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Weiner TR, Woelfle CA, Xu W, Yim DG, Shah RP, Cooper HJ. Does Lack of Initial Collar-Calcar Contact Influence Performance of Collared Cementless Femoral Stems? Arthroplast Today 2024; 27:101432. [PMID: 38882465 PMCID: PMC11180310 DOI: 10.1016/j.artd.2024.101432] [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: 11/19/2023] [Revised: 04/02/2024] [Accepted: 05/01/2024] [Indexed: 06/18/2024] Open
Abstract
Background Initial stability of cementless stems is important to minimize the risk of subsidence, pain, and periprosthetic fracture after total hip arthroplasty (THA). Collared stems improve initial component stability when contacting the femoral calcar. Direct contact is not always achieved, and collared stem performance has not been studied in this context. We hypothesized that collared stems achieving direct contact would demonstrate reduced subsidence. Methods A single-surgeon retrospective study of 482 consecutive primary THAs implanted between February 2020 and May 2023 using collared cementless stems was performed. The 2 cohorts included stems with initial collar-calcar contact vs stems without. Subsidence was evaluated by comparing intraoperative fluoroscopy to postoperative 8-week radiographs. Binary logistic regression identified independent risk factors for subsidence. Chi-square tests were used for categorical variables and t-tests for continuous variables. Results Of stems, 63.9% achieved initial collar-calcar contact, while 36.1% did not. The rate (1.3% vs 19.0%; P < .001) and magnitude (0.02 mm, range 0-3 mm vs 0.35 mm, range 0-3 mm; P < .001) of subsidence were significantly higher among stems without initial contact. Stems without initial collar-calcar contact (P < .001) and male gender (P = .007) were independent risk factors for subsidence. Two patients with initial contact had nondisplaced calcar cracks and <3 mm of subsidence at 4 weeks, which healed with protected weight-bearing. Stem survivorship was 100% in both groups, with all achieving osteointegration and none needing revision. Conclusions Excellent performance of collared cementless stems was observed at 8 weeks after primary THA. Initial collar-calcar contact lowered the risk and magnitude of minor subsidence but did not affect survivorship or fracture risk. Level of Evidence Level III.
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Affiliation(s)
- Travis R Weiner
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Catelyn A Woelfle
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Winnie Xu
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Duke G Yim
- Department of Orthopedic Surgery, Kaiser Permanente, Lone Tree, CO, USA
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
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Fiedler B, Patel V, Lygrisse KA, Kelly ME, Turcotte JJ, MacDonald J, Schwarzkopf R. The effect of reduced bone mineral density on elective total hip arthroplasty outcomes. Arch Orthop Trauma Surg 2023; 143:5993-5999. [PMID: 36920526 DOI: 10.1007/s00402-023-04830-0] [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: 03/25/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Reduced bone mineral density (BMD) and disruption of normal bony architecture are the characteristics of osteopenia and osteoporosis and in patients undergoing total hip arthroplasty (THA) may cause failure of trabecular ingrowth. The purpose of this study is to evaluate the impact of reduced BMD on outcomes following primary elective THA. METHODS A retrospective chart review of 650 elective THAs with a DEXA scan in their electronic health record (EHR) from 2011 to 2020 was conducted at an urban, academic center and a regional, health center. Patients were separated into three cohorts based on their t-score and the World Health Organizations definitions: normal (t-score ≥ - 1), osteopenia (t-score < - 1.0 and > - 2.5), and osteoporosis (t-score ≤ - 2.5). Demographic and outcome data were assessed. Subsidence was assessed for patients with non-cemented THAs. Regression models were used to account for demographic differences. RESULTS 650 elective THAs, of which only 11 were cemented, were included in the study. Patients with osteopenia and osteoporosis were significantly older than those without (p = 0.002 and p < 0.0001, respectively) and had a lower BMI (p < 0.0001 and p < 0.0001, respectively). PFx was significantly greater in patients with osteoporosis when compared to those with normal BMD (6.5% vs. 1.0%; p = 0.04). No such difference was found between osteoporotic and osteopenic patients. The revision rate was significantly higher for osteoporotic patients than osteopenic patients (7.5% vs. 1.5%; p = 0.04). No such difference was found between the other comparison groups. CONCLUSION Patients with osteoporosis were older with reduced BMI and had increased PFx after non-cemented elective THA. Understanding this can help surgeons formulate an appropriate preoperative plan for the treatment of patients with osteoporotic bone undergoing elective THA.
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Affiliation(s)
- Benjamin Fiedler
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA
| | - Vaidehi Patel
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA
| | - Katherine A Lygrisse
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA
| | - McKayla E Kelly
- Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Justin J Turcotte
- Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - James MacDonald
- Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA.
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Thomas J, Shichman I, Ohanisian L, Stoops TK, Lawrence KW, Ashkenazi I, Watson DT, Schwarzkopf R. Monoblock tapered stems in management of UCS B2 and B3 periprosthetic fractures in revision total hip arthroplasty. Bone Jt Open 2023; 4:551-558. [PMID: 37524356 PMCID: PMC10390262 DOI: 10.1302/2633-1462.48.bjo-2022-0160.r1] [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: 08/02/2023] Open
Abstract
Aims United Classification System (UCS) B2 and B3 periprosthetic fractures in total hip arthroplasties (THAs) have been commonly managed with modular tapered stems. No study has evaluated the use of monoblock fluted tapered titanium stems for this indication. This study aimed to evaluate the effects of a monoblock stems on implant survivorship, postoperative outcomes, radiological outcomes, and osseointegration following treatment of THA UCS B2 and B3 periprosthetic fractures. Methods A retrospective review was conducted of all patients who underwent revision THA (rTHA) for periprosthetic UCS B2 and B3 periprosthetic fracture who received a single design monoblock fluted tapered titanium stem at two large, tertiary care, academic hospitals. A total of 72 patients met inclusion and exclusion criteria (68 UCS B2, and four UCS B3 fractures). Primary outcomes of interest were radiological stem subsidence (> 5 mm), radiological osseointegration, and fracture union. Sub-analysis was also done for 46 patients with minimum one-year follow-up. Results For the total cohort, stem osseointegration, fracture union, and stem subsidence were 98.6%, 98.6%, and 6.9%, respectively, at latest follow-up (mean follow-up 27.0 months (SD 22.4)). For patients with minimum one-year of follow-up, stem osseointegration, fracture union, and stem subsidence were 97.8%, 97.8%, and 6.5%, respectively. Conclusion Monoblock fluted stems can be an acceptable modality for the management of UCS B2 periprosthetic fractures in rTHAs due to high rates of stem osseointegration and survival, and the low rates of stem subsidence, and revision. Further research on the use of this stem for UCS B3 periprosthetic fractures is warranted to determine if the same conclusion can be made for this fracture pattern.
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Affiliation(s)
- Jeremiah Thomas
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Ittai Shichman
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
- Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Levonti Ohanisian
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - T K Stoops
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Kyle W Lawrence
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Itay Ashkenazi
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
- Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - David T Watson
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
- Adult Reconstruction Service, Florida Orthopaedic Institute, Tampa, Florida, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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4
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Blum P, Neugebauer J, Keiler A, Putzer D, Watrinet J, Biermeier S, Dammerer D. Mid-Term Migration Behavior of an Uncemented Proximally Anchored Straight Stem-A Retrospective EBRA Migration Analysis. J Clin Med 2023; 12:4335. [PMID: 37445370 DOI: 10.3390/jcm12134335] [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: 04/17/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Aseptic loosening is one of the most-common causes of the failure of cementless stems. Einzel Bild Röntgen Analyse-Femoral Component Analysis (EBRA-FCA) allows the diagnosis of stem migration, which can be considered a factor in predicting implant survival. The current study aimed to present the migration behavior of a tapered proximally anchored straight stem. METHODS This retrospective study reviewed all consecutive patients who received a cementless CBC straight stem (Mathys AG, Bettlach, Switzerland) between 2005 and 2019. We analyzed the migration pattern using the EBRA-FCA software and reviewed their medical histories. In addition, periprosthetic radiolucency was rated according to the Gruen zones and femoral configuration according to Dorr. RESULTS A total of 333 stems in 332 patients (female 191; male 141) met our inclusion criteria. The mean age at surgery was 63 (range 21-87) years. Migration analysis by EBRA-FCA showed a mean subsidence of 1.6 mm at final follow-up at 96 months with a maximum noted mean subsidence of 2.0 mm at 72 and 84 months. Dorr Type A showed a tendency of less subsidence than did Dorr Type B and was statistically significant at 6 (p = 0.0396) and 72 months (p = 0.0127). The body mass index (BMI) and increased subsidence were not found to correlate (p > 0.05). For this cohort, the overall femoral revision-free rate was 95.2% and the revision-free rate for aseptic loosening was 99.1%. CONCLUSIONS The results showed migration behavior in cementless stems with initial increased migration and subsequent secondary stabilization, suggesting an excellent long-term outcome. Stem migration of this tapered proximally anchored stem might be lower in Dorr Type A than in Dorr Type B femurs without being statistically significant at all time points.
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Affiliation(s)
- Philipp Blum
- Department of Trauma Surgery, BG Trauma Center Murnau, 82418 Murnau, Germany
| | - Johannes Neugebauer
- Department of Orthopaedics and Traumatology, Krems University Hospital, 3500 Krems, Austria
- Karl Landsteiner Private University for Health Sciences, 3500 Krems, Austria
| | - Alexander Keiler
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - David Putzer
- Department of Experimental Orthopaedics, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Julius Watrinet
- Department of Trauma Surgery, BG Trauma Center Murnau, 82418 Murnau, Germany
| | - Sebastian Biermeier
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Krems University Hospital, 3500 Krems, Austria
- Karl Landsteiner Private University for Health Sciences, 3500 Krems, Austria
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5
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Pelkowski JN, Wilke BK, Glabach MR, Bowman JC, Ortiguera CJ, Blasser KE, Crowe MM, Sherman CE, Ledford CK. The Development and Early Experience of a Destination Center of Excellence Program for Total Joint Arthroplasty. Orthop Nurs 2023; 42:4-11. [PMID: 36702089 DOI: 10.1097/nor.0000000000000911] [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] [Indexed: 01/28/2023] Open
Abstract
High-volume total joint arthroplasty centers are becoming designated as destination centers of excellence to ensure quality of care while containing costs. This study aimed to evaluate the surgical patient journey through a new destination center of excellence program, review acute perioperative course trajectories, and report clinical outcomes. Our institution developed and implemented a destination center of excellence program to integrate into the existing total joint arthroplasty practice. A retrospective record review and analysis were performed for the first 100 destination center of excellence total knee arthroplasties and total hip arthroplasties enrolled in the program to evaluate program efficacy at a minimum 1-year follow-up. The study initially screened 213 patients, of whom 100 (47%) met program criteria and completed surgery (67 total knee arthroplasties and 33 total hip arthroplasties). The complication rate was 2%, and five patients (7.5%) required manipulation under anesthesia for stiffness after total knee arthroplasty. Two reoperations were needed: a neurectomy after total knee arthroplasty and a revision after total hip arthroplasty. The early experience of a destination center of excellence program has been favorable, with low complication rates and excellent outcomes.
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Affiliation(s)
- Jessica N Pelkowski
- Jessica N. Pelkowski, APRN, DNP , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Benjamin K. Wilke, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Michelle R. Glabach, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Jacki C. Bowman, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Cedric J. Ortiguera, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Kurt E. Blasser, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Matthew M. Crowe, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Courtney E. Sherman, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Cameron K. Ledford, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
| | - Benjamin K Wilke
- Jessica N. Pelkowski, APRN, DNP , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Benjamin K. Wilke, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Michelle R. Glabach, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Jacki C. Bowman, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Cedric J. Ortiguera, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Kurt E. Blasser, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Matthew M. Crowe, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Courtney E. Sherman, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Cameron K. Ledford, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
| | - Michelle R Glabach
- Jessica N. Pelkowski, APRN, DNP , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Benjamin K. Wilke, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Michelle R. Glabach, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Jacki C. Bowman, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Cedric J. Ortiguera, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Kurt E. Blasser, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Matthew M. Crowe, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Courtney E. Sherman, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Cameron K. Ledford, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
| | - Jacki C Bowman
- Jessica N. Pelkowski, APRN, DNP , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Benjamin K. Wilke, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Michelle R. Glabach, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Jacki C. Bowman, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Cedric J. Ortiguera, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Kurt E. Blasser, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Matthew M. Crowe, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Courtney E. Sherman, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Cameron K. Ledford, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
| | - Cedric J Ortiguera
- Jessica N. Pelkowski, APRN, DNP , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Benjamin K. Wilke, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Michelle R. Glabach, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Jacki C. Bowman, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Cedric J. Ortiguera, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Kurt E. Blasser, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Matthew M. Crowe, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Courtney E. Sherman, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Cameron K. Ledford, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
| | - Kurt E Blasser
- Jessica N. Pelkowski, APRN, DNP , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Benjamin K. Wilke, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Michelle R. Glabach, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Jacki C. Bowman, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Cedric J. Ortiguera, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Kurt E. Blasser, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Matthew M. Crowe, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Courtney E. Sherman, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Cameron K. Ledford, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
| | - Matthew M Crowe
- Jessica N. Pelkowski, APRN, DNP , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Benjamin K. Wilke, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Michelle R. Glabach, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Jacki C. Bowman, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Cedric J. Ortiguera, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Kurt E. Blasser, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Matthew M. Crowe, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Courtney E. Sherman, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Cameron K. Ledford, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
| | - Courtney E Sherman
- Jessica N. Pelkowski, APRN, DNP , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Benjamin K. Wilke, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Michelle R. Glabach, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Jacki C. Bowman, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Cedric J. Ortiguera, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Kurt E. Blasser, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Matthew M. Crowe, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Courtney E. Sherman, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Cameron K. Ledford, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
| | - Cameron K Ledford
- Jessica N. Pelkowski, APRN, DNP , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Benjamin K. Wilke, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Michelle R. Glabach, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Jacki C. Bowman, RN , Department of Nursing, Mayo Clinic, Jacksonville, FL
- Cedric J. Ortiguera, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Kurt E. Blasser, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Matthew M. Crowe, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Courtney E. Sherman, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
- Cameron K. Ledford, MD , Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
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Hoornenborg D, Schweden AMC, Sierevelt IN, van der Vis HM, Kerkhoffs G, Haverkamp D. The influence of hydroxyapatite coating on continuous migration of a Zweymuller-type hip stem: a double-blinded randomised RSA trial with 5-year follow-up. Hip Int 2023; 33:73-80. [PMID: 33845623 DOI: 10.1177/11207000211006782] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Adding hydroxyapatite to a stem to enhance ingrowth is a matter of debate, even less is known about the long-term effect on stability by adding hydroxyapatite (HA). Continuous migration in the first 2-5 years is an indicator of failed osteointegration or pending failure, enhancing the risk of loosening within 10 years after initial surgery. We performed a double-blinded randomised RSA trial with 5-year follow-up, to compare and analyse migration characteristics of the hydroxyapatite uncoated (HA-) and hydroxyapatite coated (HA+) Zweymuller-type hip stem. PATIENTS AND METHODS In this single-centre prospective randomised controlled trial 51 patients were randomised to receive either a HA- or a HA+ Zweymuller-type hip stem during total hip replacement. After 5 years, 35 patients were still eligible for follow-up evaluation. The migration pattern was measured by use of radio stereometric analysis (RSA) images up to 2 years to evaluate short-term migration, additionally RSA images were obtained 5 years postoperatively to assess late-term and continuous migration. Furthermore, the improvement of clinical outcome was analysed by HSS and HOOS ADL and pain subscales preoperative and after 5 years. RESULTS After initial settling of the implant, no significant migration occurred up to 5 years post-surgery for HA+ as well as HA- prostheses. Continuous migration within the 2-5 years' time interval was not observed for both HA+ nor the HA- group in all directions (p < 0.05). No significant difference between both groups was observed (p < 0.10). In both groups the HHS and HOOS improved significantly at 5 years compared to baseline for both groups. Improvement was not altered by the hydroxyapatite coating. No significant difference between both groups was observed (p > 0.58). CONCLUSIONS Addition of a hydroxyapatite coating did not influence the migration 5 years postoperatively for the Zweymuller-type hip stem.Clinical Trial Protocol number: NL 23524.048.08.
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Affiliation(s)
| | | | - Inger N Sierevelt
- Xpert Clinics, Orthopaedic Surgery, Amsterdam, The Netherlands.,Spaarne Gasthuis Academy, Haarlem, The Netherlands
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7
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Selecting a Press-fit Stem for Total Hip Arthroplasty: The Rationale and Evolution of the Modern Femoral Prosthesis. J Am Acad Orthop Surg 2022; 30:e1279-e1290. [PMID: 35962989 DOI: 10.5435/jaaos-d-22-00074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Noncemented press-fit femoral stems predominate in total hip arthroplasty for all age groups with generally excellent long-term survivorship. The 2021 American Joint Replacement Registry reports that 96% of all elective primary total hip arthroplasties used noncemented femoral implant fixation. 1 Today, there are many styles of press-fit stems, each with supposed benefits, based on a range of design philosophies. Design aspects to consider when selecting a stem are numerous, including stem geometry, stem length, collared or collarless, material properties, and surface structure. Although most stem designs demonstrate excellent results, the differences in stem designs are intimately linked to additional factors such as ease of use/implantation, percentage of surface osseointegration, overall bone removal versus bone stock preservation, subsequent femoral stress shielding, and consideration of complexity of later revision. A surgeon with a broad understanding and appreciation of femoral stem designs should be prepared to select between the multitude of options to best serve individual patients.
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8
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Fixation of intraoperative proximal femoral fractures during THA using two versus three cerclage wires - a biomechanical study. BMC Musculoskelet Disord 2022; 23:40. [PMID: 34996409 PMCID: PMC8742345 DOI: 10.1186/s12891-021-04956-5] [Citation(s) in RCA: 1] [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: 06/03/2021] [Accepted: 12/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intraoperative proximal femoral fractures (IPFF) are relevant complications during total hip arthroplasty. Fixation using cerclage wires (CW) represents a minimally-invasive technique to address these fractures through the same surgical approach. The goal of treatment is to mobilise the patient as early as possible, which requires high primary stability. This study aimed to compare different cerclage wire configurations fixing IPFF with regard to biomechanical primary stability. Methods Standardised IPFF (type II, Modified Mallory Classification) were created in human fresh frozen femora and were fixed either by two or three CW (1.6 mm, stainless steel). All cadaveric specimens (n = 42) were randomised to different groups (quasi-static, dynamic) or subgroups (2 CW, 3 CW) stratified by bone mineral density determined by Dual Energy X-ray Absorptiometry. Using a biomechanical testing setup, quasi-static and dynamic cyclic failure tests were carried out. Cyclic loading started from 200 N to 500 N at 1 Hz with increasing peak load by 250 N every 100 cycles until failure occurred or maximum load (5250 N) reached. The change of fracture gap size was optically captured. Results No significant differences in failure load after quasi-static (p = 0.701) or dynamic cyclic loading (p = 0.132) were found between the experimental groups. In the quasi-static load testing, all constructs resisted 250% of the body weight (BW) of their corresponding body donor. In the dynamic cyclic load testing, all but one construct (treated by 3 CW) resisted 250% BW. Conclusions Based on this in vitro data, both two and three CW provided sufficient primary stability according to the predefined minimum failure load (250% BW) to resist. The authors recommend the treatment using two CW because it reduces the risk of vascular injury and shortens procedure time. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04956-5.
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9
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Sharma AK, Cizmic Z, Dennis DA, Kreuzer SW, Miranda MA, Vigdorchik JM. Low dislocation rates with the use of patient specific "Safe zones" in total hip arthroplasty. J Orthop 2021; 27:41-48. [PMID: 34483549 DOI: 10.1016/j.jor.2021.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/06/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction The purpose of this study was to compare patient-specific acetabular cup target orientation using functional simulation to the Lewinnek Safe Zone (LSZ) and determine associated rates of postoperative dislocation. Methods A retrospective review of 1500 consecutive primary THAs was performed. Inclination, anteversion, pelvic tilt, pelvic incidence, lumbar flexion, and dislocation rates were recorded. Results 56% of dynamically planned cups were within LSZ (p < 0.05). 6/1500 (0.4%) of these cups dislocated at two year follow-up, and all were within LSZ. Conclusion Optimal acetabular cup positioning using dynamic imaging differs significantly from historical target parameters but results in low rates of dislocation. Level of evidence Level III: Retrospective.
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Affiliation(s)
- Abhinav K Sharma
- University of California, Irvine, School of Medicine, Department of Orthopaedic Surgery, Orange, CA 92868, USA
| | - Zlatan Cizmic
- Ascension Providence Hospital Southfield Campus, Department of Orthopaedic Surgery, 16001 W Nine Mile Rd., Southfield, MI, 48075, USA
| | | | | | | | - Jonathan M Vigdorchik
- Hospital for Special Surgery, Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, New York, NY 10021, USA
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10
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Yu L, Silva Santisteban TM, Liu Q, Hu C, Bi J, Wei M. Effect of three-dimensional porosity gradients of biomimetic coatings on their bonding strength and cell behavior. J Biomed Mater Res A 2020; 109:615-626. [PMID: 32608169 DOI: 10.1002/jbm.a.37046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 03/19/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
Surface modification techniques are often used to enhance the properties of Ti-based materials as hard-tissue replacements. While the microstructure of the coating and the quality of the interface between the substrate and coating are essential to evaluate the reliability and applicability of the surface modification. In this study, both a hydroxyapatite (HA) coating and a collagen-hydroxyapatite (Col-HA) composite coating were deposited onto a Ti-6Al-4V substrate using a biomimetic coating process. Importantly, a gradient cross-sectional structure with a porous coating toward the surface, while a dense layer adjacent to the interface between the coating and substrate was observed in three-dimensional (3D) from both the HA and Col-HA coatings via a dual-beam focused ion beam-scanning electron microscope (FIB-SEM). Moreover, the pore distributions within the entire coatings were reconstructed in 3D using Avizo, and the pores size distributions along the coating depth were calculated using RStudio. By evaluating the mechanical property and biocompatibility of these materials and closely observing the cross-sectional cell-coating-substrate interfaces using FIB-SEM, it was revealed that the porous surface created by both coatings well supports osteoblast cell adhesion while the dense inner layer facilitates a good bonding between the coating and the substrate. Although the mechanical property of the coating decreased with the addition of collagen, it is still strong enough for implant handling and the biocompatibility was promoted.
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Affiliation(s)
- Le Yu
- Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut, USA.,Department of Chemical and Biomolecular Engineering, Ohio University, Athens, Ohio, USA
| | | | - Qinqing Liu
- Department of Computer Science and Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - Changmin Hu
- Institute of Materials Science, University of Connecticut, Storrs, Connecticut, USA
| | - Jinbo Bi
- Department of Computer Science and Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - Mei Wei
- Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut, USA.,Institute of Materials Science, University of Connecticut, Storrs, Connecticut, USA.,Department of Mechanical Engineering, Ohio University, Athens, Ohio, USA
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11
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Cockerill I, Su Y, Sinha S, Qin YX, Zheng Y, Young ML, Zhu D. Porous zinc scaffolds for bone tissue engineering applications: A novel additive manufacturing and casting approach. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 110:110738. [PMID: 32204047 PMCID: PMC7096330 DOI: 10.1016/j.msec.2020.110738] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 12/27/2022]
Abstract
As a degradable metal, zinc (Zn) has attracted an immense amount of interest as the next generation of bioresorbable implants thanks to its modest corrosion rate and its vital role in bone remodeling, yet very few studies have thoroughly investigated its functionality as a porous implant for bone tissue engineering purposes. Zn bone scaffolds with two different pore sizes of 900 μm and 2 mm were fabricated using additive manufacturing-produced templates combined with casting. The compressive properties, corrosion rates, biocompatibility, and antibacterial performance of the bioscaffolds were examined and compared to a non-porous control. The resulting textured and porous Zn scaffolds exhibit a fully interconnected pore structure with precise control over topology. As pore size and porosity increased, mechanical strength decreased, and corrosion rate accelerated. Cell adhesion and growth on scaffolds were enhanced after an ex vivo pretreatment method. In vitro cellular tests confirmed good biocompatibility of the scaffolds. As porosity increased, potent antibacterial rates were also observed. Taken together, these results demonstrate that Zn porous bone scaffolds are promising for orthopedic applications.
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Affiliation(s)
- Irsalan Cockerill
- Department of Biomedical Engineering, University of North Texas, Denton, TX 76207, USA; Department of Materials Science and Engineering, University of North Texas, Denton, TX 76207, USA
| | - Yingchao Su
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Subhasis Sinha
- Department of Materials Science and Engineering, University of North Texas, Denton, TX 76207, USA
| | - Yi-Xian Qin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Yufeng Zheng
- Department of Materials Science and Engineering, Peking University, Beijing, China
| | - Marcus L Young
- Department of Materials Science and Engineering, University of North Texas, Denton, TX 76207, USA
| | - Donghui Zhu
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA.
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12
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Cockerill I, Su Y, Bitten R, Cloarec B, Aouadi S, Zhu D, Young ML. Salt Preform Texturing of Absorbable Zn Substrates for Bone-implant Applications. JOM (WARRENDALE, PA. : 1989) 2020; 72:1902-1909. [PMID: 33737795 PMCID: PMC7962799 DOI: 10.1007/s11837-019-03971-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Surface roughness is an important factor in improving the bone-implant contact area to enhance bone regeneration, yet this aspect has not been applied to absorbable metals. Textured zinc surfaces with varying degrees of surface roughness were produced using a salt-preform method with fine- and coarse-grained salts and compared to a polished control sample. The resulting surfaces were characterized by scanning electron microscopy (SEM), surface roughness, corrosion rates, and in vitro cytotoxicity. The resulting textured surfaces exhibit micron-sized cavities and increased roughness consistent with the initial salt particle size. The corrosion rate was shown to accelerate significantly as compared to the polished control sample, and pre-osteoblasts displayed healthy morphologies on the textures. The results confirm textured zinc surfaces support cell adhesion and can be used to control the corrosion rate. This study represents an important intermediate step that can be applied to porous absorbable metal scaffolds for bone-implant applications.
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Affiliation(s)
- Irsalan Cockerill
- Department of Biomedical Engineering, University of North Texas, Denton, TX 76210, USA
- Department of Materials Science and Engineering, University of North Texas, Denton, TX 76210, USA
| | - Yingchao Su
- Department of Biomedical Engineering, University of North Texas, Denton, TX 76210, USA
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Reid Bitten
- Department of Materials Science and Engineering, University of North Texas, Denton, TX 76210, USA
| | - Benjamin Cloarec
- Department of Materials Science and Engineering, University of North Texas, Denton, TX 76210, USA
- Department of Physical Measurements, University of Rouen, Rouen, France
| | - Samir Aouadi
- Department of Materials Science and Engineering, University of North Texas, Denton, TX 76210, USA
| | - Donghui Zhu
- Department of Biomedical Engineering, University of North Texas, Denton, TX 76210, USA
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Marcus L Young
- Department of Materials Science and Engineering, University of North Texas, Denton, TX 76210, USA
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13
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Zanocco M, Boschetto F, Zhu W, Marin E, McEntire BJ, Bal BS, Adachi T, Yamamoto T, Kanamura N, Ohgitani E, Yamamoto K, Mazda O, Pezzotti G. 3D-additive deposition of an antibacterial and osteogenic silicon nitride coating on orthopaedic titanium substrate. J Mech Behav Biomed Mater 2019; 103:103557. [PMID: 32090951 DOI: 10.1016/j.jmbbm.2019.103557] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/07/2019] [Accepted: 11/25/2019] [Indexed: 12/29/2022]
Abstract
A 3D-additive manufacturing approach produced a dense Si3N4 ceramic coating on a biomedical grade commercially pure titanium (cp-Ti) substrate by an automatic laser-sintering procedure. Si3N4 coatings could be prepared with thicknesses from the single to the tens of microns. A coating thickness, t = 15 ± 5 μm, was selected for this study, based on projections of homogeneity and scratching resistance. The Si3N4 coating met the 20 N threshold required for biomaterial applications, according to the standard scratch testing (ASTM C1624-05). The Si3N4 coating imparted both the antibacterial and osteogenic properties of bulk Si3N4 to the cp-Ti substrate. Both properties were comparable to those previously described for bulk Si3N4 biomedical implants. The newly developed Si3N4-coating was applied to commercially available Ti-alloy acetabular shells for total hip arthroplasty. A "glowing" test based on luciferase gene transformation was applied to visualize the colonization of gram-negative Escherichia coli on Si3N4-coated and uncoated Ti-alloy acetabular shells. The results showed that the coating technology conferred resistance to Staphylococcus epidermidis and Escherichia coli adhesion onto the bulk acetabular sockets.
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Affiliation(s)
- Matteo Zanocco
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan; Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, 465 Kajii-cho, Kyoto, 602-8566, Japan
| | - Francesco Boschetto
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan; Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, 465 Kajii-cho, Kyoto, 602-8566, Japan
| | - Wenliang Zhu
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
| | - Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan; Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Bryan J McEntire
- SINTX Technologies Corporation, 1885 West 2100 South, Salt Lake City, UT, 84119, USA
| | - B Sonny Bal
- SINTX Technologies Corporation, 1885 West 2100 South, Salt Lake City, UT, 84119, USA
| | - Tetsuya Adachi
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshiro Yamamoto
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Narisato Kanamura
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Eriko Ohgitani
- Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, 465 Kajii-cho, Kyoto, 602-8566, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, 160-0023, Tokyo, Japan
| | - Osam Mazda
- Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, 465 Kajii-cho, Kyoto, 602-8566, Japan
| | - Giuseppe Pezzotti
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan; Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, 465 Kajii-cho, Kyoto, 602-8566, Japan; Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, 160-0023, Tokyo, Japan; The Center for Advanced Medical Engineering and Informatics, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0854, Japan.
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14
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Incorporation of shRNA in bioactive glass coated SS316L implant material and its role in inhibition of the osteoclast activity for better post implantation fixation. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Erdem Y, Bek D, Atbasi Z, Neyisci C, Yildiz C, Basbozkurt M. Total hip arthroplasty with rectangular stems and subtrochanteric transverse shortening osteotomy in Crowe type IV hips: a retrospective study. Arthroplast Today 2019; 5:234-242. [PMID: 31286050 PMCID: PMC6588717 DOI: 10.1016/j.artd.2019.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/13/2019] [Accepted: 03/15/2019] [Indexed: 02/06/2023] Open
Abstract
Background The complexity of femoral and acetabular anatomy and restoring anatomic center of hip rotation in Crowe type IV developmental dysplasia of the hip (DDH) complicates standard reconstruction. The aim of this study is to evaluate surgical techniques and clinical outcomes of subtrochanteric transverse shortening osteotomy with the use of cementless rectangular cross-section femoral implants in Crowe IV dysplastic hips. Methods A total of 26 hips of 25 consecutive patients with Crowe type IV DDH who underwent cementless total hip arthroplasty with subtrochanteric femoral transverse shortening osteotomy were retrospectively analyzed. The Harris Hip Score, Visual Analog Scale-pain, leg length discrepancy, and vertical and lateral migration of hip rotation center were recorded. Results Mean age, follow-up, and time of union were 41 ± 9.7 years, 7.1 ± 1.2 years, and 3.7 ± 1.1 months, respectively. Mean Harris Hip Score significantly improved from 38 ± 5.7 to 86 ± 6.1 points postoperatively (P < .01). Mean leg length discrepancy and Visual Analog Scale significantly decreased from 4.3 ± 1.3 to 1.2 ± 0.6 cm, and 6.4 ± 1.2 to 1.8 ± 0.8 points, respectively (P < .01). One female patient had a dislocation due to acetabular liner wear, which was managed by liner and head change. One patient had Sudeck's atrophy, while another had pain on the lateral thigh, both of which were resolved with conservative management. Conclusions Combined transverse subtrochanteric femoral osteotomy and cementless total hip arthroplasty with rectangular cross-section femoral implants is technically demanding, effective, and safe in femoral shortening for treatment of Crowe type IV DDH.
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Affiliation(s)
- Yusuf Erdem
- Orthopaedics and Traumatology Department, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Dogan Bek
- Orthopaedics and Traumatology Department, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Zafer Atbasi
- Orthopaedics and Traumatology Department, Guven Hospital, Ankara, Turkey
| | - Cagri Neyisci
- Department of Orthopedics and Traumatology, Health Sciences University, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Cemil Yildiz
- Orthopaedics and Traumatology Department, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Mustafa Basbozkurt
- Orthopaedics and Traumatology Department, Kecioren Hospital, Ankara, Turkey
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16
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Johnson DB, Triplet JJ, Streit AR, Long NK, Wasielewski RC. Displaced Meniscus Tear in the Acute Postoperative Period After Total Hip Arthroplasty: A Case Report. JBJS Case Connect 2019; 9:e0124. [PMID: 31188794 DOI: 10.2106/jbjs.cc.18.00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CASE Total hip arthroplasty (THA) is a commonly performed surgery with well-known complications. Unreported in the literature is a displaced meniscus tear in the acute postoperative period. We present the case of a displaced meniscus tear acutely after THA and discuss our management of this unique problem. CONCLUSIONS Displaced meniscus tears after THA pose unique challenges and should be considered in patients with knee pain after THA. Arthroscopic intervention occurred 8 weeks after THA to minimize prosthetic joint dislocation and loosening during arthroscopy.
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Affiliation(s)
- David B Johnson
- Orthopedic Residency Program, OhioHealth Doctors Hospital, Columbus, Ohio
| | - Jacob J Triplet
- Orthopedic Residency Program, OhioHealth Doctors Hospital, Columbus, Ohio
| | - Adam R Streit
- Orthopedic Residency Program, OhioHealth Doctors Hospital, Columbus, Ohio
| | - Nathaniel K Long
- OhioHealth Orthopedic Surgeons, Grant Medical Center, Columbus, Ohio
| | - Ray C Wasielewski
- OhioHealth Orthopedic Surgeons, Grant Medical Center, Columbus, Ohio
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17
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Piggott RP, Lyons R, Murphy CG, Curtin W. Total Hip Replacement Revision in a Single Brand Small Cementless Stem - Our Experience after the Findings of the National Joint Registry. THE ARCHIVES OF BONE AND JOINT SURGERY 2018; 6:501-507. [PMID: 30637305 PMCID: PMC6310183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 09/23/2017] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cementless total hip replacement is the common THR performed in England, Wales, Northern Ireland and the Isle of Man. The Corail stem is the most popular cementless implant and has a ODEP 10A rating. Review of its performance in the registry identified an increase rate of revision amongst the smaller stem sizes. However, clarity was not provided on the explanation for this finding. We reviewed our own experience of smaller stems with a view to understanding the reasons for revision. METHODS We reviewed a single centre, single surgeon experience of the smaller Corail stem sizes for a ten-year period from 2003 to 2013. All data was collected from a prospectively maintained database. Details of clinical and radiological follow up were collected for all patients who had Corail stem size 8 and 9 implanted. Revision for any cause was taken as our endpoint. RESULTS 542 patients underwent total hip arthroplasty using the Corail stem during the study period. 53 small size Corail stems were implanted. The average age was 59 (range 17-88 years) and the average follow up was 41.4 months (range 1-118 months). 6 patients underwent revision during the study period, but only 4 stems required revision. The reasons for revision were aseptic loosening, fracture and metal-on metal complications. Only two stems required revision for stem related factors (3.8%). CONCLUSION There was no evidence of an increased rate of revision in the small Corail stems in our cohort.
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Affiliation(s)
- Robert Pearse Piggott
- Research performed at Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
- Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
| | - Rebecca Lyons
- Research performed at Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
- Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
| | - Colin Gerard Murphy
- Research performed at Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
- Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
| | - William Curtin
- Research performed at Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
- Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
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