below the lesser trochanter and the manual broaching as independent factors affecting post-operative stem subsidence. At the latest follow-up, all stems showed stable fixation by bone ingrowth in both groups. CONCLUSION Our results showed that the pneumatic broaching device was useful in maximizing the mediolateral canal filling and initial stability and minimizing the subsidence of taper-wedge stems.
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Affiliation(s)
- Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi. Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi. Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi. Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi. Higashi-ku, Fukuoka, 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi. Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi. Higashi-ku, Fukuoka, 812-8582, Japan
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Wuestemann T, Hoare SG, Petersik A, Hofstaetter B, Fehily M, Matsubara M, Markel DC. Bone morphology of the proximal femoral canal: ethnicity related differences and the influence on cementless tapered wedge stem designs. Hip Int 2021; 31:482-491. [PMID: 31868035 DOI: 10.1177/1120700019895458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Differences in proximal femoral morphology between ethnicities may have implications on the design of cementless tapered wedge stems. This study analyses the differences in Asian and Caucasian bone morphology as well as the related fit of various cementless tapered wedge stem designs. METHODS A computed tomography database and modelling software was used to retrospectively analyse a total of 1345 femora. Ethnicity related comparisons as well as the fit of the stem designs were analysed. RESULTS Statistically significant differences between canal shape of Caucasian and Japanese as well as non-Japanese Asians were observed. The fit of the stems within the femoral canal was highly dependent on the respective stem shape. CONCLUSIONS The shape differences in stem designs had a larger influence on the fit within the femoral canal than the differences in ethnicity related to bone morphology.
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Affiliation(s)
| | | | | | | | | | | | - David C Markel
- The CORE Institute, Wayne State University and Providence Hospital, Detroit, MI, USA
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Narayanan R, Elbuluk AM, Chen KK, Eftekhary N, Zuckerman JD, Deshmukh AJ. Does femoral morphology and stem alignment influence outcomes of cementless total hip arthroplasty with proximally coated double-tapered titanium stems? Hip Int 2021; 31:354-361. [PMID: 31912748 DOI: 10.1177/1120700019891702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Stem subsidence and thigh pain can cause significant patient dissatisfaction after cementless THA. The purpose of this study was to examine the effect of proximal-femoral morphology and stem alignment on clinical outcomes using a double-tapered, cementless titanium femoral component. METHODS We retrospectively reviewed 281 consecutive, primary THAs from 2012 to 2014 with a mean follow-up of 4 years. Preoperative radiographs were used to assess femoral neck shaft angle (FNS), canal flare index (CFI), Dorr classification, and greater trochanter (GT) overhang. Postoperative radiographs were used to determine stem alignment and 6-week follow-up radiographs were used to determine subsidence. Clinical outcomes included thigh pain, leg-length discrepancy (LLD), patient-reported outcome measures (PROMs) and revision surgeries. RESULTS 271 stems (96%) did not subside (<4 mm) and 10 (4%) showed evidence of subsidence (>4 mm). Subsidence was significantly associated with subsequent revision surgery (p < 0.01). 278 stems (99%) were in neutral alignment and 3 in varus (1%). Alignment did not significantly influence subsidence, thigh pain, LLD, revisions, or PROMs. Femoral morphology measures (FNS, CFI, Dorr classification, and GT overhang) were not significantly associated with stem alignment, subsidence, LLD, or revisions. CFI was significantly associated with intraoperative calcar fractures (p = 0.02). GT overhang was associated with thigh pain (p = 0.03) and FNS was inversely associated with postoperative HOOS scores. CONCLUSIONS Subsidence and proximal-femoral morphology are potential sources of postoperative morbidity in certain cementless THA patients. In accordance with prior studies, CFI was identified as a potential risk factor for intraoperative calcar fractures. More research into preoperative femoral morphologies, such as GT overhang and FNS, is warranted as these may contribute to unsatisfactory results related to cementless THA.
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Affiliation(s)
| | | | - Kevin K Chen
- NYU Langone Orthopedic Hospital, New York, NY, USA
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Garavaglia G, Gonzalez A, Barea C, Peter R, Hoffmeyer P, Lübbeke A, Hannouche D. Short stem total hip arthroplasty with the direct anterior approach demonstrates suboptimal fixation. INTERNATIONAL ORTHOPAEDICS 2021; 45:575-583. [PMID: 33427897 PMCID: PMC7892742 DOI: 10.1007/s00264-020-04910-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/11/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Short stems use has increased substantially despite variable results reported in the literature. The purpose of this study was to report the rate of complications using a short stem implanted through the direct anterior approach (DAA), and to evaluate mid-term clinical and radiological results focusing on femoral stem fixation. METHODS Between April 2009 and November 2014, 698 elective total hip arthroplasties (THAs) were performed using a fully hydroxyapatite-coated short stem (AMIStem-H®). The mean age was 65.7 years (SD 12.6). Patients were invited for clinical and radiological evaluation, and to complete patient-reported outcomes questionnaires at two and five years after surgery. The mean follow-up was 6.2 years (range 2-9.73 years). RESULTS During the study period, 59 (8.5%) patients died and 24 (3.4%) were lost to follow-up. There were six (0.9%) dislocations and 12 (1.7%) fractures, seven occurred intra-operatively. Twenty-nine (4.2%) THAs required revision surgery. Eleven THAs were revised for aseptic loosening of the stem at a mean 4.9 years (1.2-7.3 years). Five years after surgery, radiographs of 324 THAs (324/425 eligible = 76.2%) were available. Stem subsidence ≥ 2 mm was present in 42 cases (12.9%), proximal radiolucencies in 101 hips (31.5%), cortical thickening in 52 (16.0%), and a pedestal in 219 (67.6%). An Engh score between - 10 and 0 was associated with lower HHS pain subscore (p = 0.005), a higher risk of stem revision for aseptic loosening (18.8% vs. 2.7%; p = 0.008), and was more frequent in younger patients with ASA score 1. CONCLUSION Patients presenting radiological alterations at five years had an increased risk of revision for aseptic stem loosening and also inferior clinical results. Our study warrants further continued scrutiny of mid- and long-term survivorship of the AMIStem-H®, with radiological results at five years indicating suboptimal fixation of the stem in younger and active patients.
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Affiliation(s)
- Guido Garavaglia
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland.
| | - Amanda Gonzalez
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Barea
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Peter
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Hoffmeyer
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Lübbeke
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Didier Hannouche
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
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Ishii S, Homma Y, Baba T, Shirogane Y, Kaneko K, Ishijima M. Does increased diameter of metal femoral head associated with highly cross-linked polyethylene augment stress on the femoral stem and cortical hypertrophy? INTERNATIONAL ORTHOPAEDICS 2021; 45:1169-1177. [PMID: 33619587 DOI: 10.1007/s00264-021-04994-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Cortical hypertrophy (CH) after total hip arthroplasty (THA) is thought as a process of femoral cortical functional adaptation against the stem. However, no study has been performed to investigate the association between CH and femoral head size. The purpose of this study is to investigate the factors related to femoral CH around the cementless stem after THA. METHODS THAs in 31 patients using 36-mm metal head and as a control, age-matched 62 THAs with 32-mm metal head have been analyzed. Radiographs were reviewed at four years to determine cortical thickness change from immediate post-operative one. Pre-operative and immediate post-operative radiographs were used to calculate the femoral morphology, canal fill ratio, stem alignment, and femoral and acetabular offset. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for CH. RESULTS Patients with a 36-mm metal head had a significantly higher rate of severe CH (P = 0.001) than those with a 32-mm metal head. The multivariate logistic regression analysis with dependent variables of CH showed that the use of a 36-mm metal head had a significantly positive effect on CH. The odds ratio of a 36-mm metal head in mild CH was 2.517 (95% confidence interval, 1.032-6.143; P = 0.043), and that in severe CH was 8.273 (95% confidence interval, 2.679-25.551; P = 0.000). Age and the canal flare index were weakly and negatively influenced by mild CH. CONCLUSIONS The use of a 36-mm metal head was the dominant risk factor for CH.
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Affiliation(s)
- Seiya Ishii
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuichi Shirogane
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Uemura K, Hamada H, Ando W, Takao M, Sugano N. Minimum 10 years clinical results of an anatomical short stem with a proximal hydroxyapatite coating. Mod Rheumatol 2021; 31:1066-1072. [PMID: 33428474 DOI: 10.1080/14397595.2020.1868129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The CentPillar stem (Stryker Orthopaedics), an anatomical short stem, was designed to match the proximal femoral canal shape in both patients with normal hips and those with developmental dysplasia of the hip (DDH). The long-term outcomes of the CentPillar stem was examined herein. METHODS In total, 222 hips that underwent total hip arthroplasty using the CentPillar stem were analyzed. DDH was the main reason for surgery (79.3%). Implant survivorship was assessed using Kaplan-Meier analysis. For radiographic evaluation, stress shielding was assessed using the Engh classification. For functional evaluation, patients' ability to perform deep hip bending activities (sit on the floor, squat, and sit straight) was assessed. RESULTS During a median follow-up of 13.1 years, 2 stem revisions were performed (aseptic loosening and late hematogenous periprosthetic infection), and the overall cumulative implant survival rate was 99.0% at 15 years. In the radiographic evaluation, grade >3 stress shielding was found in only one hip. More than 80% of the patients were able to perform each of the three deep hip bending activities. CONCLUSIONS Good fixation at the proximal part of the femur was obtained, and the implant survival rate of the CentPillar stem was excellent during a long-term follow-up.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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Kobayashi K, Kidera K, Itose M, Motokawa T, Chiba K, Osaki M. Higher incidence of aseptic loosening caused by a lower canal filling ratio with a modified modular stem in total hip arthroplasty. J Orthop Surg Res 2020; 15:568. [PMID: 33256767 PMCID: PMC7706283 DOI: 10.1186/s13018-020-02101-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/19/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose Although a cementless modular prosthesis has shown reliable results, cases of unstable fixation and revision due to aseptic loosening were observed in our institute. The purpose of this study was to clarify the causes of unstable fixation of the prosthesis. Methods A total of 144 patients (154 hips) who underwent total hip arthroplasty using the modular prosthesis were retrospectively investigated. For the cohort study, 97 patients (104 hips) were included. The femoral component survival rate and sleeve fixation were assessed at a minimum follow-up of 5 years. Patients were divided into 2 groups, including stable and unstable fixation groups, by sleeve fixation. Clinical and radiographic outcomes were compared. Results The Kaplan-Meier survival rate at 9 years was 93% with revision for any reason as the endpoint in study cohort. The reasons for revision were recurrent dislocation (1 hip) and aseptic loosening of the stem (5 hips). A total of 88 hips (84.6%) showed stable fixation, and 16 hips (15.4%) showed unstable fixation at final follow-up. There was no significant difference in clinical outcomes between the 2 groups at final follow-up. The canal flare index was significantly higher, and the canal filling ratio was significantly lower in the unstable fixation group. Conclusion Although the modified modular prosthesis was useful for treating anatomically difficult patients, we need to pay attention to both proximal/distal mismatch of the intramedullary canal and the canal filling ratio to achieve stable fixation and good long-term results.
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Affiliation(s)
- Kyosuke Kobayashi
- Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
| | - Kenichi Kidera
- Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Masaru Itose
- Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Tetsuhiko Motokawa
- Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Ko Chiba
- Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Makoto Osaki
- Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
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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.
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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
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Cementless femoral stem fixation and leg-length discrepancy after total hip arthroplasty in different proximal femoral morphological types. INTERNATIONAL ORTHOPAEDICS 2020; 45:891-896. [PMID: 32572540 DOI: 10.1007/s00264-020-04671-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Leg-length changes at total hip arthroplasty (THA) may result from too proximal position of the femoral component, i.e. not being sunk deep enough into the femoral canal due to the size and shape of both medullary canal and implant. Some femoral implants are designed to achieve such fixation in the mediolateral dimension, while others also engage the bone anteroposteriorly. Our aim was to examine the relationship between proximal femoral morphology, osseointegration and leg-length equalization at THA. We asked whether the Dorr classification, femoral cortical index and canal flare index on preoperative radiographs had significant impact on THA aseptic loosening rates and post-operative leg-length discrepancy (LLD). METHODS Literature review included original articles on proximal femoral morphology with post-operative LLD and other clinical outcomes of THA, published in the last decade. Case reports and biomechanical studies without clinical data were excluded. RESULTS Higher femoral cortical index and/or canal flare index (corresponding to the Dorr type A) increases the risk of leg lengthening at THA. This is particularly notable in femoral stems with metaphyseal fixation, where high canal flare index has also been linked to osseointegration failure and implant loosening. On the other hand, lower canal flare index (corresponding to the Dorr type C) is more prevalent in the elderly population and increases late periprosthetic fracture rates and stress shielding. Even the most commonly used cementless femoral stems cannot offer optimal fit to intra-/extramedullary geometry or offset restoration in up to 30% of clinical cases. CONCLUSIONS Femoral morphology can have significant impact on post-operative LLD and osseointegration of cementless THA. Quantitative measurements of the proximal femoral canal may improve the choice of a particular implant and fixation method.
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D'Ambrosio A, Peduzzi L, Roche O, Bothorel H, Saffarini M, Bonnomet F. Influence of femoral morphology and canal fill ratio on early radiological and clinical outcomes of uncemented total hip arthroplasty using a fully coated stem. Bone Joint Res 2020; 9:182-191. [PMID: 32431809 PMCID: PMC7229336 DOI: 10.1302/2046-3758.94.bjr-2019-0149.r2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims The diversity of femoral morphology renders femoral component sizing in total hip arthroplasty (THA) challenging. We aimed to determine whether femoral morphology and femoral component filling influence early clinical and radiological outcomes following THA using fully hydroxyapatite (HA)-coated femoral components. Methods We retrospectively reviewed records of 183 primary uncemented THAs. Femoral morphology, including Dorr classification, canal bone ratio (CBR), canal flare index (CFI), and canal-calcar ratio (CCR), were calculated on preoperative radiographs. The canal fill ratio (CFR) was calculated at different levels relative to the lesser trochanter (LT) using immediate postoperative radiographs: P1, 2 cm above LT; P2, at LT; P3, 2 cm below LT; and D1, 7 cm below LT. At two years, radiological femoral component osseointegration was evaluated using the Engh score, and hip function using the Postel Merle d’Aubigné (PMA) and Oxford Hip Score (OHS). Results CFR was moderately correlated with CCR at P1 (r = 0.44; p < 0.001), P2 (r = 0.53; p < 0.001), and CFI at P1 (r = − 0.56; p < 0.001). Absence of spot welds (n = 3, 2%) was associated with lower CCR (p = 0.049), greater CFI (p = 0.017), and lower CFR at P3 (p = 0.015). Migration (n = 9, 7%) was associated with lower CFR at P2 (p = 0.028) and P3 (p = 0.007). Varus malalignment (n = 7, 5%), predominantly in Dorr A femurs (p = 0.028), was associated with lower CFR at all levels (p < 0.05). Absence of spot welds was associated with lower PMA gait (p = 0.012) and migration with worse OHS (p = 0.032). Conclusion This study revealed that femurs with insufficient proximal filling tend to have less favourable radiological outcomes following uncemented THA using a fully HA-coated double-tapered femoral component. Cite this article: Bone Joint Res. 2020;9(4):182–191.
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Affiliation(s)
- Adrien D'Ambrosio
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospitals, Strasbourg, France
| | | | - Olivier Roche
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospitals, Strasbourg, France
| | | | | | - François Bonnomet
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospitals, Strasbourg, France
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Griffiths SZ, Post ZD, Buxbaum EJ, Paziuk TM, Orozco FR, Ong AC, Ponzio DY. Predictors of Perioperative Vancouver B Periprosthetic Femoral Fractures Associated With the Direct Anterior Approach to Total Hip Arthroplasty. J Arthroplasty 2020; 35:1407-1411. [PMID: 31902614 DOI: 10.1016/j.arth.2019.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/29/2019] [Accepted: 12/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is an association between intraoperative and postoperative femoral fractures and the direct anterior approach (DAA) to total hip arthroplasty (THA). The purpose of our study is to identify risk factors for Vancouver B fractures and to establish a predictable timeline for when these occur. METHODS We retrospectively identified patients with Vancouver B periprosthetic femoral fractures (n = 49) after 11,509 elective primary cementless THA procedures through the DAA between 2012 and 2018 at a single institution. Fracture patients were matched to nonfracture patients (n = 267) by date of surgery and surgeon. Clinical and radiographic factors were collected for multivariable analysis to identify predictors of fracture. RESULTS Periprosthetic Vancouver B femoral fracture incidence was 0.4%. 48 (98%) fractures were postoperative. Fractures occurred at an average of 44 days after surgery (range: 1 to 653 days) with >85% of fractures occurring in the first 6 weeks postoperatively. Significant variables predictive of fracture included >3 degrees valgus and >5 degrees varus coronal stem malalignment, Dorr B and C femoral geometry, lower canal flare index (2.75 vs 3.20), advanced age, increased comorbidities, greater stem canal fill, and right-sided procedures. CONCLUSION Despite an overall low rate of Vancouver B perioperative periprosthetic femoral fractures, it is a devastating complication that typically presents within the first 6 weeks after DAA THA surgery. The risk is increased in patients with unfavorable proximal femoral geometry, coronal stem malalignment, advanced age, increased comorbidities, and right-sided procedures.
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Affiliation(s)
| | - Zachary D Post
- Department of Orthopaedic Surgery, The Rothman Institute, Egg Harbor Township, NJ
| | - Eric J Buxbaum
- Advanced Orthopedics and Sports Medicine Institute, Freehold, NJ
| | - Taylor M Paziuk
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Fabio R Orozco
- Department of Orthopaedic Surgery, The Rothman Institute, Egg Harbor Township, NJ
| | - Alvin C Ong
- Department of Orthopaedic Surgery, The Rothman Institute, Egg Harbor Township, NJ
| | - Danielle Y Ponzio
- Department of Orthopaedic Surgery, The Rothman Institute, Egg Harbor Township, NJ
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Anderson PA, Morgan SL, Krueger D, Zapalowski C, Tanner B, Jeray KJ, Krohn KD, Lane JP, Yeap SS, Shuhart CR, Shepherd J. Use of Bone Health Evaluation in Orthopedic Surgery: 2019 ISCD Official Position. J Clin Densitom 2019; 22:517-543. [PMID: 31519473 DOI: 10.1016/j.jocd.2019.07.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023]
Abstract
This position development conference (PDC) Task Force examined the assessment of bone status in orthopedic surgery patients. Key questions included which orthopedic surgery patients should be evaluated for poor bone health prior to surgery and which subsets of patients are at high risk for poor bone health and adverse outcomes. Second, the reliability and validity of using bone densitometry techniques and measurement of specific geometries around the hip and knee before and after arthroplasty was determined. Finally, the use of computed tomography (CT) attenuation coefficients (Hounsfield units) to estimate bone quality at anatomic locations where orthopedic surgery is performed including femur, tibia, shoulder, wrist, and ankle were reviewed. The literature review identified 665 articles of which 198 met inclusion exclusion criteria and were selected based on reporting of methodology, reliability, or validity results. We recommend that the orthopedic surgeon be aware of established ISCD guidelines for determining who should have additional screening for osteoporosis. Patients with inflammatory arthritis, chronic corticosteroid use, chronic renal disease, and those with history of fracture after age 50 are at high risk of osteoporosis and adverse events from surgery and should have dual energy X-ray absorptiometry (DXA) screening before surgery. In addition to standard DXA, bone mineral density (BMD) measurement along the femur and proximal tibia is reliable and valid around implants and can provide valuable information regarding bone remodeling and identification of loosening. Attention to positioning, selection of regions of interest, and use of special techniques and software is required. Plain radiographs and CT provide simple, reliable methods to classify the shape of the proximal femur and to predict osteoporosis; these include the Dorr Classification, Cortical Index, and critical thickness. Correlation of these indices to central BMD is moderate to good. Many patients undergoing orthopedic surgery have had preoperative CT which can be utilized to assess regional quality of bone. The simplest method available on most picture archiving and communications systems is to simply measure a regions of interest and determine the mean Hounsfield units. This method has excellent reliability throughout the skeleton and has moderate correlation to DXA based on BMD. The prediction of outcome and correlation to mechanical strength of fixation of a screw or implant is unknown.
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Affiliation(s)
- Paul A Anderson
- Department of Orthopedics Surgery & Rehabilitation, University of Wisconsin UWMF Centennial Building, Madison, WI, USA.
| | - Sarah L Morgan
- UAB Osteoporosis Prevention and Treatment Clinic, University of Alabama Birmingham, Birmingham, AL, USA
| | - Diane Krueger
- University of Wisconsin, Osteoporosis Clinical Research Program, Madison, WI, USA
| | | | - Bobo Tanner
- Division Rheumatology, Vanderbilt University, Nashville, TN, USA
| | - Kyle J Jeray
- Greenville Health System, Deparment of Orthopaedic Surgery, Greenville, SC, USA
| | | | - Joseph P Lane
- Department of Orthopedic Surgery, Hospital for Special surgery, New York, USA
| | | | | | - John Shepherd
- University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI, USA
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Zang J, Uchiyama K, Moriya M, Li Z, Fukushima K, Yamamoto T, Takahira N, Takaso M, Liu J, Feng W. Long-term clinical and radiographic results of the cementless Spotorno stem in Japanese patients: A more than 15-year follow-up. J Orthop Surg (Hong Kong) 2019; 26:2309499017750310. [PMID: 29320963 DOI: 10.1177/2309499017750310] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Although previous studies have reported encouraging results of cementless Spotorno (CLS) stem, studies with more than 15 years of follow-up are rare. The objective of this study is to investigate the long-term results of CLS stem and the factors potentially influencing the outcomes. METHODS The clinical and radiographic data of 79 hips (64 patients) were reviewed. Clinical outcome was determined using the Japanese Orthopedic Association's hip scoring system (JOA hip score). Survival rate was assessed by Kaplan-Meier survival analysis. The main end point for survival analysis was revision of stem. The correlations between patient demographics, radiographic factors, and stem survival rates were analyzed. RESULTS At a mean follow-up period of 20.1 years, the mean JOA hip score at final follow-up was 84.7 points. Stem survival rate for all revisions was 97.5% at 20 years, and stem survival for aseptic loosening was 98.9%. Varus alignment had a significant negative influence on the survival of the femoral stem. CONCLUSION This study demonstrates acceptable long-term clinical and radiographic results of the CLS stem in Japanese patients. Caution should be exercised to avoid varus stem alignment.
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Affiliation(s)
- Junting Zang
- 1 Department of Orthopedic Surgery, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Katsufumi Uchiyama
- 2 Department of Orthopedic Surgery, School of Medicine, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Mitsutoshi Moriya
- 2 Department of Orthopedic Surgery, School of Medicine, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Zhengwei Li
- 3 Department of Orthopedic Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Kensuke Fukushima
- 2 Department of Orthopedic Surgery, School of Medicine, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Takeaki Yamamoto
- 2 Department of Orthopedic Surgery, School of Medicine, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Naonobu Takahira
- 4 Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Masashi Takaso
- 2 Department of Orthopedic Surgery, School of Medicine, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Jianguo Liu
- 1 Department of Orthopedic Surgery, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Wei Feng
- 1 Department of Orthopedic Surgery, the First Hospital of Jilin University, Changchun, Jilin Province, China
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Yun HH, Lim JT, Yang SH, Park PS. Occult periprosthetic femoral fractures occur frequently during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA. PLoS One 2019; 14:e0221731. [PMID: 31536499 PMCID: PMC6752856 DOI: 10.1371/journal.pone.0221731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/13/2019] [Indexed: 11/19/2022] Open
Abstract
The present study aimed to investigate the prevalence and clinical consequences of occult intra-operative periprosthetic femoral fractures in total hip arthroplasty (THA). Between 2012 and 2017, a total of 113 primary THAs were enrolled. The mean age of the patients was 66.4 ± 7.6 years. We assessed occult intra-operative periprosthetic femoral fractures with the use of computed tomography (CT) and risk factors, including age, sex, body mass index, diagnosis, stem size, and radiographic parameters of proximal femoral geometry were analyzed. We also assessed the differences in thigh pain and stem subsidence and alignment between the patients with and without occult periprosthetic femoral fracture. Occult intra-operative periprosthetic femoral fractures were found in 13 of 113 hips (11.5%). In 9/13 (69.2%) of occult fractures, fracture lines were started from the region below the tip of the lesser trochanter. Six periprosthetic femoral fractures (5.3%) were found during the operation. Out of the five hips that had detected femoral fractures around the lesser trochanter intra-operatively, four hips (80%) showed concurrent occult fractures on different levels. The female sex (P = .01) and canal filling ratio at 7 cm below the tip of the lesser trochanter (P = .01) were significantly different between the patients with and without occult periprosthetic femoral fracture. The sex was significantly associated with an increased risk in predicting an occult intra-operative periprosthetic femoral fracture (odds ratio of male, 0.25 compared with the female; 95% CI, 0.08-0.85; p = .02). There was a significant difference in the incidence of thigh pain between occult fracture group and non-occult fracture group (P < .05). There were no significant differences in stem subsidence and alignment between the patients with and without occult periprosthetic femoral fracture. All 13 cases of occult intra-operative periprosthetic femoral fractures were healed at the final follow-up. Occult periprosthetic femoral fractures are common during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA, that CT scans are helpful to identify them, and that these fractures do not adversely affect the implant's survival if a rigid fixation of the implants has been achieved.
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Affiliation(s)
- Ho Hyun Yun
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
- * E-mail:
| | - Jung Taek Lim
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
| | - Se-Hyun Yang
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
| | - Phil Sun Park
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
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Rattanaprichavej P, Laoruengthana A, Chotanaphuti T, Khuangsirikul S, Phreethanutt C, Pongpirul K. Subsidence of Hydroxyapatite-Coated Femoral Stem in Dorr Type C Proximal Femoral Morphology. J Arthroplasty 2019; 34:2011-2015. [PMID: 31182412 DOI: 10.1016/j.arth.2019.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Good bone quality and proper proximal femoral morphology are thought to be necessary for tapered design, cementless femoral stems to resist subsidence. Using tapered, cementless stem for patients with stovepipe morphology or Dorr type C is controversial. The purpose of this study is to analyze (1) subsidence of the fully hydroxyapatite (HA)-coated, tapered, cementless stem in different morphology according to Dorr classification, (2) subsidence of the stem related to radiographic canal-fill ratio. METHODS The digitized radiographs of 311 consecutive cementless primary total hip arthroplasty with fully HA-coated, tapered stem were retrospectively reviewed. Subsidence and the canal-fill ratio at 4 locations were evaluated postoperatively after a minimum of 2 years of follow-up. The threshold of subsidence >3 mm was considered as a clinically significant migration. RESULTS A multivariate regression analysis of subsidence across Dorr type, controlling for age, gender, and intraoperative calcar fracture, demonstrated 0.40 mm (P = .28) and 0.18 mm (P = .51) greater subsidence in Dorr type C and B when compared to Dorr type A. Age, gender, and calcar fracture had no influence on subsidence, whereas greater canal-fill ratio at 2 cm below lesser trochanter resulted in significantly less subsidence (P = .02). Additionally, all variables did not affect the risk of having subsidence >3 mm. CONCLUSION The proximal femoral morphology has no statistically significant effect on the subsidence of fully HA-coated stem. Therefore, this stem type might be a viable option for Dorr type C. Increasing the canal-fill ratio at metadiaphyseal junction may ensure the stability of the stem.
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Affiliation(s)
- Piti Rattanaprichavej
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | | | | | | | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Jacquel A, Le Viguelloux A, Valluy J, Saffarini M, Bonin N. A shortened uncemented stem offers comparable positioning and increased metaphyseal fill compared to a standard uncemented stem. J Exp Orthop 2019; 6:28. [PMID: 31240502 PMCID: PMC6593034 DOI: 10.1186/s40634-019-0197-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/14/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Shortened stems are increasingly used in uncemented total hip arthroplasty (THA) as they represent a compromise between the metaphyseal anchorage of short stems and the facilitated axial alignment of standard stems. The purpose of this study was to compare the metaphyseal canal-fill ratio (CFR) and axial alignment of a shortened double-tapered stem with those of a standard stem. The hypothesis was that the shortened stem would achieve greater metaphyseal fill and comparable axial alignment. METHODS The authors reviewed routine follow-up anteroposterior radiographs taken 2 months after THA to evaluate metaphyseal fill and axial alignment of a shortened stem (n = 96) and a standard stem (n = 101). The CFR was calculated at the level of the tip and superior margin of the lesser trochanter. Stem alignment was defined as the angle between the stem axis and the proximal anatomic femoral axis. Stems were classified as being in varus or valgus alignment if they deviated by more than 3° from the anatomic axis of the femur. RESULTS Hips implanted with shortened and standard stems had comparable demographics and axial alignment (1.1° ± 1.7° vs 0.8° ± 1.2°; p = 0.331). However, varus alignment was observed in 5% of shortened stems compared to only 1% of standard stems, though this difference was not significant (p = 0.111). The femoral CFR was greater using shortened stems than using standard stems, both at the level of the tip of the lesser trochanter (0.91 ± 0.05 vs 0.85 ± 0.08; p < 0.001) and at its superior margin (0.76 ± 0.06 vs 0.72 ± 0.07; p < 0.001). CONCLUSIONS Compared to the standard stem, the shortened stem had increased metaphyseal filling and equivalent alignment. These findings suggest that shortened stems could provide adequate metaphyseal fixation and correct alignment. Further studies remain necessary to evaluate how shortened stems perform in terms of osseointegration, clinical outcomes and survival.
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Affiliation(s)
- Alexandre Jacquel
- Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon-Ortho-Clinic, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Augustin Le Viguelloux
- Centre Hospitalier William Morey, 4 Rue Capitaine Drillien, 71100, Chalon Sur Saône, France
| | - Jeremy Valluy
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland
| | - Mo Saffarini
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland.
| | - Nicolas Bonin
- Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon-Ortho-Clinic, 8 Avenue Ben Gourion, 69009, Lyon, France
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Park CW, Eun HJ, Oh SH, Kim HJ, Lim SJ, Park YS. Femoral Stem Survivorship in Dorr Type A Femurs After Total Hip Arthroplasty Using a Cementless Tapered Wedge Stem: A Matched Comparative Study With Type B Femurs. J Arthroplasty 2019; 34:527-533. [PMID: 30545654 DOI: 10.1016/j.arth.2018.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/16/2018] [Accepted: 11/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is a lack of understanding on relationship between the femoral geometry and outcomes of total hip arthroplasty (THA). We investigated clinical and radiographic outcomes of THA using a cementless tapered wedge stem in patients with Dorr type A proximal femoral morphology and compared with those of type B femurs at a minimum follow-up of 5 years. METHODS We analyzed 1089 hips (876 patients) that underwent THA using an identical cementless tapered wedge stem. We divided all femurs into 3 types (Dorr type A, B, and C). Type A and B femurs were statistically matched with age, gender, body mass index, and diagnosis by using propensity score matching. Clinical, radiographic results, and stem survivorship were compared between the matched 2 groups. RESULTS A total of 611 femurs (56%) were classified as type A, 427 (39%) as type B, and 51 (5%) as type C. More radiolucent lines around femoral stems were found in type A femurs (7.8%) than in type B femurs (2.5%) (P < .001). Patients with radiolucency showed worse Harris Hip Score (86.2 points) compared with those without radiolucency (93.0 points) (P < .001). The stem survivorship of type A femur (97.8%) was lower than that of type B femur (99.5%) (P = .041). The reasons for femoral revision in type A femurs were periprosthetic fracture (67%), aseptic loosening (22%), and deep infection (11%). CONCLUSIONS This study showed a higher rate of complications after THAs using a cementless tapered wedge stem in Dorr type A femurs than those performed in type B femurs.
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Affiliation(s)
- Chan-Woo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyeon-Jun Eun
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Hak Oh
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun-Jun Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Femoral stem subsidence in cementless total hip arthroplasty: a retrospective single-centre study. INTERNATIONAL ORTHOPAEDICS 2018; 43:307-314. [PMID: 29916001 DOI: 10.1007/s00264-018-4020-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/04/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE AND HYPOTHESIS Subsidence is a known reason for early failure of total hip arthroplasty (THA). In particular, cementless THA might be vulnerable to migration. The present study analysed femoral stem subsidence after primary cementless THA. Prosthetic and anatomical risk factors for early femoral stem subsidence were evaluated. METHODS Two hundred thirty-one consecutive patients who underwent primary cementless THA in a single centre were retrospectively analysed. Post-operative results were evaluated in consideration of prosthetic and anatomical properties in correlation with subsidence on standing pelvic anteroposterior radiographs. Stem type and design, demographic data, BMI, canal flare index (CFI) and canal fill ratio (CFR) were evaluated. RESULTS The subsidence rate was significantly higher in collarless femoral stems [3.1 mm (SD 2.8 mm) vs. 1.9 mm (SD 1.5 mm); p = 0.013] while the anatomical type of the proximal femur as described by the canal flare index did not influenced subsidence (p = 0.050). Also, the canal fill ratio showed no significant correlation with subsidence at any level. CONCLUSIONS In the present study, stem subsidence was significantly higher in the collarless group compared to collared stems. No anatomical parameter (CFI and CFR) could be identified as risk factor for subsidence. Neither age nor BMI influenced subsidence in this cohort. Still, subgroup analysis indicated a sex-dependent role of BMI. Prospective studies of large cohorts should address the problem of subsidence in the future. LEVEL OF EVIDENCE Retrospective therapeutic study, Level IV.
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Preoperative Canal Bone Ratio is Related to High-Degree Stress Shielding: A Minimum 5-Year Follow-Up Study of a Proximally Hydroxyapatite-Coated Straight Tapered Titanium Femoral Component. J Arthroplasty 2018; 33:1764-1769. [PMID: 29366730 DOI: 10.1016/j.arth.2017.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/04/2017] [Accepted: 12/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few studies have reported risk factors for stress shielding. We sought to evaluate clinical and radiographic outcomes of a proximally hydroxyapatite-coated straight tapered titanium femoral component stem during a minimum 5-year follow-up and identify factors associated with high-degree stress shielding. METHODS A total of 156 total hip arthroplasties (n = 124; 98 women and 26 men; mean age, 56.5 years) with a minimum follow-up period of 5 years were included in the study. Clinical and radiologic measurements at follow-up (range, 5-16.3 years; mean, 10.2 years) were analyzed. RESULTS The mean preoperative Harris Hip Score (HHS) was 56.6, and the mean HHS at the latest follow-up was considerably improved at 86.8. Stress shielding at the latest follow-up was low degree in 136 (87%) hips and high degree in 20 (13%) hips. On average, high-degree stress shielding occurred 9.9 years (5-14 years) after surgery. The results of Cox proportional hazard analysis showed that a canal bone ratio ≥ 0.49 was an independent risk factor for high-degree stress shielding (P = .0075; hazard ratio, 3.981). HHS at the latest follow-up was significantly lower in high-degree stress shielding than in low-degree stress shielding (80.7 and 87.7, respectively; P = .0030). CONCLUSION Preoperative canal bone ratio ≥ 0.49 is independently associated with high-degree stress shielding. In addition, the number of cases with high-degree stress shielding significantly increased over time during a mean 10-year follow-up.
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Brumat P, Pompe B, Antolič V, Mavčič B. The impact of canal flare index on leg length discrepancy after total hip arthroplasty. Arch Orthop Trauma Surg 2018; 138:123-129. [PMID: 29134317 DOI: 10.1007/s00402-017-2840-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The femoral stem should protrude from femur by an appropriate vertical distance to allow leg length equalization at hip arthroplasty; this distance depends on the size/shape of medullary canal and implant. The relationship between femoral morphology and achievability of leg length restoration is currently unclear. Our aim was to examine the impact of the femoral canal flare index (CFI) on the risk of leg length discrepancy (LLD) after total hip arthroplasty with different femoral stems. MATERIALS AND METHODS The study cohort included 126 patients with unilateral primary total hip arthroplasty due to idiopathic osteoarthritis and three different types of implanted femoral stems. The impact of CFI on postoperative LLD was assessed with separate logistic regression model for each implant and covariables of age, gender, body mass index and femoral neck resection level. RESULTS Higher CFI was an independent risk factor for postoperative LLD ≥ 5 mm with odds ratio 4.5 (p = 0.03) in 49 stems with cementless metaphyseal fixation Implantcast-EcoFit®, regardless of the femoral neck resection level. CFI had no significant impact on LLD in 30 stems with cementless diaphyseal fixation EndoPlus-Zweymüller® or 47 cemented collared stems Link-SPII®. No significant difference was observed between groups in pre/postoperative WOMAC scores, postoperative radiographic LLD, subjectively reported LLD, insole use or complications after mean 6.8 years of follow-up. CONCLUSIONS Higher CFI increases the risk of clinically detectable postoperative LLD in single-wedge femoral stems with cementless metaphyseal fixation. CFI has no significant impact on LLD in femoral stems with cementless diaphyseal fixation or cemented fixation.
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Affiliation(s)
- Peter Brumat
- University Medical Centre Ljubljana and Faculty of Medicine, Zaloška 9, 1000, Ljubljana, Slovenia
| | - Borut Pompe
- University Medical Centre Ljubljana and Faculty of Medicine, Zaloška 9, 1000, Ljubljana, Slovenia
| | - Vane Antolič
- University Medical Centre Ljubljana and Faculty of Medicine, Zaloška 9, 1000, Ljubljana, Slovenia
| | - Blaž Mavčič
- University Medical Centre Ljubljana and Faculty of Medicine, Zaloška 9, 1000, Ljubljana, Slovenia.
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Tang ZH, Yeoh CSN, Tan GMJ. Radiographic study of the proximal femur morphology of elderly patients with femoral neck fractures: is there a difference among ethnic groups? Singapore Med J 2016; 58:717-720. [PMID: 27570869 DOI: 10.11622/smedj.2016148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to determine ethnic differences in the proximal femur morphology of elderly patients with femoral neck fractures in Singapore. METHODS We reviewed the medical records of 101 men and 288 women aged 60-109 (mean 76.4) years who underwent hip hemiarthroplasty for femoral neck fractures between 1 June 2010 and 31 December 2015. Patients' age, gender and race were recorded. Plain anteroposterior radiography was used to measure the following: calcar width to canal width ratio of the ipsilateral femur; neck-shaft angle; hip offset; neck length; and neck width of the contralateral proximal femur. RESULTS Chinese women had slightly larger femoral heads (mean 43.88 mm) as compared to Malay (mean 42.92 mm, p = 0.044) and Indian (mean 42.34 mm, p = 0.025) women. Chinese women also had a significantly lower mean calcar-to-canal width ratio (0.606) as compared to Malay (0.664, p = 0.002) and Indian (0.693, p = 0.004) women. The mean neck-shaft angle of Chinese women was significantly greater than that of Indian women (137.48° vs. 127.00°, p = 0.001). CONCLUSION We found statistically significant differences in the femoral head sizes and calcar-to-canal width ratios among women of different ethnic groups. There were also differences in neck-shaft angles between Chinese and Indian women, and between Malay and Indian women.
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Affiliation(s)
- Zhi Hao Tang
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
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