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Kayani B, Neufeld ME, Bautista M, Howard LC, Abdelmalek M, Greidanus NV, Masri BA, Garbuz DS. The Wagner Cone Stem for Atypical Femoral Anatomy in Total Hip Arthroplasty: A Report of 320 Cases with Minimum 5-Year Follow-up. J Bone Joint Surg Am 2024:00004623-990000000-01120. [PMID: 38815006 DOI: 10.2106/jbjs.23.00849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND The Wagner Cone Prosthesis was designed to address complex femoral deformities during total hip arthroplasty (THA), but its mid-term component survivorship and functional outcomes remain undetermined. The objectives of this study were to determine the implant survivorship, patient satisfaction, functional outcomes, osseointegration as seen radiographically, implant subsidence, and complications of THA using the Wagner Cone Prosthesis stem at intermediate-term follow-up. METHODS This study involved 302 patients with proximal femoral deformities, including developmental hip dysplasia and Legg-Calvé-Perthes disease, who underwent a total of 320 primary THAs using the Wagner Cone Prosthesis. The average age at the time of surgery was 49.4 ± 14.5 years (range, 18.8 to 85.6 years). Patient satisfaction was recorded using a self-administered questionnaire assessing satisfaction in 4 domains. The University of California at Los Angeles (UCLA) activity score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Hip Score (OHS), the Forgotten Joint Score (FJS), radiographic outcomes, and complications were recorded. The mean follow-up time was 10.1 years (range, 5.2 to 15.5 years). RESULTS Survivorship of the Wagner Cone Prosthesis was 98.7% (95% confidence interval [CI]: 97.2% to 100%) with stem revision as the end point and 95.8% (95% CI: 93.5% to 98.2%) with reoperation for any reason as the end point at 10 years postoperatively. In total, 3 stems were revised: 2 for infection and 1 for chronic hip dislocation. The median patient satisfaction score was 95 (interquartile range [IQR], 80 to 100), median UCLA score was 6 (IQR, 6 to 7), median WOMAC score was 18 (IQR, 16 to 22), median OHS was 40 (IQR, 36 to 47), and median FJS was 80 (IQR, 76 to 88) at the time of final follow-up. All Wagner Cone stems that were not revised showed radiographic evidence of osseointegration, with a mean stem subsidence of 0.9 ± 0.8 mm at the most recent follow-up. CONCLUSIONS The use of the Wagner Cone Prosthesis stem in patients with complex femoral anatomy undergoing primary THA is associated with excellent component survivorship, high levels of patient satisfaction, good functional outcomes, and reliable osseointegration with minimal stem subsidence as seen on radiographs at intermediate-term follow-up. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Babar Kayani
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael E Neufeld
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maria Bautista
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa C Howard
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammed Abdelmalek
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nelson V Greidanus
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bassam A Masri
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald S Garbuz
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Innocenti M, Smulders K, Andreotti M, Willems JH, Van Hellemondt G, Nijhof MW. The use of a standard-length conical tapered stem in hip revision arthroplasty to address Paprosky type I-II femoral defects: a prospective study of 87 patients. Arch Orthop Trauma Surg 2023; 143:5945-5955. [PMID: 36806987 PMCID: PMC10449674 DOI: 10.1007/s00402-023-04797-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Low-grade femoral defects in revision total hip arthroplasty (rTHA) might be preferably treated with a primary implant. Almost no previous study reported the use of standard-length conical tapered (SLCT) stems in these cases. We analyzed a series of cases using a SLCT stem in rTHA with Paprosky type I-II femoral defects. The purpose of the study was to determine clinical and radiographic outcomes in this series of rTHA. MATERIALS AND METHODS We prospectively followed 87 patients undergoing a femoral component rTHA: 53 Paprosky type I and 34 type II femoral defects. Patient-reported measures (Oxford Hip Score, EQ-5D, VAS pain during rest and activity) were administered at baseline, 1 and 2 years post-operatively. Radiographic subsidence overtime was scored. Kaplan-Meier curves were used to evaluate the subsidence over time, the complication-free survival, and the implant survivorship with reoperation and stem revision as endpoints. RESULTS The mean follow-up was 72.5 (SD ± 23.9) months. All PROMs significatively improved over time. The average subsidence was 2.8 (SD ± 3.2), 3.6 (SD ± 4.4), and 4.0 (SD ± 4.9) mm at 4, 12, and 24 months respectively. 6 stems had subsidence > 10 mm. The survival without complication was 0.85 (95% CI 0.94-0.77), while the implant survival without reoperation was 0.83 (95% CI 0.95-0.72). The overall stem survival rate was 93.7% (95% CI 0.91-0.97) at 2 years. CONCLUSION The use of a SLCT stem in rTHA with Paprosky type I-II femoral defects demonstrated good survival with low subsidence rates during the first 2 years after surgery. Surgeons should consider the use of this primary prosthesis as a potential treatment during stem revision in cases with limited femoral bone loss.
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Affiliation(s)
- Matteo Innocenti
- Department of Orthopaedic Surgery, University of Florence, Florence, Italy
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Mattia Andreotti
- Department of Orthopaedic, Ospedale Riuniti Padova, Padua, Italy
| | - Jore H. Willems
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Gijs Van Hellemondt
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Marc W. Nijhof
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
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Shahin M, Massé V, Belzile É, Bédard L, Angers M, Vendittoli PA. Midterm results of titanium conical Wagner stem with challenging femoral anatomy: Survivorship and unique bone remodeling. Orthop Traumatol Surg Res 2023; 109:103242. [PMID: 35158103 DOI: 10.1016/j.otsr.2022.103242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/04/2021] [Accepted: 08/31/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Complex anatomy of the proximal femur makes total hip arthroplasty (THA) more challenging. Short, straight, fluted and conical titanium stem like the Wagner Cone can be helpful to address small femoral canal, increased femoral neck version, important leg length discrepancy or proximal femoral deformity. The outcome in these patients is less assured and associated with high rate of complications. Therefore, we did a retrospective study aiming to answer: 1) can the Wagner Cone stem provide acceptable mid- to long-term implant survivorship; 2) help minimizing perioperative adverse events; 3) produce favorable clinical outcome measured by WOMAC score; and 4) be associated with a favorable radiographic femoral bone remodeling at the last follow-up? HYPOTHESIS Wagner Cone stem is an advantageous solution for the distorted proximal femur in complex THA. PATIENTS AND METHOD Our cohort was derived from the patient registries where medical records of 88 patients (103 hips) who underwent primary THA using the Wagner prosthesis were retrospectively reviewed. Then, data was analyzed for patients' demographics and surgical data, and comparing preoperative, immediate postoperative and last follow-up data. Eleven patients (12 hips) were excluded (7 hips followed up less than 2 years or lost to follow-up, 3 hips that had the Wagner stem for revision and 2 Wagner stems inserted for periprosthetic fracture). This left 77 patients (91 hips) with Wagner cone stems implanted for more than 2 years between March 2003 and February 2017 by 7 surgeons in 3 academic hospitals. Implant revision, reoperations, WOMAC score and radiographic analyses were recorded at last follow-up. RESULTS After a mean follow-up of 7.8 (range, 2.0-16.2) years, Wagner stem survivorship was 98.9% (95% CI: 94 to 100%) with one (1.1%) stem revision for failure of osteointegration. Five (5.5%) acetabular revisions, one for aseptic loosening, 2 for adverse reaction to metal debris and 2 for infection. One (1.1%) sciatic neuropathy and 4 (4.4%) intraoperative fractures were encountered. The mean WOMAC score was 90.5±11.4 (59-100). Radiographic analysis showed clear signs of stem osseointegration and hypertrophic bone remodeling in 82 cases (92.1%). CONCLUSIONS Used in complex cases with proximal distorted femurs, the Wagner Cone stem demonstrated a low complication rate, a high-rate consistent adaptive bone remodeling, excellent clinical results, and midterm survival. It is a safe, reliable and advantageous option in complex primary THA. However, the contribution of the underlying cause of the secondary osteoarthritis on the long-term survival of the stem remains to be demonstrated. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Maged Shahin
- Surgery Department, Montreal University, Hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - Vincent Massé
- Surgery Department, Montreal University, Hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada; Clinique Orthopédique Duval, 1487, boulevard des Laurentides, H7M 2Y3 Laval, Québec, Canada
| | - Étienne Belzile
- Division of Orthopaedic Surgery, CHU de Québec, Université Laval, 1401 18(e), rue, Quebec, G1J 1Z4 QC, Canada; Personalized Arthroplasty Society, 3525, Piedmont road NE, Building 5 suite 300, 30305 Atlanta, GA, USA
| | - Luc Bédard
- Division of Orthopaedic Surgery, CHU de Québec, Université Laval, 1401 18(e), rue, Quebec, G1J 1Z4 QC, Canada
| | - Michèle Angers
- Division of Orthopaedic Surgery, CHU de Québec, Université Laval, 1401 18(e), rue, Quebec, G1J 1Z4 QC, Canada
| | - Pascal-André Vendittoli
- Surgery Department, Montreal University, Hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada; Clinique Orthopédique Duval, 1487, boulevard des Laurentides, H7M 2Y3 Laval, Québec, Canada; Personalized Arthroplasty Society, 3525, Piedmont road NE, Building 5 suite 300, 30305 Atlanta, GA, USA.
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Mo TT, Zhu YS, Zhang JN, Zhang WK, Jiang C. The clinical effect of trochanteric slide osteotomy combined with a cementless femoral conical stem in total hip replacement for the treatment of Crowe type IV developmental dysplasia of the hip. Technol Health Care 2023; 31:553-563. [PMID: 36120798 DOI: 10.3233/thc-220147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Total hip replacement (THR) for Crowe type IV developmental dysplasia of the hip (DDH) is still challenging due to specific joint deformities and the high incidence of post-operative complications. OBJECTIVE This study aimed to evaluate the clinical effect of trochanteric slide osteotomy (TSO) combined with a cementless femoral conical stem in THR for the treatment of Crowe type IV DDH. METHODS Thirty-one total hip replacements (26 patients) with Crowe type IV DDH were performed using TSO combined with a cementless femoral conical stem. Surgical outcomes were evaluated using leg length discrepancy (LLD), Harris hip score, and post-operative complications. RESULTS The average pre-operative LLD was 51 mm (range 46-58 mm), decreasing to an average of 10 mm (range 8-12 mm) post-operatively. As a result, the post-operative incidence of the Trendelenburg sign significantly decreased compared with the pre-operative incidence (P< 0.05). Bony union was identified in 26 hips (83.9%), fibrous union in four (12.9%), and non-union in one (3.2%). No acetabular or femoral component loosening, dislocation, or deep infection around the component was found in any of the patients during the follow-up period (27 to 39 months). The average Harris hip score improved from 63.0 ± 3.0 (range 58-69) to 93.3 ± 2.0 (range 91-96). CONCLUSION TSO combined with a cementless conical stem in THR is an appropriate option for patients with high congenital hip dislocation.
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Willems JH, Smulders K, Innocenti M, Bosker BH, van Hellemondt GG. Stay Short or Go Long in Revision Total Hip Arthroplasty With Paprosky Type II Femoral Defects: A Comparative Study With the Use of an Uncemented Distal Fixating Modular Stem and a Primary Monobloc Conical Stem With 5-Year Follow-Up. J Arthroplasty 2022; 37:2239-2246. [PMID: 35537612 DOI: 10.1016/j.arth.2022.05.009] [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: 12/27/2021] [Revised: 04/21/2022] [Accepted: 05/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In the revisions for Paprosky type II femoral defects, diaphyseal fixating femoral stems are commonly used. To preserve bone stock, the use of a shorter primary conical stem could be an adequate alternative. The objective of this study is to compare the results of a primary conical stem to the more commonly used diaphyseal fixating modular revision stem in revision total hip arthroplasty surgery with Paprosky type II femoral defects. METHODS A total of 59 consecutive patients with Paprosky type II femoral defects from our prospective revision registry were included. Thirty patients who received a long distal fixating modular stem (Revision Stem, Lima Corporate) and 29 patients who received a primary conical short stem (Wagner Cone, Zimmer) were prospectively followed. Minimal follow-up time was 2 years for subsidence and patient-reported outcome measures and 5 years for complications, reoperation, and revision. We compared subsidence, perioperative complications, reoperations, femoral component survival, Oxford Hip Score, EuroQol 5 Dimension, visual analog scale (VAS) for pain at rest, and VAS for pain during activity between stems. RESULTS Both groups were comparable regarding demographic, clinical, and surgery-related characteristics. We found more perioperative complications and stem revisions with the modular revision stem than with the primary conical stem. There were no statistical differences in subsidence, EuroQol 5 Dimension, Oxford Hip Score, and VAS for pain at rest or during activity between both stems. CONCLUSION In revision total hip arthroplasty with Paprosky type II femoral defects, uncemented primary monobloc conical femoral stems showed the same clinical result as distal fixating modular stems with fewer complications and fewer stem revisions.
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Affiliation(s)
- Jore H Willems
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Katrijn Smulders
- Department for Scientific Research, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Matteo Innocenti
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Bart H Bosker
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Ubbergen, The Netherlands
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Daud A, Perlus R, Anand A, Safir OA, Gross AE, Kuzyk PR. Mid-term outcomes of the Wagner Cone Prosthesis™ stem for developmental dysplasia of the hip: minimum two year follow-up. INTERNATIONAL ORTHOPAEDICS 2022; 46:1733-1740. [PMID: 35593929 DOI: 10.1007/s00264-022-05437-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Treatment of symptomatic developmental dysplasia of the hip (DDH) requires a technically demanding total hip arthroplasty (THA) reconstruction. In patients with DDH, prostheses can be difficult to implant and often face the risk of fracture, mismatch, and loosening. The Wagner Cone Prosthesis™ is a tapered, conical stem which can improve treatment success in this population. We look at midterm survivorship and outcomes of THA for DDH using the Wagner Cone Prosthesis™. METHODS We retrospectively analyzed 28 patients (33 hips) with DDH undergoing THA using the Wagner Cone Prosthesis™ between January 2008 and January 2020. Ten, nine, and fourteen included patients were classified as Hartofilakidis A, B, and C, respectively. Survivorship according to Kaplan-Meier analysis was the primary outcome, with re-operation and revision as endpoints. The Oxford hip score (OHS) was used to assess clinical outcome. We used multivariate analysis to determine predictors of poor outcomes. The average follow-up was 4.6 years, with a minimum of two years. RESULTS Kaplan-Meier survivorship over the 13-year study period was 93.9 ± 4.2% for all-cause revision as an endpoint and 96.9 ± 3.1% for stem revisions only. The overall reoperation rate was 6.1%, with periprosthetic fracture and dislocation being reasons for re-operation. No patients were revised for aseptic loosening, and no patients were revised for subsidence. OHS improved from 19.3 ± 9.6 (4-39) pre-operatively to 37.6 ± 8.4 (19-48) at latest follow-up (p < 0.05). CONCLUSION In patients with DDH, THA with the Wagner Cone Prosthesis™ demonstrates excellent clinical, radiographic, and patient-reported functional outcomes at midterm follow-up.
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Affiliation(s)
- Anser Daud
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada. .,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada.
| | - Ryan Perlus
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada
| | - Amit Anand
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada
| | - Oleg A Safir
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada
| | - Allan E Gross
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada
| | - Paul R Kuzyk
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada
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Sakamoto K, Motomura G, Hamai S, Ikemura S, Fujii M, Kawahara S, Ayabe Y, Nakashima Y. Short-term results of total hip arthroplasty using a tapered cone stem for patients with previous femoral osteotomy. J Orthop 2022; 30:83-87. [PMID: 35241894 PMCID: PMC8881525 DOI: 10.1016/j.jor.2022.02.021] [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: 10/10/2021] [Revised: 01/17/2022] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In total hip arthroplasty (THA) for patients with previous femoral osteotomy, we hypothesized that a tapered cone stem may be an option due to the altered morphology of the proximal femur. The purpose of this study was to assess the short-term results of THA after femoral osteotomy using a tapered cone stem, and to identify issues that require further attention. METHODS Twenty-two hips in 21 consecutive patients who underwent THA after femoral osteotomy using a Wagner Cone tapered cone stem were retrospectively reviewed, with a mean follow-up period of 34.4 (range, 24-50) months. Clinical information was obtained from medical records. On preoperative radiographs, the Dorr type was classified based on the anteroposterior cortical index. On postoperative radiographs, the degree of stem subsidence and the stem location with the highest canal fill ratio were assessed. RESULTS The mean Harris hip score significantly improved from 55.2 at baseline to 84.8 at final follow-up. Radiologically, stem subsidence (>3 mm) was observed in seven hips, and it stabilized within 1 year after THA in all cases. In five of seven hips with stem subsidence, the highest postoperative canal fill ratio was observed in the distal third of the stem. The proportions of males and Dorr type A were significantly higher among hips with stem subsidence than among those without. During the follow-up period, no hips showed implant loosening or required revision surgery. CONCLUSIONS The occurrence of stem subsidence should be noted when using Wagner Cone stems for Dorr type A femurs after femoral osteotomy.
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Affiliation(s)
- Kosei Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu Universit 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu Universit 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Corresponding author.
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu Universit 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu Universit 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu Universit 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu Universit 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yusuke Ayabe
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu Universit 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu Universit 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Pan Y, Li Y, Zhang X, Wang Q, Chen Y, Jiang C. [Application of sliding trochanteric osteotomy in total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1525-1530. [PMID: 34913307 DOI: 10.7507/1002-1892.202108125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of sliding trochanteric osteotomy (STO) in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods Between July 2016 and April 2021, 52 patients (57 hips) with Crowe type Ⅳ DDH who underwent primary THA were enrolled according to inclusion criteria. There were 5 males and 47 females with a median age of 51 years (range, 18-76 years). There were 47 cases of single hip and 5 cases of bilateral hips. The leg length discrepancy (LLD) was 50.50 (44.00, 55.00) mm, visual analogue scale (VAS) score was 8.0 (6.0, 9.0), and Harris score was 58.0±5.0 before operation. Trendelenburg sign was positive in 46 patients (46 hips). All patients underwent STO and THA using Wagner-cone stem. The operation time, intraoperative blood loss, blood transfusion volume, Trendelenburg sign, and related complications were observed. During follow-up, VAS and Harris scores were recorded to evaluate the hip pain and function. X-ray film was used to measure the LLD and observe the bone union situations. Results The operation time was 90-125 minutes (mean, 105 minutes). Introperative blood loss was 420-800 mL (mean, 640 mL). Ten patients underwent blood transfusion and the amount of allogeneic blood transfusion was 2-4 U (mean, 3 U). All incisions healed by first intention after operation. All patients were followed up 4-60 months (median, 24 months). At last follow-up, LLD was 6.00 (4.00, 7.75) mm, showing significant difference when compared with that before operation ( Z=-6.278, P=0.000). After operation, 51 hips (89.5%) achieved bone union at the osteotomy site, 4 hips (7.0%) had fibrous union, and 2 hips (3.5%) had nonunion. The healing time of osteotomy was 3-12 months, with an average of 6 months. At last follow-up, the VAS score was 3.0 (2.0, 5.0) and the Harris score was 85.0±6.0. The differences between pre- and post-operation were significant ( Z=-6.176, P=0.000; t=-25.285, P=0.000). Trendelenburg sign remained positive in 4 patients (4 hips) at last follow-up and the difference was significant when compared with preoperative ( χ 2=67.947, P=0.000). One patient had a medial femoral cortical fracture when Wagner-cone stem was implanted during operation, and 2 patients had early symptoms of sciatic nerve palsy after operation, and no other related complications occurred. Conclusion For Crowe type Ⅳ DDH patients, STO applied in THA can reduce the resected bone mass, provide better exposure of hip as well as improve function of hip abductor muscle. Wagner-cone stem is recommended.
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Affiliation(s)
- Yuqi Pan
- Department of Joint Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, P.R.China
| | - Yamin Li
- Department of Joint Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, P.R.China
| | - Xianlong Zhang
- Department of Joint Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, P.R.China
| | - Qi Wang
- Department of Joint Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, P.R.China
| | - Yunsu Chen
- Department of Joint Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, P.R.China
| | - Chang Jiang
- Department of Joint Surgery, the First People's Hospital of Wenling, Wenling Zhejiang, 317500, P.R.China
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Zhang M, Liu BL, Qi XZ, Yang QQ, Sun JY, Zheng QY, Zhang GQ, Cheng CK. The Three-Dimensional Morphology of Femoral Medullary Cavity in the Developmental Dysplasia of the Hip. Front Bioeng Biotechnol 2021; 9:684832. [PMID: 34249886 PMCID: PMC8264541 DOI: 10.3389/fbioe.2021.684832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/01/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study aimed to assess the morphology of the femoral medullary canal in subjects with developmental dysplasia of the hip (DDH) with the intent of improving the design of femoral stems in total hip arthroplasty. METHODS Computed tomography images of 56 DDH hips, which were classified into Crowe I to Crowe IV, and 30 normal hips were collected and used to reconstruct three-dimensional morphology of the femoral medullary cavity. Images of twenty-one cross sections were taken from 20 mm above the apex of the lesser trochanter to the isthmus. The morphology of femoral cavity was evaluated on each cross section for the longest canal diameter, the femoral medullary torsion angle (FMTA), and the femoral medullary roundness index (FMRI). RESULTS The Crowe IV group displayed the narrowest medullary canal in the region superior to the end of the lesser trochanter, but then gradually aligned with the medullary diameter of the other groups down to the isthmus. The FMTA along the femoral cavity increased with the severity of DDH, but the rate of variation of FMTA along the femoral canal was consistent in the DDH groups. The DDH hips generally showed a larger FMRI than the normal hips, indicating more elliptical shapes. CONCLUSION A femoral stem with a cone shape in the proximal femur and a cylindrical shape for the remainder down to the isthmus may benefit the subjects with severe DDH. This design could protect bone, recover excessive femoral anteversion and facilitate the implantation in the narrow medullary canal.
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Affiliation(s)
- Min Zhang
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Bo-Lun Liu
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xin-Zheng Qi
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Qing-Qing Yang
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jing-Yang Sun
- Department of Orthopedics, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Qing-Yuan Zheng
- Department of Orthopedics, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Guo-Qiang Zhang
- Department of Orthopedics, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Cheng-Kung Cheng
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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Solarino G, Vicenti G, Piazzolla A, Maruccia F, Notarnicola A, Moretti B. Total hip arthroplasty for dysplastic coxarthrosis using a cementless Wagner Cone stem. J Orthop Traumatol 2021; 22:16. [PMID: 33864539 PMCID: PMC8053138 DOI: 10.1186/s10195-021-00578-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background Total hip arthroplasty (THA) is currently the best surgical option for hip osteoarthritis secondary to developmental hip dysplasia (DDH); it may be extremely challenging, because of the hypoplasic proximal metaphysis, pathological anteversion, and excessive cervico-diaphyseal angle of the neck at the femoral side. The purpose of this retrospective study was to evaluate the long-term survival and clinical and radiological results of Conus uncemented stems, implanted in patients affected by hip osteoarthritis with Crowe not-type IV secondary to DDH. Material and methods We identified 100 consecutive THAs performed for DDH in 63 women and 24 men, with an average age of 53 years in a single center. Thirteen patients underwent bilateral hip replacement. The patients’ mean body mass index was 29.8 kg/m2 (range 27.1–35.6 kg/m2). The main indications for surgery were severe hip pain and considerable functional impairment: the preoperative Harris Hip Score was 29.5 on average (range 22–61). Radiologically, 8 hips were classified as Crowe I, 43 hips as Crowe II, and 49 hips as Crowe III. In all cases, we implanted the Wagner femoral cone prosthesis using the direct lateral approach; in the attempt to reestablish native hip biomechanics, 66 stems were 135° and 34 were 125°. Results The mean follow-up of the study was 11.7 years (range 2.2–21.8 years). Harris Hip Score increased to a mean value of 71.5 points (range 52–93 points). Radiographic evaluation demonstrated osteointegration of the implant with stable bone growth observed at the stem–endosteum interface; signs of bone readaptation and thinning of the femoral calcar were present in nine hips. None of the patients underwent revision for septic or aseptic loosening of the stem; none sustained a periprosthetic fracture. Conclusions This study confirms the theoretical advantages that suggest the choice of the Wagner cone when technical difficulties during prosthetic surgery are expected owing to abnormal proximal femoral anatomy. Level of evidence Level IV, retrospective case study
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Affiliation(s)
- Giuseppe Solarino
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università Di Bari "AldoMoro", Piazza Giulio Cesare n.11, 70124, Bari, Italy
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università Di Bari "AldoMoro", Piazza Giulio Cesare n.11, 70124, Bari, Italy
| | - Andrea Piazzolla
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università Di Bari "AldoMoro", Piazza Giulio Cesare n.11, 70124, Bari, Italy
| | - Francesco Maruccia
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università Di Bari "AldoMoro", Piazza Giulio Cesare n.11, 70124, Bari, Italy
| | - Angela Notarnicola
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università Di Bari "AldoMoro", Piazza Giulio Cesare n.11, 70124, Bari, Italy.
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università Di Bari "AldoMoro", Piazza Giulio Cesare n.11, 70124, Bari, Italy
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