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Kutzner KP, Walz A, Afghanyar Y, Drees P, Schneider M. Calcar-guided short-stem total hip arthroplasty in fractures of the femoral neck: a prospective observational study of 68 hips. Arch Orthop Trauma Surg 2024; 144:1793-1802. [PMID: 38172436 DOI: 10.1007/s00402-023-05170-9] [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: 08/13/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION The indications for cementless short-stem total hip arthroplasty (THA) have been expanded due to encouraging results. However, no evidence in cases of femoral neck fractures (FNFs) is available. We aimed to prospectively obtain data on the safety and the clinical outcomes of a cementless calcar-guided short stem in patients with FNFs. MATERIALS AND METHODS We conducted a prospective observational study of 68 patients diagnosed with FNFs who underwent short-stem THA between 2016 and 2019 with a calcar-guided stem. Complications during follow-up leading to revision were documented, and patient reported outcome measurements recorded. Stem migration was analyzed using the Einzel-Bild-Röntgen-Analysis Femoral Component Analysis software. RESULTS The mean follow-up was 33.8 ± 14.8 months. The patient mortality at last follow-up was 10.6%. Two patients required stem revision, due to periprosthetic fracture and late aseptic loosening, respectively, corresponding to 96.2% stem survival. Survivorship for the endpoint of revision for any reason was 91.1% at 6 years. All revisions occurred in females. The mean Harris Hip Score at the last follow-up was 93.0 ± 8.9. The mean axial migration at last follow-up was 1.90 ± 1.81 mm. No significant influence on migration was found regarding gender, age, weight, and body mass index. CONCLUSIONS The clinical and radiological findings were satisfying and most patients benefited from the minimally invasive procedure. However, as for conventional THA as well, implant survivorship and mortality were markedly worse compared to results regarding osteoarthritis. Especially in elderly female patients with FNF, cementless short-stem THA is a concern and a cemented THA should be the first choice.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Alexander Walz
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Yama Afghanyar
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Michael Schneider
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
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Anderl C, Johl C, Krüger T, Hubel W, Weigert U, Mittelstaedt H, Ortmaier R. Subsidence after calcar-guided short stem total hip arthroplasty: five-year results of a prospective multicentre study. INTERNATIONAL ORTHOPAEDICS 2024; 48:229-234. [PMID: 37606768 DOI: 10.1007/s00264-023-05934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Calcar-guided short-stem total hip arthroplasty (THA) has shown excellent clinical outcomes. However, the migration pattern of such prostheses and its effect on clinical outcomes are less known. Therefore, we assessed the five-year subsidence after calcar-guided short-stem THA and its implications on clinical outcomes, patient-related factors, and complications. METHODS In this prospective multicentre study, we enrolled 213 patients (224 hips) who underwent calcar-guided short-stem THA mostly for degenerative hip diseases. We examined patients radiographically and clinically after six to 12 weeks, one year, two years, and five years. We evaluated subsidence using Einzel-Bild-Roentgen-Analyse femoral component analysis, assessed clinical outcomes, and systematically recorded all complications. RESULTS Overall, 131 patients (133 hips) were available for final follow-up at a median of 60 months (range, 2 to 72 months). We found a mean subsidence of 0.63 ± 1.22 mm at three months, 1.03 ± 1.60 mm at one year, 1.21 ± 1.91 mm at two years, and 1.54 ± 1.97 mm at five years. Patient-related factors (sex, age, weight, and BMI) did not significantly impact subsidence at five years (P > 0.05). Additionally, the Harris hip score, pain, and satisfaction improved significantly at five years compared to pre-operative values (P < 0.0001). Lastly, five patients underwent revision. CONCLUSION Calcar-guided short-stems revealed the highest subsidence rate within the first three months after THA and stabilisation after one year through the final follow-up examination. Moreover, patient-related factors had no influence on subsidence. Finally, clinical scores and patient satisfaction remained high at five years.
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Affiliation(s)
- Conrad Anderl
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Linz, Austria.
| | - Carsten Johl
- Klinikum Dahme-Spreewald GmbH, Lübben (Spreewald), Germany
| | - Thomas Krüger
- Abteilung Für Orthopädie Und Unfallchirurgie, Collm Klinik Oschatz GmbH, Oschatz, Germany
| | - Wilmar Hubel
- Kreiskrankenhaus Stollberg GmbH, Stollberg, Germany
| | - Ulrich Weigert
- Praxis Für Orthopädie Und Unfallchirurgie, Erkner, Germany
| | - Hagen Mittelstaedt
- UKSH Campus Lübeck, Klinik Für Orthopädie und Unfallchirurgie Sektion Orthopädie, Lübeck, Germany
| | - Reinhold Ortmaier
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Linz, Austria
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Mittelstaedt H, Anderl C, Ortmaier R, Johl C, Krüger T, Wallroth K, Weigert U, Schagemann JC. Subsidence analysis of a cementless short stem THA using EBRA-FCA - A seven-year prospective multicentre study. J Orthop 2023; 43:93-100. [PMID: 37575949 PMCID: PMC10415660 DOI: 10.1016/j.jor.2023.06.009] [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: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023] Open
Abstract
Background Metaphyseal fixation of short stem THA allows for minimally invasive surgery, less bone removal, improved bone load transfer and reduced stress shielding. Short stems facilitate the anatomic restoration i.a. of leg length, femoroacetabular offset, and center of rotation. However, metaphyseal fixation might cause impaired primary and/or secondary stability resulting in an inherent tendency for early axial migration and aseptic loosening eventually. The objective of this study was to investigate the long-term outcome and migration pattern of a calcar-guided short stem. Methods In a prospective multicenter study, 213 patients (224 THAs) were enrolled. Patients were followed for up to 84 months postoperatively. Clinical outcome was assessed using the Harris Hip Score and the VAS for pain and satisfaction. Standardized and calibrated radiographs were screened i.a. for stress shielding and loosening. Einzel-Bild-Roentgen-Analyse - femoral component analysis (EBRA-FCA) was used to detect longitudinal subsidence. Results At 7 year follow-up, n = 139/224 cases were available for analysis. All clinical parameters improved significantly (p < 0.001) and improvement persisted. There were no radiographic changes indicating stress shielding. EBRA-FCA revealed a mean subsidence of -1.44 mm followed by a stabilization. Weight >80 kg (p = 0.115), BMI <30 kg/m2 (p = 0.282), male gender (p = 0.246), and age <65 years (p = 0.304) seemed to be associated with a higher risk for migration. The cumulative revision rate was 2.23%. Revisions due to stem migration (0.89%) occurred early (mean time between index surgery and revision: 3.3 months). Conclusions If at all, there appears to be a pronounced initial subsidence, which stabilizes thereafter. Stem migration was rarely a compelling reason for failure or revision. Demographics do not seem to have a significant effect on migration pattern. The absence of radioluce lines, resorption or hypertrophy of the proximal femora support the hypothesis of a reduced stress shielding for metaphyseal anchoring short stems.
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Affiliation(s)
- Hagen Mittelstaedt
- UKSH Campus Lübeck, Klinik für Orthopädie und Unfallchirurgie Sektion Orthopädie, Ratzeburger Allee, Lübeck, Germany
| | - Conrad Anderl
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Seilerstätte, Linz, Austria
| | - Reinhold Ortmaier
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Seilerstätte, Linz, Austria
| | - Carsten Johl
- Klinikum Dahme-Spreewald GmbH, Lübben (Spreewald), Germany
| | - Thomas Krüger
- Helios Klinik Köthen, Hallesche Straße, Köthen (Anhalt), Germany
| | - Karsten Wallroth
- Kreiskrankenhaus Stollberg GmbH, Jahnsdorfer Straße Stollberg, Stollberg, Germany
| | - Ulrich Weigert
- Praxis für Orthopädie und Unfallchirurgie, Friedrichstraße, Erkner, Germany
| | - Jan C. Schagemann
- UKSH Campus Lübeck, Klinik für Orthopädie und Unfallchirurgie Sektion Orthopädie, Ratzeburger Allee, Lübeck, Germany
- Christophorus Kliniken Coesfeld, Südring 41, 48653, Coesfeld, Germany
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Gabrion M, Rattier S, Blondin E, Michaud A, Mertl P, Gabrion A. Survival and radioclinical evaluation of the Optimys™ short stem at more than 6years' mean follow-up: A retrospective study of 108 cases. Orthop Traumatol Surg Res 2023; 109:103470. [PMID: 36336294 DOI: 10.1016/j.otsr.2022.103470] [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: 01/08/2022] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The short stems developed in recent years offer an interesting alternative to standard long stems. The Optimys™ short stem has been widely studied, but not according to the National Institute for Health and Care Excellence (NICE) criteria. We therefore conducted a retrospective study of Optimys™ at a minimum 5years' follow-up, to assess: (1) survival on NICE criteria, (2) complications, (3) functional results, and (4) subsidence, restoration of offset and bone remodeling. HYPOTHESIS Optimys™ shows survival comparable to that of other non-cemented standard and short stems, with a<0.5% per year revision rate or<2.5% at 5years on NICE criteria. MATERIAL AND METHODS A single-center retrospective study included 108 Optimys™ stems at a mean 76.5months' follow-up (range: 60-112months). Clinical [Harris, Oxford-12 and forgotten hip (French version: SHO-12) scores] and radiologic data were collected pre- and postoperatively. Analysis focused on implant survival, complications, functional results and radiological results (restoration of offset, bone remodeling, subsidence and osseointegration) and risk factors for stem migration. RESULTS At a mean 76.5months' follow-up (range: 60-112months), Optimys™ survival was 97.7% (95% CI: 0.945-1). Oxford and Harris scores improved significantly: respectively, 16.1 vs. 44.7 [Δ=28.598; 95% CI: 27.410-29.785 (p<0.001)] and 45.3 vs. 95 [Δ=49.662; 95% CI: 47.442-51.882 (p<0.001)]. Mean forgotten hip score (SHO-12) at last follow-up was 82.7±19.6 (range: 35.4-100.0). There was 1 case of aseptic revision at 11months for femoral osseointegration defect. Mean subsidence was 1.64mm (range: 0-20.63mm); no predisposing factors could be identified. Femoral offset increased by a mean 2.41±4.53mm (range: -10.10 to 14.70mm). CONCLUSION The present study reports good survival for the Optimys™ stem, which meets NICE criteria. Radiologic and clinical results were encouraging, with a low rate of subsidence, comparable to other series, but with increased femoral offset. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Matthieu Gabrion
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France.
| | - Simon Rattier
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Emile Blondin
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Audrey Michaud
- Direction de la recherche clinique et de l'innovation, site Sud - Hall 1 - 1(er) étage zone administrative, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Patrice Mertl
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, pôle santé, 3, rue des Louvels, CS 13036, 80036 Amiens, France
| | - Antoine Gabrion
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, pôle santé, 3, rue des Louvels, CS 13036, 80036 Amiens, France
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Kutzner KP, Maurer SM, Meinecke I, Heers G, Bosson D. Survivorship, complications and patient-reported outcomes in calcar-guided short-stem THA: prospective mid-term multicenter data of the first 879 hips. Arch Orthop Trauma Surg 2023; 143:1049-1059. [PMID: 35076767 PMCID: PMC9925563 DOI: 10.1007/s00402-022-04354-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/06/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Short stems are a bone and soft-tissue preserving alternative to conventional stems. The aim of this multicenter study is to present the mid-term outcomes of a calcar-guided short stem. MATERIALS AND METHODS This is a prospective case series of the first 879 total hip arthroplasties performed on 782 patients across 5 centers using identical calcar-guided short stems. In a mid-term follow-up (6 years), rates and reasons for complications and revisions were documented. The Harris Hip Score (HHS) was obtained; patients reported pain and satisfaction using a visual analog scale. RESULTS A total of 43 patients died in the study cohort for non-related reasons; 26 patients (3.0%) required at least 1 revision after the index procedure. The survival rate for endpoint stem revision at mid-term was 98.4%. The main reasons for stem revision were aseptic loosening and early periprosthetic fractures. Sex had no influence on stem survival. Older patients or those with a high body mass index showed increased risk for stem revision during follow-up. Dorr type A morphology revealed a significantly lower risk of stem revision than Dorr type B or C (p = 0.0465). The HHS, satisfaction, and load pain at mid-term were 96.5 (SD 8.0), 9.7 (SD 0.9), and 0.5 (SD 1.9), respectively. CONCLUSIONS This short stem produced highly satisfactory outcomes at mid-term, with 98.4% implant survival for any cause of stem revision and low complication rates. Long-term results are required to further evaluate these promising mid-term results.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany. .,Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Steven Mark Maurer
- grid.477516.60000 0000 9399 7727Department of Orthopedic Surgery, Bürgerspital Solothurn, Schöngrünstr. 38, 4500 Solothurn, Switzerland
| | - Ingmar Meinecke
- Helios Park-Clinic Leipzig, Strümpellstr. 41, 04289 Leipzig, Germany
| | - Guido Heers
- Department of Orthopedic Surgery and Arthroplasty, Vitos Orthopaedic Clinic Kassel, Wilhelmshöher Allee 345, 34131 Kassel, Germany
| | - Dominique Bosson
- grid.418680.30000 0004 0417 3996Clinique de Genolier, Route du Muids 3, 1272 Genolier, Switzerland
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Reinbacher P, Smolle MA, Friesenbichler J, Draschl A, Leithner A, Maurer-Ertl W. Three-year migration analysis of a new metaphyseal anchoring short femoral stem in THA using EBRA-FCA. Sci Rep 2022; 12:17173. [PMID: 36229640 PMCID: PMC9561653 DOI: 10.1038/s41598-022-22160-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 10/10/2022] [Indexed: 01/04/2023] Open
Abstract
Cementless calcar-guided femoral short stems in total hip arthroplasty (THA) have become increasingly popular over the years. Early distal migration of femoral stems measured by Einzel-Bild-Roentgen Analyse, Femoral Component Analyse (EBRA-FCA) has been reported to be a risk factor for aseptic loosening. The aim of this study was to analyse axial migration behavior and subsidence of a new short stem (launched in 2015) over a follow-up period of 3 years. According to the study protocol, 100 hip osteoarthritis patients who consecutively received an unilateral cementless calcar-guided short stem (ANA.NOVA proxy) at a single department were prospectively included in this mid-term follow-up study. Thirteen patients were lost to follow-up, resulting in 87 patients with unilateral THA who fulfilled the criteria for migration analysis with EBRA-FCA. The cohort comprised 41 males (mean age: 60 ± 16.5; mean BMI (Body Mass Index): 30 ± 13) and 46 females (mean age: 61 ± 15.5; mean BMI: 27 ± 10). Seven standardized radiographs per patient were analyzed with EBRA-FCA. An average migration of 2.0 mm (0.95-3.35) was observed within the first 3 years. The median increase during the first year was higher than in the second and third year (1.2 mm [IQR: 0.5-2.15] vs. 0.3 mm [IQR: 0.1-0.6 mm] vs. 0.25 mm [IQR: 0.1-0.5 mm]. Detected migration did not lead to stem loosening, instability, dislocation, or revision surgery in any patient. A higher risk for subsidence was observed in male and heavyweight patients, whereas the female gender was associated with a lower risk. No correlation between migration and revision could be observed. Although moderate subsidence was detectable, the performance of the short stem ANA.NOVA proxy is encouraging. Yet, its use may be re-considered in overweight and male patients due to more pronounced subsidence.
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Affiliation(s)
- Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Joerg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Alexander Draschl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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Hochreiter J, Böhm G, Fierlbeck J, Anderl C, Birke M, Münger P, Ortmaier R. Femoral antetorsion after calcar-guided short-stem total hip arthroplasty: A cadaver study. J Orthop Res 2022; 40:2127-2132. [PMID: 34873734 PMCID: PMC9540338 DOI: 10.1002/jor.25228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 10/19/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
Calcar-guided short stems in total hip arthroplasty (THA) permit surgeons to successfully reconstruct postoperative femoroacetabular offset, accurately restore leg length, and adequately re-establish a wide range of caput-collum-diaphyseal angles. However, their effect on femoral antetorsion is less known. Indeed, controlling antetorsion of the femoral stem can be challenging because of the differences in individual femoral geometry and curvature. Therefore, we investigated if calcar-guided short-stem THA alters femoral antetorsion and compared it with conventional-stem THA. Using 12 Thiel-fixed, full-body cadaver specimens from donors without known hip disorders, we compared an uncemented calcar-guided femoral short-stem prosthesis with an uncemented conventional straight-stem prosthesis. In a paired study setup, each specimen received a calcar-guided short stem on one side and a conventional stem on the other. On the acetabular side, all specimens received a press-fit, monobloc acetabular cup. Femoral antetorsion angles were measured using the Waidelich method, and pre- and post-operative angles of both sides were recorded. The mean preoperative femoral antetorsion angles were similar in both groups (24.8° ± 7.5° vs. 23.8° ± 6.1°, p = 0.313). Mean postoperative femoral antetorsion angles were 23.0° ± 5.5° in short-stem and 13.5° ± 7.1° in conventional-stem hips. Short-stem hips had a small but nonsignificant difference in femoral antetorsion angles pre- and post-operatively (1.8° ± 3.2°, p = 0.109), while the difference for conventional-stem hips was much larger and highly significant (10.3° ± 5.8°, p < 0.001). Calcar-guided short-stem THA effectively restores femoral antetorsion. However, how this affects long-term clinical outcomes and complications warrants further exploration.
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Affiliation(s)
- Josef Hochreiter
- Department of Orthopedic Surgery, Ordensklinikum Linz GmbHBarmherzige Schwestern HospitalLinzAustria,Department of Orthopedics and TraumatologyParacelsus Medical UniversitySalzburgAustria
| | - Gernot Böhm
- Department of Diagnostic and Interventional RadiologyOrdensklinikum Linz GmbHLinzAustria
| | - Johann Fierlbeck
- Institute for Clinical InnovationParacelsus Medical UniversitySalzburgAustria
| | - Conrad Anderl
- Department of Orthopedic Surgery, Ordensklinikum Linz GmbHBarmherzige Schwestern HospitalLinzAustria
| | - Marco Birke
- Institute of Anatomy and Cell BiologyParacelsus Medical UniversitySalzburgAustria
| | | | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Linz GmbHBarmherzige Schwestern HospitalLinzAustria,Department of Orthopedics and TraumatologyParacelsus Medical UniversitySalzburgAustria,Research Unit of Orthopedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT Private University for Health SciencesMedical Informatics and Technology GmbHHall in TirolAustria
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Conversion of failed internal fixation in proximal femur fractures using calcar-guided short-stem total hip arthroplasty. J Orthop Traumatol 2022; 23:34. [PMID: 35876963 PMCID: PMC9310680 DOI: 10.1186/s10195-022-00655-6] [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: 02/17/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Reoperations for secondary osteoarthritis, osteonecrosis, or hardware failure following failed internal fixation after intertrochanteric fracture (ITF) or femoral neck fracture (FNF) are common. An effective salvage treatment often involves complete removal of the hardware followed by total hip arthroplasty (THA). Almost no data are available regarding conversion to short-stem THA. This study aimed to evaluate clinical and radiological outcomes, potential complications, and the survival rate of short-stem THA following revision surgery. METHODS We investigated 27 patients who underwent conversion THA using a calcar-guided short stem. Patient-reported outcome measurements were obtained, including the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index, as well as pain and satisfaction on the visual analogue scale. Radiological follow-up was also performed. RESULTS We identified 18 (66.7%) patients diagnosed with FNF and 9 (33.3%) patients with ITF. Clinical and radiological outcomes were satisfactory at the last follow-up (30.56 ± 11.62 months). One patient required early revision surgery due to dislocation and greater trochanter fracture. At the last follow-up, none of the short stems required revision. No other major complications occurred. CONCLUSION Given the low rate of complications and 100% survival, our findings indicate that short stems for conversion THA due to failed internal fixation may be considered an option in a properly selected patient population. However, it should not be considered a standard procedure and should only be performed by experienced surgeons.
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Afghanyar Y, Kutzner KP, Pfeil J, Drees P, Rehbein P, Dargel J. Cementless Short Stems in Total Hip Arthroplasty: Chances and Limits. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022. [PMID: 35104904 DOI: 10.1055/a-1678-7684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In recent decades, a large number of cementless short stems have been introduced to the market. The concept aims at saving soft tissue using minimally invasive surgery and at the same time preserving as much bone as possible. In particular, the latest generation of short stems, which are implanted using a calcar-guided round-the-corner technique, are attracting increasing attention. An individualised resection level allows individual stem alignment and thus an ideal reconstruction of the hip anatomy. The early clinical results of short-stem total hip arthroplasty (THA) are promising and have led to an expansion of the indications and limitations for the use of short stems. In particular, the individual positioning in valgus or varus and the resulting individual metaphyseal or metadiaphyseal anchorage offers various possibilities to reconstruct even abnormal joint morphologies. Consequently, short stems are increasingly used in patients with complex anatomical variations or in cases of osteonecrosis of the femoral head. In some various cases, they can also be used in revision or conversion arthroplasty. In some patients, short stems can also be used after femoral neck fracture. Currently, scientific data on those areas of indication of short-stem THA is scarce.
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Affiliation(s)
- Yama Afghanyar
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Karl Philipp Kutzner
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland.,Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Joachim Pfeil
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Philipp Drees
- Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Philipp Rehbein
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Jens Dargel
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
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Subsidence of a metaphyseal-anchored press-fit stem after 4-year follow-up: an EBRA-FCA analysis. Arch Orthop Trauma Surg 2022; 142:2075-2082. [PMID: 34287700 PMCID: PMC9296414 DOI: 10.1007/s00402-021-04068-8] [Citation(s) in RCA: 2] [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: 09/18/2020] [Accepted: 07/10/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Uncemented stem migration analysis by EBRA-FCA (Einzel-Bild-Roentgen Analyse, Femoral Component Analyse) has been seen to be a good predictive indicator for early implant failure. In this study, we investigated the migration behavior of a cementless metaphyseal-anchored press-fit stem after 4-year follow-up. METHODS Applying a retrospective study design, we reviewed all consecutive patients who between 2012 and 2017 received a cementless Accolade II press-fit stem at our Department. We reviewed medical histories and performed radiological measurements using EBRA-FCA software. EBRA-FCA measurements and statistical investigations were performed by two independent investigators. RESULTS A total of 102 stems in 91 patients (female 60; male 31) fulfilled our inclusion criteria. Mean age at surgery was 66.2 (range 24.3-92.6) years. EBRA migration analysis showed a mean subsidence of 1.4 mm (range 0.0-12.0) at final follow-up. The angle between stem and femur axis was 0.5° (range 0.0°-2.8°) after 48 months. No correlations between gender or Dorr types and subsidence were found (p > 0.05). A body mass index > 30 kg/m2 showed a significant increase in stem subsidence within the first 6 (p = 0.0258) and 12 months (p = 0.0466) postoperative. CONCLUSIONS Migration pattern of the metaphyseal-anchored stem and a low subsidence rate at final follow-up may predict a good long-term clinical result. TRIAL REGISTRATION Number: 20181024-1875.
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Smolle MA, Fischerauer SF, Maier M, Reinbacher P, Friesenbichler J, Ruckenstuhl P, Grandesso M, Leithner A, Maurer-Ertl W. Leg length measures appear inaccurate in the early phase following total hip arthroplasty. Sci Rep 2021; 11:23262. [PMID: 34853409 PMCID: PMC8636479 DOI: 10.1038/s41598-021-02684-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022] Open
Abstract
The aims of this study were to (1) assess reliability of leg length discrepancy (LLD) measurements at different anatomical landmarks, (2) longitudinally investigate LLD in patients within the first year following total hip arthroplasty (THA) and to (3) correlate changes in LLD with functional outcome. Ninety-nine patients with short stem THA (53.3% males, mean age: 61.0 ± 8.1 years) were prospectively included. Upright pelvic anteroposterior (a.p.) radiographs taken at 6 timepoints (preoperatively, discharge, 6, 12, 24, 52 weeks postoperatively) were used to assess LLD at 5 anatomical landmarks (iliac crest, upper sacroiliac joint, lower sacroiliac joint, tear drop figure, greater trochanter). WOMAC and Harris Hip Score (HHS) were obtained preoperatively and at 6 and 52 weeks. LLD measures significantly increased in the initial phase following THA, from discharge to 6 weeks postoperatively and remained constant thereafter. Documentation of LLDs is dependent on measurement site: LLDs varied significantly between trochanter and iliac crest to tear drop figure (p < 0.001). Functional assessments did not correlate with the occurrence of LLDs [WOMAC (p = 0.252); HHS (p = 0.798)]. Radiographic assessment of LLD following THA may not be performed early postoperatively, as measurements appear to inaccurately reflect actual LLDs at this time, potentially due incomplete leg extension and/or inhibited weight-bearing.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Stefan Franz Fischerauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Michael Maier
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Jörg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Paul Ruckenstuhl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Maria Grandesso
- Dipartimento Universitario Clinico Di Scienze Mediche, Chirurgiche E Della Salute, Universitá Degli Studi Di Trieste, Strada Di Fiume, 447, Trieste, Italy
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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Kutzner KP. Calcar-guided short-stem total hip arthroplasty: Will it be the future standard? Review and perspectives. World J Orthop 2021; 12:534-547. [PMID: 34485100 PMCID: PMC8384612 DOI: 10.5312/wjo.v12.i8.534] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/10/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
Short stems in total hip arthroplasty (THA) are becoming increasingly popular. In Germany, already 10.4% of all primary THAs are performed using a cementless short stem. The concept of modern, calcar-guided, short stems aims for an individualized reconstruction of the hip anatomy by following the calcar of the femoral neck, a bone- and soft-tissue-sparing implantation technique, and physiological loading. The stem design uses either metaphyseal fixation alone or additional diaphyseal anchoring, depending on the stem alignment and indication. These individualized anchorage types increase the potential indications for the safe use of a short stem. The design features may account for potential advantages of current short stem implants compared with earlier short-stem designs, particularly in cases of reduced bone quality or osteonecrosis of the femoral head and femoral neck fractures. The implantation technique, however, requires distinct knowledge regarding the characteristics of varus and valgus positioning, with the potential for clinical consequences. A learning curve for surgeons new to this technique must be taken into account. Cortical contact with the distal lateral cortex appears to be crucial to provide sufficient primary stability, and the use of intraoperative imaging to identify “undersizing” is highly recommended. Current results of several national registries indicate that calcar-guided short stems are among the most successful implants in terms of mid-term survivorship. However, long-term data remain scarce. This review introduces the characteristics of calcar-guided short-stem THA and summarizes the current evidence.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedic Surgery, St Josefs Hospital Wiesbaden, Germany, Wiesbaden 65189, Germany
- Department of Hip Surgery, Gelenkzentrum Rhein-Main, Wiesbaden 65183, Germany
- Center of Orthopedics and Traumatology, Johannes Gutenberg-University of Mainz, Mainz 55131, Germany
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13
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Holzapfel BM, Rak D, Kreuzer S, Arnholdt J, Thaler M, Rudert M. Short stem hip arthroplasty via the minimally invasive direct anterior approach. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 33:288-303. [PMID: 34251469 DOI: 10.1007/s00064-021-00723-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/12/2021] [Accepted: 02/25/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Tissue-sparing, minimally invasive hip arthroplasty via the direct anterior approach (DAA) using a partially neck-preserving, calcar-guided short stem. INDICATIONS Primary and secondary osteoarthritis of the hip due to developmental dysplasia, femoroacetabular impingement, femoral head necrosis or trauma sequelae. CONTRAINDICATIONS Severe osteoporosis, active infection, American Society of Anesthesiologists (ASA) > III, large metaphyseal bone defects, severe metaphyseal deformities, Dorr type C femur. SURGICAL TECHNIQUE Supine position on a standard operating table without extension device. Classic DAA skin incision or bikini incision distal to the inguinal fold. Blunt dissection entering the Hueter interval. Capsulotomy with capsule preservation or partial capsulectomy. Intraoperatively, it is crucial to adhere to the preoperatively planned angle and height of the femoral neck osteotomy. During femoral head removal and acetabular preparation, care must be taken to avoid iatrogenic damage to the remaining neck. After cup positioning, femoral access is achieved by release of superior capsular structures. During opening of the medullary canal and broaching, femoral torsion and axis have to be taken into account for correct rotational and axial alignment. Femoral broaches are inserted in an ascending series of sizes until the last broach is firmly lodged and is in direct contact with the antero-medial femoral neck cortex. Fluoroscopic control in two planes to check for femoral anatomic and overall offset and assess whether the implant is adequately seated with cortical support at the calcar, the distal lateral and the dorsal cortex. Implantation of the definitive implants, local infiltration analgesia and wound closure. RESULTS Between 1/2011 and 12/2016 60 patients (24 female, 36 male; mean age 44 years) were treated with a partially neck-preserving short stem via the described approach. Seven patients underwent a bi-lateral procedure. Thus, 67 procedures were analysed in this retrospective cohort study. Mean follow-up was 70 months (range 28-93). The median Harris Hip Score was 48 (range 11-88) preoperatively and 98 (range 80-100) postoperatively. CONCLUSION The minimally invasive implantation of a partially neck-preserving stem via DAA provides a safe technique with good to excellent clinical results in the mid-term.
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Affiliation(s)
- Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Dominik Rak
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany
| | - Stefan Kreuzer
- Memorial Bone & Joint Clinic, The University of Texas Health Science Center at Houston Medical School, 1140 Business Center Drive, Suite 101, 77043, Houston, TX, USA
| | - Joerg Arnholdt
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany
| | - Martin Thaler
- Department of Orthopaedic and Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany
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Shoji T, Saka H, Inoue T, Kato Y, Fujiwara Y, Yamasaki T, Yasunaga Y, Adachi N. Three-dimensional analysis of the cortical contact state of short and conventional stems in different stem positions in total hip arthroplasty. Clin Biomech (Bristol, Avon) 2021; 83:105297. [PMID: 33640706 DOI: 10.1016/j.clinbiomech.2021.105297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the increasing use of short cementless stems in total hip arthroplasty, their potential benefits have yet to be confirmed. We evaluated the cortical contact state of short and conventional stems in different femoral canal types and stem positions using a CT-based 3-dimensional templating software. METHODS We reviewed 153 hips in 153 patients, grouped according to femoral canal type-normal (68), champagne-flute (41), and stove-pipe canal (44). We investigated the influence of stem position on the contact state by evaluating three situations of stem anteversion (original anteversion, +5°anteverted, and +5°retroverted), three stem positions, neutral +2°extended, and +2°flexed positions using Taperloc Complete MicroplastyⓇ stem. FINDINGS The contact values of all zones between both stems in all canal types exhibited no significant differences. The values in zones 1, 2, 6, and 7 of both stems in 5° retroverted and anteverted, 2° extended and flexed positions were not significantly different compared to those of the neutral position. However, the values in zones 3, 4, and 5 of both stems were significantly greater compared to those of the neutral position in 2° extended and flexed positions; these values were also significantly larger in all canal types for the conventional stem. INTERPRETATION We demonstrated that the short and conventional stems can achieve the same proximal cortical contact in any femoral canal, regardless of the stem position. However, extended and flexed stem positions increase the distal contact, especially in conventional stems. Furthermore, the distal contact increases for the retroverted stem insertions.
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Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Hideki Saka
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Tadashi Inoue
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuichi Kato
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yusuke Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima 739-0036, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Primary stability of calcar-guided short-stem total hip arthroplasty in the treatment of osteonecrosis of the femoral head: migration analysis using EBRA-FCA. Arch Orthop Trauma Surg 2020; 140:2091-2100. [PMID: 33011847 PMCID: PMC7674354 DOI: 10.1007/s00402-020-03610-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Osteonecrosis of the femoral head (ONFH) is a disabling condition that often results in secondary arthritis necessitating total hip arthroplasty (THA). Short-stem THA has constantly gained popularity. It remains controversial, whether ONFH represents a risk factor for failure after the implantation of short stems with pronounced metaphyseal anchorage. The potential spread of the osteonecrotic area and bone marrow edema into the metaphyseal bone might result in compromised stability. Early implant migration is considered predictive of subsequent aseptic loosening. The purpose of this study was a migration analysis of a modern, calcar-guided short-stem implant in patients with ONFH in a mid-term follow-up. MATERIALS AND METHODS This retrospective analysis investigated the migration pattern of 45 calcar-guided short stems in patients with ONFH, using Einzel-Bild-Roentgen-Analyse Femoral-Component-Analysis (EBRA-FCA). Influencing factors such as ARCO categories, age, gender, body weight and BMI were analyzed. Complications and adverse events were documented. RESULTS At mid-term [48.1 months (SD 20.7 months)], mean axial migration was 1.56 mm (SD 1.77 mm). Mean migration rate stabilized after 2 years. No influence of ARCO categories, age and BMI was found. A tendency of increased axial migration was observed in male patients and in overweight patients. No revision surgeries had to be performed during follow-up. CONCLUSION The results indicate a migration pattern comparable to that of primary osteoarthritis patients with slight initial migration under full load followed by subsequent stabilization in the metaphyseal femur. The 100% survival rate at mid-term supports the usage of this short-stem design in patients with ONFH.
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