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Nerys-Figueroa J, Parsa A, Curley A, Charif S, Domb BG, Schinsky MF. Slightly reduced early subsidence with similar outcomes and complications rate in collared stems - A systematic review of randomized clinical trials. J Orthop 2024; 50:170-176. [PMID: 38328796 PMCID: PMC10845209 DOI: 10.1016/j.jor.2024.01.013] [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: 11/27/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Background There is a growing trend towards using femoral stems with a medial calcar collar during total hip arthroplasty (THA). Purpose Systematically review the literature comparing a femoral collared stem and femoral collarless stem on subsidence, patient-reported outcomes (PROs), and revision rate. Study design Systematic Review, Level of Evidence 1. Methods A literature search of Pubmed and Medline was according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials that evaluated collared and collarless stems, subsidence and PROs for adult patients undergoing total hip arthroplasty (THA) were included. Additional data collection included patient demographics, stem-calcar contact, canal-fill ratio (CFR), stem orientation, surgical approach, Dorr Type, complications, and revisions. Results Five studies met inclusion criteria. 674 patients (704 hips) were included. Mean patient ages ranged 58.5-72.4 years old, and mean BMI ranged 26.6-29.8 kg/m2. Mean reported follow-up of the included clinical trials ranged 1-9.6 years. Two studies reported mean early subsidence at two weeks postoperatively, which was 0.36, 0.99 mm for collared stems and 0.52, 3.22 mm for collarless stems, proving to be statistically significant (P = 0.023), (P = 0.05). All studies demonstrated improved PROs at most recent follow-up. Revision rates ranged from 4 to 11.3 %, but these were not statistically significant. Conclusions Implantation of collared stems compared to collarless may reduce early post-operative subsidence, while no substantial effect on aseptic loosening, thigh pain, proximal femoral fracture, and revision is seen. When measuring patient-reported outcomes, the collared femoral stem was not superior to the collarless femoral stem as both resulted in similar improvement preoperatively to postoperative state.
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Affiliation(s)
| | - Ali Parsa
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Andrew Curley
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Sam Charif
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
- American Hip Institute, Chicago, IL, 60018, USA
| | - Mark F. Schinsky
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
- American Hip Institute, Chicago, IL, 60018, USA
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Herold D, Kuttner A, Dreyer L, Eingartner C. Mid-term results of a cementless hip stem in femoral revision: how much diaphyseal press-fit do we need? Arch Orthop Trauma Surg 2024; 144:1813-1820. [PMID: 38217640 PMCID: PMC10965576 DOI: 10.1007/s00402-023-05191-4] [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: 08/01/2023] [Accepted: 12/19/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION The aim of this retrospective study was to analyze the clinical and functional outcome of a modular tapered revision hip stem after mid-term follow-up with a special focus on the length of the distal bicortical fixation of the cementless hip stem. MATERIALS AND METHODS Follow-up examination was carried out for all patients with implantation of the Prevision hip stem between 2014 and 2019 to collect demographic, functional, and radiographic data. RESULTS 44 patients with stem in situ were examined, and 61 patients could be included in the Kaplan-Meier survival analysis. Oxford's hip score was 37.3 at the mean follow-up of 4.0 years. Two hip stem revisions were performed due to periprosthetic infection, which resulted in a hip stem survival rate of 96.7% (CI: 87.4-99.1%) at the final follow-up of 7.5 years. No aseptic hip stem revision was required. The length of bicortical distal fixation was in the interquartile range of 6.8 to 9.0 cm, which was associated with good bone healing and a low rate of subsidence (4.5%). Implant-associated complications were observed in 10 cases (21.7%). CONCLUSIONS The modular revision hip stem provides promising results at medium-term follow-up, with satisfactory clinical and functional outcomes comparable to other modular revision hip stems. The presented length of bicortical distal fixation shows the practice of the study center and was associated with good implant survival, bone healing and radiological results. REGISTRATION Clinicaltrials.gov registration: NCT04833634 registered on April 6, 2021.
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Zampogna B, Papalia GF, Parisi FR, Luciano C, Zampoli A, Vorini F, Marongiu G, Marinozzi A, Farsetti P, Papalia R. Modular versus monoblock stem in revision total hip arthroplasty: a systematic review and meta-analysis. ANNALS OF JOINT 2023; 8:32. [PMID: 38529243 PMCID: PMC10929344 DOI: 10.21037/aoj-23-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 08/31/2023] [Indexed: 03/27/2024]
Abstract
Background Total hip arthroplasty (THA) is estimated to grow in the following decades with a consequent increase of THA revisions (rTHA). This systematic review and meta-analysis aims to compare modular and monoblock stem in rTHA surgery, focusing on clinical and radiological outcomes and complication rates. Methods A literature search was performed using the following search strategy: ((Modular stem) OR (monolithic stem)) AND (hip review) on PubMed, Scopus, and Cochrane. Randomized controlled trials (RCTs) and observational studies (OS) compared clinical and radiological outcomes, and complication rates for monoblock and modular revision femoral stem were included. The risk of bias was assessed through the Methodological Index for Non-Randomized Studies (MINORS) score. The Review Manager (RevMan) software was used for the meta-analysis. The rate of complications was assessed using odds ratio (OR) with 95% confidence intervals (CIs). Results The authors included 11 OS and one RCT with 3,671 participants (mean age: 68.4 years old). The mean follow-up was 46.9 months. There was no prevalence of subsidence for one type of stem. Mean subsidence was from 0.92 to 10 mm for modular stem and from 1 to 15 mm for monoblock stem. Postoperative Harris Hip Score (HHS) showed better results with modular stems without statistical significance [mean difference (MD) =1.32; 95% CI: -1.62 to 4.27; P=0.38]. No statistically significant difference was found for dislocations (OR =2.48; 95% CI: 0.67 to 9.14; P=0.17), infections (OR =1.07; 95% CI: 0.51 to 2.23; P=0.86), intraoperative fractures (OR =1.62; 95% CI: 0.42 to 6.21; P=0.48), and postoperative fractures (OR =1.60; 95% CI: 0.55 to 4.64; P=0.39). Conclusions Modular and monoblock stems show comparable and satisfactory clinical and radiological outcomes for rTHA. Both stems are valid and effective options for managing femoral bone deficit in hip revision surgery. The main limitation of this study is the small number and low quality of enclosed studies that compared the two stems. Moreover, the modular stem is usually used for more complex cases with lower quality femoral bone stock.
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Affiliation(s)
- Biagio Zampogna
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giuseppe Francesco Papalia
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Rosario Parisi
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Claudia Luciano
- Section of Orthopaedics and Traumatology, Department of Clinical Science and Translational Medicine, the University of Rome “Tor Vergata”, Rome, Italy
| | - Andrea Zampoli
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Ferruccio Vorini
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giuseppe Marongiu
- Orthopaedic Unit, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Andrea Marinozzi
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Pasquale Farsetti
- Section of Orthopaedics and Traumatology, Department of Clinical Science and Translational Medicine, the University of Rome “Tor Vergata”, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedics and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Wang D, Li H, Zhang W, Li H, Xu C, Liu W, Li J. Efficacy and safety of modular versus monoblock stems in revision total hip arthroplasty: a systematic review and meta-analysis. J Orthop Traumatol 2023; 24:50. [PMID: 37715867 PMCID: PMC10505121 DOI: 10.1186/s10195-023-00731-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Both modular and monoblock tapered fluted titanium (TFT) stems are increasingly being used for revision total hip arthroplasty (rTHA). However, the differences between the two designs in clinical outcomes and complications are not yet clear. Here, we intend to compare the efficacy and safety of modular versus monoblock TFT stems in rTHA. METHODS PubMed, Embase, Web of Science, and Cochrane Library databases were searched to include studies comparing modular and monoblock implants in rTHA. Data on the survivorship of stems, postoperative hip function, and complications were extracted following inclusion criteria. Inverse variance and Mantel-Haenszel methods in Review Manager (version 5.3 from Cochrane Collaboration) were used to evaluate differences between the two groups. RESULTS Ten studies with a total of 2188 hips (1430 modular and 758 monoblock stems) were finally included. The main reason for the revision was aseptic loosening. Paprosky type III was the most common type in both groups. Both stems showed similar re-revision rates (modular vs monoblock: 10.3% vs 9.5%, P = 0.80) and Harris Hip Scores (WMD = 0.43, P = 0.46) for hip function. The intraoperative fracture rate was 11.6% and 5.0% (P = 0.0004) for modular and monoblock stems, respectively. The rate of subsidence > 10 mm was significantly higher in the monoblock group (4.5% vs 1.0%, P = 0.003). The application of extended trochanteric osteotomy was more popular in monoblock stems (22.7% vs 17.5%, P = 0.003). The incidence of postoperative complications such as periprosthetic femoral fracture and dislocation was similar between both stems. CONCLUSIONS No significant difference was found between modular and monoblock tapered stems as regards postoperative hip function, re-revision rates, and complications. Severe subsidence was more frequent in monoblock stems while modular ones were at higher risk of intraoperative fracture. LEVEL OF EVIDENCE Level III, systematic review of randomized control and non-randomized studies. TRIAL REGISTRATION We registered our study in the international prospective register of systematic reviews (PROSPERO) (CRD42020213642).
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Affiliation(s)
- Daofeng Wang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Hua Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wupeng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Tianjin, 300071, China
| | - Huanyu Li
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Wanheng Liu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
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