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Kebbach M, Schulze C, Meyenburg C, Kluess D, Sungu M, Hartmann A, Günther KP, Bader R. Do hip resurfacing and short hip stem arthroplasties differ from conventional hip stem replacement regarding impingement-free range of motion? J Orthop Res 2023; 41:2501-2515. [PMID: 37132090 DOI: 10.1002/jor.25584] [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: 01/06/2023] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/04/2023]
Abstract
Total hip joint replacement (THR) is clinically well-established. In this context, the resulting range of motion (ROM) is crucial for patient satisfaction when performing joint movements. However, the ROM for THR with different bone preserving strategies (short hip stem and hip resurfacing) raises the question of whether the ROM is comparable with conventional hip stems. Therefore, this computer-based study aimed to investigate the ROM and type of impingement for different implant systems. An established framework with computer-aided design 3D models based on magnetic resonance imaging data of 19 patients with hip osteoarthritis was used to analyse the ROM for three different implant systems (conventional hip stem vs. short hip stem vs. hip resurfacing) during typical joint movements. Our results revealed that all three designs led to mean maximum flexion higher than 110°. However, hip resurfacing showed less ROM (-5% against conventional and -6% against short hip stem). No significant differences were observed between the conventional and short hip stem during maximum flexion and internal rotation. Contrarily, a significant difference was detected between the conventional hip stem and hip resurfacing during internal rotation (p = 0.003). The ROM of the hip resurfacing was lower than the conventional and short hip stem during all three movements. Furthermore, hip resurfacing shifted the impingement type to implant-to-bone impingement compared with the other implant designs. The calculated ROMs of the implant systems achieved physiological levels during maximum flexion and internal rotation. However, bone impingement was more likely during internal rotation with increasing bone preservation. Despite the larger head diameter of hip resurfacing, the ROM examined was substantially lower than that of conventional and short hip stem.
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Affiliation(s)
- Maeruan Kebbach
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christian Schulze
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christian Meyenburg
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Daniel Kluess
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Mevluet Sungu
- Research and Development, Aesculap AG, Tuttlingen, Germany
| | - Albrecht Hartmann
- Department of Orthopedic Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- Department of Orthopedic Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
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2
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Van Veghel MHW, Hannink G, Van Oldenrijk J, Van Steenbergen LN, Schreurs BW. A comparison of uncemented short versus standard stem length in total hip arthroplasty: results from the Dutch Arthroplasty Register. Acta Orthop 2023; 94:330-335. [PMID: 37417696 DOI: 10.2340/17453674.2023.13652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND PURPOSE We aimed to compare revision rates between uncemented short and standard stems in total hip arthroplasties (THAs) and the corresponding patient-reported outcome measures (PROMs). PATIENTS AND METHODS We included all short (C.F.P., Fitmore, GTS, Metha, Nanos, Optimys, Pulchra, and Taperloc Microplasty) and standard stems in uncemented THAs registered between 2009 and 2021 in the Dutch Arthroplasty Register. Kaplan-Meier survival and multivariable Cox regression analyses were performed with overall and femoral stem revision as endpoints. RESULTS Short stems were used in 3,352 and standard stems in 228,917 hips. 10-year overall revision rates (4.8%, 95% confidence interval [CI] 3.7-6.3 vs. 4.5%, CI 4.4-4.6) and femoral stem revision rates (3.0%, CI 2.2-4.2 vs. 2.3%, CI 2.2-2.4) were comparable for short- and standard-stem THAs. Today's predominant short stems (Fitmore and Optimys) showed short-term revision rates similar to that of standard-stem THAs. Other, less frequently used short stems had higher 10-year overall (6.3%, CI 4.7-8.5) and femoral stem (4.5%, CI 3.1-6.3) revision rates. Multivariable Cox regression also showed a higher risk for overall (HR 1.7, CI 1.0-2.9) and femoral stem revision (HR 2.0, CI 1.1-3.5) using the latter short stems compared with standard stems. An exploratory analysis of PROMs showed no difference. CONCLUSION There was no overall difference in revision rates but a tendency toward increased revision of short stems both for the whole THA and for the stem itself. The less frequently used short stems had increased revision risk. No difference in PROMs was shown.
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Affiliation(s)
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen
| | - Jakob Van Oldenrijk
- Erasmus University Medical Center, Department of Orthopedics and Sport Medicine, Rotterdam
| | - Liza N Van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), 's-Hertogenbosch, the Netherlands
| | - B Willem Schreurs
- Department of Orthopedics, Radboud University Medical Center, Nijmegen; Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), 's-Hertogenbosch, the Netherlands
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3
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Fawley DW, Croker S, Irving JF, Swank ML. Intermediate-Term Survivorship of Total Hip Arthroplasty With a Proximally Coated Tapered-Wedge Femoral Stem: A Retrospective, Multi-Center Registry Review. Cureus 2023; 15:e36623. [PMID: 37155454 PMCID: PMC10122831 DOI: 10.7759/cureus.36623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Short tapered-wedge stems have been used frequently over the past decade, but long-term follow-up data are not readily available in the literature. METHODS A retrospective outcomes review was conducted to assess survivorship and clinical outcomes for the TRI-LOCK® Bone Preservation Stem (TRI-LOCK BPS; DePuy Synthes, Warsaw, IN, USA), a proximally coated, tapered-wedge femoral stem. RESULTS In a cohort of 2,040 hips, Kaplan-Meier survivorship estimates (95% CI {confidence interval}; N with further follow-up, where N is the number of hips remaining at each post-operative interval), with survivorship defined as no revision of any component for any reason were 96.6% (92.8%,98.4%; 45) at eight years under the clinical assumption and 98.6% (97.9%,99.1%; 90) at 14 years under the registry assumption. With survivorship defined as stem revision for any reason, estimates were 97.7% (93.7%,99.2%; 45) at eight years under the clinical assumption and 99.2% (98.6%,99.5%; 90) under the registry assumption. Mean Harris Hip Scores and WOMAC scores were 90.08 and 21.98, respectively, at 10 years postoperatively. CONCLUSION Our evaluation demonstrates excellent construct and stem survivorship and clinical outcomes at intermediate-term postoperative follow-up.
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Affiliation(s)
| | - Sean Croker
- Clinical Research, DePuy Synthes, Warsaw, USA
| | - John F Irving
- Orthopaedic Surgery, Connecticut Orthopaedics, Hamden, USA
| | - Michael L Swank
- Orthopaedic Surgery, Cincinnati Orthopaedic Research Institute, Cincinnati, USA
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Radaelli M, Buchalter DB, Mont MA, Schwarzkopf R, Hepinstall MS. A New Classification System for Cementless Femoral Stems in Total Hip Arthroplasty. J Arthroplasty 2023; 38:502-510. [PMID: 36122690 DOI: 10.1016/j.arth.2022.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/18/2022] [Accepted: 09/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The growing variety of total hip arthroplasty implants necessitates a standardized, simple, and brand-neutral language to precisely classify femoral components. Although previous classifications have been useful, they need updating to include stems that have current surface treatment technologies, modularity, collar features, and other geometric characteristics. METHODS To accomplish this, we propose a new classification system for stems based on 3 distinguishing stem features: (1) geometry, (2) location of modularity, and (3) length. RESULTS Our system allows for the easy classification of all currently used stem types. CONCLUSIONS One goal of this endeavor is to improve clinical record keeping to facilitate study comparisons as well as literature reviews.
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Affiliation(s)
- Marco Radaelli
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Daniel B Buchalter
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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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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Nelson JT, Zheng H, Hallstrom BR, Hughes RE, Mont MA, Masini MA. Are Short Stems Associated With Higher Fracture Rates and Early Revision Rates in Primary Total Hip Arthroplasty? A Noninferiority Analysis. J Arthroplasty 2023:S0883-5403(23)00008-6. [PMID: 36639113 DOI: 10.1016/j.arth.2023.01.008] [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: 07/06/2022] [Revised: 11/22/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This study aimed to determine if "short" femoral stems were noninferior to (at least as good as) standard-length stems in regards to 90-day periprosthetic fracture and 1-year revision rates. METHODS Using the MARCQI implant registry, a retrospective study of statewide data was carried out on 64,084 total hip arthroplasties (THAs) between 2012 and 2017. We noticed an increase in the use of "short" uncemented femoral hip stems during THA. Chi-square tests were used to test homogeneity of categorical variables. The covariates included in the analyses were identified using modern epidemiological methods. A Type I probability of 0.05 was used as the level of statistical significance. Inverse probability of treatment weighting (IPTW) was used to mitigate confounding variables. RESULTS One hundred and seven stems were implanted by surgeons in the state of Michigan. They were classified according to the Khanuja Classification System as Type 2A (trapezoidal, double-tapered calcar loading, n = 3,281), Type 3 (calcar loading with lateral flare, n = 1,898), and Type 4 (shortened, tapered, conventional, n = 19,580), and were compared to standard-length, type 5, stems (n = 33,322) in regards to the 2 outcomes (periprosthetic fractures and 1-year revision rates). Overall, 1-year revision and the 90-day fracture rates were 1.3% (791/57,853) and 1.1% (631/57,968), respectively. Noninferiority was established for all short stems at the clinical threshold of an odds ratio (OR) of 1.5 with P-values <0.05 for 90-day fractures. In regards to 1-year revision rates, noninferiority was also established for Type 3 and 4 stems (P < .05). CONCLUSION The increased use of "short stems" in Michigan did not lead to increased 1-year revision or 90-day fracture rates.
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Affiliation(s)
- Joseph T Nelson
- Dignity Health Medical Group, Arizona Creighton University School of Medicine- Phoenix, Phoenix, Arizona
| | - Huiyong Zheng
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brian R Hallstrom
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Richard E Hughes
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael A Mont
- Northwell Health Orthopaedic Institute at Lenox Hill, New York, New York
| | - Michael A Masini
- Department of Orthopedic Surgery, St. Joseph Mercy Hospital, Ann Arbor, Michigan
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Nishioka ST, Andrews SN, Mathews K, Nakasone CK. Varus malalignment of short femoral stem not associated with post-hip arthroplasty fracture. Arch Orthop Trauma Surg 2022; 142:3533-3538. [PMID: 34846588 DOI: 10.1007/s00402-021-04244-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/31/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Periprosthetic femoral fractures are an increasingly common post-operative complication of total hip arthroplasty (THA). Though varus malalignment is known to increase fracture risk in standard-length femoral stems, varus malalignment is not as well studied in short stems. Therefore, the purpose of this study was to determine if varus malalignment contributes to early periprosthetic fracture risk in a cementless taper-wedged, short femoral stem. MATERIALS AND METHODS This retrospective review included 366 consecutive patients (441 THAs) having undergone THA via anterior approach by a single surgeon between July 2014 and December 2016. All patients received the same short, cementless femoral stem. Femoral component angle was measured on 6-week post-THA weight-bearing radiographs, with malalignment defined as a femoral component angle exceeding 0° ± 3°. Periprosthetic femoral fracture and aseptic loosening occurring within 2 years post-THA were recorded. RESULTS The final data analysis included 426 hips with a mean follow-up time of 32.9 ± 10.2 months. Varus and neutral alignment occurred in 84 (19.6%) and 342 (79.9%) of stems, respectively. Three (0.7%) periprosthetic femoral fractures occurred within 2 years, all occurring in patients with neutrally aligned femoral stems. One (0.2%) stem failed due to aseptic loosening and was malaligned. CONCLUSION Despite nearly 20% of stems placed in varus alignment, three of the four early complications occurred in a neutrally aligned stem. Based on these results, forceful intraoperative realignment of a short femoral stem with good initial fixation may present an unnecessary increased risk of intraoperative fracture.
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Affiliation(s)
- Scott T Nishioka
- Bone & Joint Center, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA
| | - Samantha N Andrews
- Bone & Joint Center, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA. .,Department of Surgery, University of Hawai'i, John A. Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
| | - Kristin Mathews
- Bone & Joint Center, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA
| | - Cass K Nakasone
- Bone & Joint Center, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA.,Department of Surgery, University of Hawai'i, John A. Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA
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8
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Reddy GB, Haziza S, Constantinescu DS, Pagan DN, Schneiderbauer MM, Robinson RP, Hernandez VH. Survivorship and Outcomes of Femoral Neck Preserving Stems in Primary Total Hip Arthroplasty. J Arthroplasty 2022; 37:1606-1611. [PMID: 35378233 DOI: 10.1016/j.arth.2022.03.080] [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: 12/01/2021] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Short-stem femoral implants (SSFIs) promote the preservation of bone in the femoral neck, reduce soft tissue disruption, and facilitate minimally invasive surgical techniques. The purpose of this study was to report the revision rate, complication rate, patient satisfaction, patient-reported outcomes, and radiographic outcomes of patients who underwent total hip arthroplasty (THA) with the Alteon Neck Preserving Femoral Stem (ANPS). METHODS A prospectively maintained database was reviewed which analyzed 92 THAs between the years 2016 and 2018. Patient-reported outcomes, patient satisfaction, complication rates, and radiographic outcomes were assessed at 2-5 years postoperatively. RESULTS The final cohort consisted of 63 hips. Five patients (7.9%) underwent revision surgery and 2 (3.2%) had other complications not requiring revision. Survivorship when considering only the femoral component was 93.7% at an average of 41.4 months of follow-up. The average postoperative Oxford Hip Score (41.5 ± 8.3) and Harris Hip Score (77.9 ± 16.6) demonstrated significant improvement among our nonrevised patients, respectively (P < .001). Radiographs demonstrated spot welding in 56% of arthroplasties most commonly in Gruen Zones 2, 3, and 13 and that femur radiolucencies were visualized in 58% predominantly along the distal aspect of the stem. Radiographic femoral component subsidence was present in 9.7% of patients. CONCLUSION The ANPS may be less reliable than previously reported. Our cohort's revision rate was unacceptably high with 6.3% requiring revision surgery for femoral component loosening in less than 5 years. Surgeons should consider the challenges and prohibitive failure rate associated with SSFIs before routine usage in THA.
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Affiliation(s)
- Gireesh B Reddy
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
| | - Sagie Haziza
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
| | - David S Constantinescu
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
| | - Dianne N Pagan
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
| | | | - Raymond P Robinson
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
| | - Victor H Hernandez
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
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De Santis V, Bonfiglio N, Basilico M, Tanzi Germani G, Matrangolo MR, Carosini A, Malerba G, Maccauro G. Clinical and radiographic outcomes after total hip arthroplasty with the NANOS neck preserving hip stem: a 10 to 16-year follow-up study. BMC Musculoskelet Disord 2022; 22:1061. [PMID: 35012499 PMCID: PMC8750837 DOI: 10.1186/s12891-021-04953-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Short-stem Hip Arthroplasty (SHA) are increasingly implanted in recent years thanks to their potential advantage in preserving metaphyseal bone-stock. Among them, the NANOS® short-stem implant demonstrated satisfactory results to short and mid-term. The purpose of this retrospective study was to evaluate the clinical and radiographic outcome of the Nanos® short stem at a minimum follow-up of 10 years. METHODS Sixty-seven patients aged 53 ± 20 years were enlisted in the study, for a total of 72 hips. Primary outcomes were survivorship of the implant and clinical outcome measured using the Hip disability and Osteoarthritis Outcome scores (HOOS) and the Short Form Survey (SF12) questionnaire. The secondary outcome was a radiological evaluation calculating the inclination and the anteversion angle of the acetabular cup for each implant and investigating osteolysis, heterotopic ossifications and stem position. RESULTS We observed a 95.5% stem survivorship. The complication rate was 7.6% and three implants underwent revision because of an aseptic loosening, an infection and a periprosthetic fracture due to trauma. Among 58 patients (63 hips) evaluated in an outpatient visit 10-16 years after surgery, improvement in clinically relevant scores comparing with baseline was observed: HOOS score increased after surgery in all its subcategories (from 32.25 ± 14.07% up to 91.91 ± 9.13%) as well as SF12 which increased by more than 18 percentage points. On clinical assessment, the range of motion (ROM) was restored at follow-up, 1 patient (1.7%) showed a squeaking hip and 2 (3.4%) reported leg-length discrepancy. Neutral stem positioning was achieved in 58 hips and heterotopic ossifications occurred in 10 hips (16%). CONCLUSIONS The current study reports good clinical and radiological outcomes following NANOS® short-stem hip implant at minimum 10 years-follow-up. Since the high rate of stem survivorship, the low complication rate demonstrated and the overall patient satisfaction, our results suggest NANOS® neck-preserving prostheses should be considered as a valid alternative to standard implants.
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Affiliation(s)
- Vincenzo De Santis
- Department of Orthopaedics, Mater Olbia Hospital, Olbia, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nadia Bonfiglio
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Mattia Basilico
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | | | - Maria Rosaria Matrangolo
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Angelo Carosini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Giuseppe Malerba
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy.
| | - Giulio Maccauro
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
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10
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Yang H, Kim K, Kim HS, Yoo JJ. Total Hip Arthroplasty Performed with a Novel Design Type 1 Femoral Stem: A Retrospective Minimum 5-Year Follow-up Study. Clin Orthop Surg 2022; 14:28-34. [PMID: 35251538 PMCID: PMC8858893 DOI: 10.4055/cios21048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/19/2021] [Accepted: 06/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background The Bencox M stem is a mid-short type 1 stem with additional unique design features. It has a reduced stem length and a lateral shoulder to facilitate minimally invasive surgery, as well as an angular lateral shoulder and a trapezoidal neck to minimize stem-liner impingement. There have been many mid-term reports on type 1 stems, but no results have been reported so far on this novel design type 1 femoral stem. This study presents the clinical and radiological outcomes of total hip arthroplasty performed with the M stem after a minimum 5-year follow-up. Methods From July 2014 to February 2015, 125 primary total hip arthroplasties using the M cementless femoral stem were performed on 112 patients in our hospital. Among them, 94 patients (106 hips) were eligible for the study and were followed up for more than 5 years. Our primary outcome was clinical results, which were evaluated by the Harris Hip Score (HHS), thigh pain, noise, and other complications. Secondary outcome was radiological outcomes. Seventy-seven hips were evaluated radiologically with attention to implant fixation, migration, loosening of component, degree of stress shielding, radiolucent lines, focal osteolysis, heterotopic ossification, and the evidence of impingement between the stem and liner. Results The average HHS improved from 54.6 points (range, 24–67 points) to 96.8 points (range, 91–100 points) at the latest follow-up. Three hips (2.8%) had intermittent thigh pain, which was tolerable without medication. Five hips (4.7%) had ceramic-related noise. There were no other complications such as infection, nerve injury, dislocation, or revision. All implants showed radiographic evidence of stable fixation by bone ingrowth without migration. Fifty-seven hips (74%) showed mild femoral stress shielding. Distal cortical hypertrophy was detected in 7 hips (9%), and heterotopic ossification was observed in 17 hips (22%). No implant demonstrated focal osteolysis and notching of the femoral neck or shoulder on radiographs. Conclusions The minimum 5-year results of total hip arthroplasty performed with the M cementless femoral stem were encouraging clinically and radiologically. A long-term follow-up will be necessary to evaluate its longevity.
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Affiliation(s)
- Hanbual Yang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Kangbaek Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hong Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Godoy-Monzon D, Perez Torres J, Pascual Espinosa J, Garcia-Mansilla A. [Translated article] Evaluation of the learning curve and initial outcomes with a short cervicometaphyseal fixation stem: A case series. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Uçan V, Ezici V, Aliyev O, Uzer G, Tuncay İ, Yıldız F. Comparison of tapered-wedge short and standard-length femoral stems in single-stage bilateral direct anterior total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:3119-3127. [PMID: 34347131 DOI: 10.1007/s00264-021-05152-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/17/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was performed to compare short and standard-length tapered-wedge-type femoral stems in single-stage bilateral total hip arthroplasty (THA) through a direct anterior approach (DAA). MATERIALS AND METHODS The patients were divided into two groups according to their femoral stem types as short tapered-wedge stem and standard-length tapered-wedge stem groups. Outcome parameters were the surgical time, estimated blood loss (EBL), length of stay (LOS), thigh pain, Harris Hip Score (HHS), and visual analog scale (VAS) score clinically, and canal fill ratio (CFR), coronal plan alignment of the stems, subsidence, and postoperative leg length difference (LLD), radiologically. RESULTS The short-stem group and standard-length-stem group consisted of 20 patients (40 hips, mean age 52.0 ± 14.1) and 22 patients (44 hips, mean age 49.4 ± 11.9), respectively. There were no significant differences between the groups in terms of mean surgical times (p = 0.6), EBL (p = 0.2), LOS (p = 0.2), the rate of thigh pain (p = 0.4), improvements in HHS (p = 0.4) and VAS scores (p = 0.6), LLD (p = 0.3), amount of subsidence (p = 0.9), and varus or valgus misalignment (p = 0.7). The CFR at the level of the lesser trochanter was significantly higher in the short-stem group (0.79 ± 0.1) than the standard-length-stem group (0.73 ± 0.1) (p < 0.01). CONCLUSION In single-stage bilateral THA through DAA, short, tapered-wedge femoral stems provide similar radiographic and functional results to standard stems at short-term follow-up.
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Affiliation(s)
- Vahdet Uçan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - Volkan Ezici
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - Orkhan Aliyev
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - Gökçer Uzer
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - İbrahim Tuncay
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey
| | - Fatih Yıldız
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih, İstanbul, Turkey.
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Batailler C, Shatrov J, Schmidt A, Servien E, Puch JM, Lustig S. Similar stress repartition for a standard uncemented collared femoral stem versus a shortened collared femoral stem. SICOT J 2021; 7:58. [PMID: 34797213 PMCID: PMC8603923 DOI: 10.1051/sicotj/2021061] [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: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction: The design of uncemented femoral stems for use in total hip arthroplasty has evolved. Several uncemented short stems have been developed with different bone fixations, shapes, or stem lengths. The literature analyzing the biomechanical performance of short to standard stem lengths is limited. The aim was to compare the stress repartition on a standard uncemented stem and a shortened uncemented femoral stem with the same design features. Material and methods: This finite element analysis assessed the stress repartition on two femoral components with the same design (uncemented, collared, proximal trapezoidal cross-section, and a tapered quadrangular distal stem) but with two different lengths. The shortened stem was shorter by 40 mm compared to the standard stem. The stress repartition was analysed according to the Von Mises criterion. Results: The stress repartition was similar for the standard and shorter stem without significant difference (p = 0.94). The mean Von Mises stress was 58.1 MPa [0.2; 154.1] for the standard stem and 57.2 MPa [0.03; 160.2] for the short stem. The distal part of the standard stem, which was removed in the short stem, had mean stress of 3.7 MPa [0.2; 7.0]. Conclusion: The finite element analysis found similar stress repartitions between a standard uncemented collared stem and a short, collared stem with the same design. A clinical study assessing the clinical outcomes and the bone remodelling with a collared short stem would be interesting to confirm these first promising results.
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Affiliation(s)
- Cécile Batailler
- Department of Orthopaedic surgery and Sports Medicine, Croix-Rousse Hospital, Lyon University Hospital, 103 grande rue de la Croix Rousse, 69004, Lyon, France - Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Jobe Shatrov
- Department of Orthopaedic surgery and Sports Medicine, Croix-Rousse Hospital, Lyon University Hospital, 103 grande rue de la Croix Rousse, 69004, Lyon, France - Sydney Orthopaedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, NSW 2067, Sydney, Australia
| | - Axel Schmidt
- Department of Orthopaedic surgery and Sports Medicine, Croix-Rousse Hospital, Lyon University Hospital, 103 grande rue de la Croix Rousse, 69004, Lyon, France
| | - Elvire Servien
- Department of Orthopaedic surgery and Sports Medicine, Croix-Rousse Hospital, Lyon University Hospital, 103 grande rue de la Croix Rousse, 69004, Lyon, France - LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 69003 Lyon, France
| | - Jean Marc Puch
- Department of Orthopaedic Surgery, Clinique Saint-Georges, 2 Av. de Rimiez, 06105 Nice, France
| | - Sébastien Lustig
- Department of Orthopaedic surgery and Sports Medicine, Croix-Rousse Hospital, Lyon University Hospital, 103 grande rue de la Croix Rousse, 69004, Lyon, France - Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
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Godoy-Monzon D, Perez Torres J, Pascual Espinosa JM, Garcia-Mansilla A. Evaluation of the learning curve and initial outcomes with a short cervicometaphyseal fixation stem: A case series. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:60-67. [PMID: 34373231 DOI: 10.1016/j.recot.2021.06.002] [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: 12/14/2020] [Revised: 02/03/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Total hip arthroplasty in young patients has evolved in recent decades, and the use of short stems in young adult patients has been gaining popularity. The restitution of the biomechanics of the hip is a primary requirement to determine the future success of total hip replacement, and even more so in young adults who present the particularity of having a high functional demand and a long life expectancy. OBJECTIVE The aim of this prospective study was to evaluate the learning curve and initial clinical-radiological outcomes of the Alteon Neck Preserving Stem™ (ANPS) (Exactech, Gainesville, FL, USA) with a minimum of 2 years follow up. MATERIAL AND METHODS We conducted a multicenter prospective study that analyzed 90 consecutive total hip replacements during 2014. We performed a clinical-radiological analysis measuring Harris Hip Score (HHS), subjective Rodes and Maudsley satisfaction evaluation, radiolucencies, components position, limb length discrepancy, heterotopic ossification, medical and surgical complications and learning curve. RESULTS During the first 30 cases, the intraoperative complication rate was 16%, while in the next 60 cases no intraoperative complications were reported. Thigh pain was reported in 3 cases (3.3%), being 2 moderates, and 1 severe. In 2 cases subsidences of 3 mm were detected in the first scheduled X-ray, both related to intraoperative fractures with no progression after 3 months. Mean HHS improved from 42.9 points (range 37-54 points) preoperatively to 93.2 on average (range, 87-96) at the end of the follow up (p < 0.01). Subjective evaluation was excellent in 75 (83.3%) cases and good in 15 patients (16.6%). CONCLUSIONS This short stem has good clinical radiological results in a short and medium term follow-up and in the hands of surgeons specializing in arthroplasty the learning curve is estimated to be less than 30 surgeries.
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Affiliation(s)
- Daniel Godoy-Monzon
- Servicio de Ortopedia y Traumatología, Unidad de Cadera, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Clínica Palermo, Bogotá, Colombia; Hospital San Rafael, Cádiz, España.
| | | | | | - Agustin Garcia-Mansilla
- Servicio de Ortopedia y Traumatología, Unidad de Cadera, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Primary outcomes of a femoral neck-preserving stem: a multicentre clinical-radiological analysis at 5-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:533-540. [PMID: 34041595 DOI: 10.1007/s00590-021-03000-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this prospective study was to evaluate the clinical-radiological outcomes of the Alteon Neck Preserving Stem (ANPS) (Exactech, Gainesville, FL, USA) implanted in four different centres by five senior hip surgeons with a minimum of 5 years of follow-up. MATERIAL AND METHOD We conducted a multicentre prospective study that analysed 155 consecutive total hip replacements during 2014. We performed clinical-radiological analysis measuring Harris Hip Score (HHS), subjective satisfaction evaluation, radiolucencies, position of components, limb length discrepancy, heterotopic ossification, medical and surgical complications and a survival analysis at 5 years follow-up. RESULTS Thigh pain was reported in 5 cases (3.2%), 2 of which reported mild pain, 2 moderate, and 1 severe. In 2 cases, subsidences of 3 mm were detected in the first scheduled X-ray, both related to intraoperative fractures with no progression after 3 months. The overall complication rate was 5.8% and 6 of the 9 complications were in the first 30 cases. Mean HHS improved from 42.9 points (range 37.2-55.7 points) preoperatively to 94.9 on average (range 87-98) at the end of the follow-up (p <0.01). Subjective evaluation was excellent in 130 (83.87%) cases and good in 25 patients (16.13%). CONCLUSIONS The clinical-radiographic results of ANPS THR are satisfactory. The mid-term results are promising. However, long-term follow-up studies are necessary to confirm the validity of the concept.
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Rivera F, Bardelli A, Giolitti A. Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty. J Orthop Traumatol 2021; 22:8. [PMID: 33675436 PMCID: PMC7936996 DOI: 10.1186/s10195-021-00567-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In the last decade, the increase in the use of the direct anterior approach to the hip has contributed to the diffusion of the use of short stems in orthopedic surgery. The aim of the study is to verify the medium-term clinical and radiographic results of a cementless anatomic short stem in the anterior approach to the hip. We also want to verify whether the use of the standard operating room table or the leg positioner can affect the incidence of pre- and postoperative complications. MATERIALS AND METHODS All total hip arthroplasty patients with a 1-year minimum follow-up who were operated using the MiniMAX stem between January 2010 and December 2019 were included in this study. Clinical evaluation included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC) Score, and Short Form-36 (SF-36) questionnaires. Bone resorption and remodeling, radiolucency, osteolysis, and cortical hypertrophy were analyzed in the postoperative radiograph and were related to the final follow-up radiographic results. Complications due to the use of the standard operating room table or the leg positioner were evaluated. RESULTS A total of 227 patients (238 hips) were included in the study. Average age at time of surgery was 62 years (range 38-77 years). Mean follow-up time was 67.7 months (range 12-120 months). Kaplan-Meier survivorship analysis after 10 years revealed 98.2% survival rate with revision for loosening as endpoint. The mean preoperative and postoperative HHS were 38.35 and 94.2, respectively. The mean preoperative and postoperative WOMAC Scores were 82.4 and 16.8, respectively. SF-36 physical and mental scores averaged 36.8 and 42.4, respectively, before surgery and 72.4 and 76.2, respectively, at final follow-up. The radiographic change around the stem showed bone hypertrophy in 55 cases (23%) at zone 3. In total, 183 surgeries were performed via the direct anterior approach (DAA) on a standard operating room table, and 44 surgeries were performed on the AMIS mobile leg positioner. Comparison between the two patient groups did not reveal significant differences. CONCLUSION In conclusion, a short, anatomic, cementless femoral stem provided stable metaphyseal fixation in younger patients. Our clinical and radiographic results support the use of this short stem in the direct anterior approach. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Fabrizio Rivera
- Orthopedics and Trauma Department, SS Annunziata Hospital, ASL CN1, Savigliano (CN), Italy.
| | - Alessandro Bardelli
- Orthopedics and Trauma Department, SS Annunziata Hospital, ASL CN1, Savigliano (CN), Italy
| | - Andrea Giolitti
- Orthopeadics and Traumatology Department, Faculty of Medicine and Surgery, CTO Hospital, University of Turin, Turin, Italy
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Slullitel PA, Mahatma MM, Farzi M, Grammatopoulos G, Wilkinson JM, Beaulé PE. Influence of Femoral Component Design on Proximal Femoral Bone Mass After Total Hip Replacement: A Randomized Controlled Trial. J Bone Joint Surg Am 2021; 103:74-83. [PMID: 33079901 DOI: 10.2106/jbjs.20.00351] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In this randomized controlled trial (RCT), we compared bone remodeling and bone turnover between 2 total hip arthroplasty implants-the short, proximally porous-coated Tri-Lock Bone-Preservation Stem and a conventional, fully-coated Corail prosthesis-over a 2-year postoperative period. METHODS Forty-six participants received the Tri-Lock prosthesis and 40 received the Corail prosthesis. At baseline, the 2 groups had similar demographics, proximal femoral bone mineral density (BMD), bone turnover markers, radiographic canal flare index, and patient-reported outcome measure (PROM) scores. Outcomes were measured at weeks 26, 52, and 104. RESULTS Loss of periprosthetic bone, measured by high-sensitivity dual x-ray absorptiometry region-free analysis (DXA-RFA), was identified at the calcar and proximal-lateral aspect of the femur in both prosthesis groups (p < 0.05). However, the conventional prosthesis was associated with a smaller reduction in BMD compared with the bone-preservation prosthesis (p < 0.001). This effect was most prominent in the region of the femoral calcar and greater trochanter. A small gain in BMD was also identified in some areas, and this gain was greater with the conventional than the bone-preservation prosthesis (p < 0.001). The 2 groups had similar changes in bone turnover markers and improvement in PROM scores over the study period (p > 0.05). The adverse-event rate was also similar between the groups (p > 0.05). CONCLUSIONS This RCT shows that prostheses intended to preserve proximal femoral bone do not necessarily perform better in this regard than conventional cementless designs. DXA-RFA is a sensitive tool for detecting spatially complex patterns of periprosthetic bone remodeling. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Pablo A Slullitel
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.,Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Mohit M Mahatma
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Mohsen Farzi
- Centre for Computational Imaging and Simulation Technologies in Bioscience, University of Leeds, Leeds, United Kingdom
| | | | - J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Freitag T, Kutzner KP, Bieger R, Reichel H, Ignatius A, Dürselen L. Biomechanics of a cemented short stem: a comparative in vitro study regarding primary stability and maximum fracture load. Arch Orthop Trauma Surg 2021; 141:1797-1806. [PMID: 33755800 PMCID: PMC8437915 DOI: 10.1007/s00402-021-03843-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE In total hip arthroplasty, uncemented short stems have been used more and more frequently in recent years. Especially for short and curved femoral implants, bone-preserving and soft tissue-sparing properties are postulated. However, indication is limited to sufficient bone quality. At present, there are no curved short stems available which are based on cemented fixation. METHODS In this in vitro study, primary stability and maximum fracture load of a newly developed cemented short-stem implant was evaluated in comparison to an already well-established cemented conventional straight stem using six pairs of human cadaver femurs with minor bone quality. Primary stability, including reversible micromotion and irreversible migration, was assessed in a dynamic material-testing machine. Furthermore, a subsequent load-to-failure test revealed the periprosthetic fracture characteristics. RESULTS Reversible and irreversible micromotions showed no statistical difference between the two investigated stems. All short stems fractured under maximum load according to Vancouver type B3, whereas 4 out of 6 conventional stems suffered a periprosthetic fracture according to Vancouver type C. Mean fracture load of the short stems was 3062 N versus 3160 N for the conventional stems (p = 0.84). CONCLUSION Primary stability of the cemented short stem was not negatively influenced compared to the cemented conventional stem and no significant difference in fracture load was observed. However, a clear difference in the fracture pattern has been identified.
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Affiliation(s)
- Tobias Freitag
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Ralf Bieger
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Medical Centre, Helmholtzstr. 14, 89081, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Medical Centre, Helmholtzstr. 14, 89081, Ulm, Germany
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Buttaro MA, Slullitel PA, Oñativia JI, Nally F, Andreoli M, Salcedo R, Comba FM, Piccaluga F. 4- to 8-year complication analysis of 2 'partial collum' femoral stems in primary THA. Hip Int 2021; 31:75-82. [PMID: 31558044 DOI: 10.1177/1120700019879360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Compare the clinical and radiological outcome of CFP stem with the MiniHip design in a prospective series, with special interest in intraoperative periprosthetic fracture (IPPF). METHODS We prospectively followed 101 cases treated with the MiniHip stem (Group 1) and 89 with the CFP stem (Group 2) operated between 2010 and 2014. No significant demographic differences were observed between both groups. Median follow-up was 72 months. Average stem length was 41% shorter in the MiniHip group (p < 0.001). Radiological parameters were measured and a logistcic regression model was created to evaluate factors associated with IPPF. RESULTS Mean mHHS improved from 54 to 95 in the MiniHip group (p < 0.001) and from 64 to 98 in the CFP group (p < 0.001). No significant differences were observed in terms of loosening, infection or instability. We observed 7 IPPFs (3.68%), 3 in group 1 and 4 in group 2. After adjusting for confounders, CFP was not associated with a greater risk of IPPF (OR 3.23; 95% CI, 0.250-42.034, p = 0.368), however, a more complex fracture pattern was observed with this stem design. Prior acetabular fractures were associated with IPPF (OR 66.85; 95% CI, 1.142-3911, p = 0.043). Compared to Dorr A femurs, type Dorr B appeared protective against IPPF (OR 0.039; 95% CI, 0.001-1.109, p = 0.058). Valgus alignment tended to increase the risk of IPPF (OR 20.59; 95% CI 0.870-487.221, p = 0.061). CONCLUSIONS MiniHip showed similar radiological outcomes to CFP at short- to mid-term follow-up without increasing IPPFs with a shorter stem length. Given that CFP produced a more complex IPPF pattern, surgeons should be cautious with alignment of this particular design, especially in Dorr A femur.
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Affiliation(s)
- Martin A Buttaro
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Pablo A Slullitel
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - José I Oñativia
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Nally
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Mauro Andreoli
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Salcedo
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Fernando M Comba
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Piccaluga
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Kim JT, Kim HS, Lee YK, Ha YC, Koo KH. Total Hip Arthroplasty With Trochanteric Ostectomy for Patients With Angular Deformity of the Proximal Femur. J Arthroplasty 2020; 35:2911-2918. [PMID: 32473769 DOI: 10.1016/j.arth.2020.04.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) of patients with a proximal femoral deformity is technically demanding. This deformity poses the risk of femoral fracture or perforation; stem malposition; and failed stem fixation. To insert a femoral stem in neutral position with a good fit, we removed the greater trochanter in case of a varus deformity, and the lesser trochanter in case of valgus deformity, while performing THA. We aimed to evaluate stem position, implant stability, clinical results, and radiological changes after THAs using this technique. METHODS Fifteen patients (17 hips; 11 varus hips and 6 valgus hips) underwent cementless THA using the trochanteric osteotomy technique in one institution. We evaluated procedure-specific complications: intraoperative femoral fracture, stem malposition, weakness of the abductor power and limp. Modified Harris Hip Score, radiological changes, and the stability of stems were assessed at a mean of 7.1 years of follow-up (range 2.0-15.5). RESULTS Femoral fracture occurred during the insertion of the stem in 4 hips. All stems were aligned in neutral position. At the latest follow-up, the mean power of the abductor was 4.3 (range 3-5). Eleven patients had slight limp and 4 patients had moderate limp. All stems had bone-ingrown stability and no stem was revised. The mean modified Harris Hip Score improved from 50 points at the preoperative evaluation to 81 points at the final follow-up. CONCLUSION The trochanteric excision enabled neutral insertion of cementless stem in patients with varus/valgus deformity of the proximal femur, and THA using this technique rendered favorable results.
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Affiliation(s)
- Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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21
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Kheir MM, Drayer NJ, Chen AF. An Update on Cementless Femoral Fixation in Total Hip Arthroplasty. J Bone Joint Surg Am 2020; 102:1646-1661. [PMID: 32740265 DOI: 10.2106/jbjs.19.01397] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael M Kheir
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nicholas J Drayer
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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22
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Babu S, Singh P, Wiik A, Shastri O, Malik K, Bailey J, Ghosh K, Cobb J. A comparison of patient-reported outcome measures (PROMs) between short and conventional stem hip replacements: a systematic review and meta-analysis. Hip Int 2020; 30:513-522. [PMID: 31746234 DOI: 10.1177/1120700019888210] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Short stem hip replacements may allow preservation of proximal bone stock and minimise soft tissue disruption, easing future revision surgery. However patient satisfaction with these implants must be determined before widespread use. We aimed to compare patient reported outcome measures (PROMs) between short and conventional stem hip replacements. METHODS A systematic review was conducted according to PRISMA guidelines for studies comparing short and conventional stem hip replacements with validated PROMs. Meta-analyses were performed for studies reporting Harris Hip and WOMAC scores. Study bias was assessed with the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. RESULTS 24 studies, incorporating 2593 total hip replacements were included for qualitative analysis. 17 studies were included in the meta-analyses. Of the 7 excluded, 1 study reported the Japanese Orthopaedic Association score and 2 others reported the Oxford Hip score. All three showed no difference between the stems. A meta-analysis of 17 studies reporting Harris hip scores showed no statistically significant difference between short and conventional stems (standard mean difference (SMD) -0.06, 95% CI -0.20-0.07, p = 0.35). 6 studies reported WOMAC scores with higher scores indicating worse outcome. No difference was seen between the two groups (SMD 0.21, 95%CI, -0.01-0.42, p = 0.06). 4 studies reported higher WOMAC scores as better. Once again, a meta-analysis showed no statistically significant difference between the stems (SMD 0.28, 95% CI -0.07-0.63, p = 0.12). CONCLUSIONS Our systematic review showed no difference in PROMs between short and conventional stem total hip replacements. This is in keeping with previous evidence but is a more comprehensive analysis. Short stems may have an important role in younger individuals as they allow preservation of proximal femoral bone, minimal access surgery and are amenable to abnormal anatomy. The current literature is hindered by non-uniform methodologies and outcome assessments across studies. Further, standardised, high quality evidence is required before widespread changes in practice.
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Christiansen JD, Ejaz A, Nielsen PT, Laursen M. An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction. J Bone Joint Surg Am 2020; 102:128-136. [PMID: 31596796 DOI: 10.2106/jbjs.19.00104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) with a diaphyseal stem may risk bone loss. In order to save proximal bone stock in young patients with a high activity level and a long life expectancy, the interest in short stems has evolved. The purpose of this prospective observational cohort study was to evaluate the fixation of, and bone remodeling around, the Primoris femoral neck-preserving hip implant. METHODS Fifty younger patients with end-stage osteoarthritis were managed with the Primoris hip implant. We evaluated bone mineral density (BMD) using dual x-ray absorptiometry (DXA) and implant migration using radiostereometric analysis (RSA). A region-of-interest (ROI) protocol for 4 ROIs was applied to assess BMD. The association between BMD and migration was evaluated to determine the fixation of the Primoris implant and bone remodeling in the proximal part of the femur. Follow-up evaluation was performed at regular intervals from day 1 (baseline) until 24 months after surgery. RESULTS The major stem migrations were subsidence (Y axis; mean, 0.38 mm) at 6 weeks and varus tilt (rotation) (Z axis; mean, 0.93°) at 6 to 12 months. In ROI4 (the calcar area), a significant gain in bone was found with a mean difference of 4.1% (95% confidence interval [CI], 0.8% to 7.4%; p < 0.02) at 24 months postoperatively. Significant bone loss was found in ROI1 and ROI2, with a mean difference of -4.9% (95% CI, -7.4% to -2.4%; p = 0.0003) and -8.9% (95% CI, -11.5% to -6.2%; p = 0.0001), respectively. Linear regression and multivariate regression analysis showed a significant negative association between maximal total point motion and BMD (p = 0.02, R = 15%; and p < 0.05, R = 26%, respectively). CONCLUSIONS The Primoris component showed satisfactory primary stability with promising results at the 24-month follow-up. DXA scans showed limited stress-shielding with the proximal loading pattern of the Primoris. Better bone quality was associated with less implant migration. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Janus D Christiansen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ashir Ejaz
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul T Nielsen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark
| | - Mogens Laursen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Comparison of short-stem with conventional-stem prostheses in total hip arthroplasty: an 8-year follow-up study. Arch Orthop Trauma Surg 2020; 140:1285-1291. [PMID: 32572595 PMCID: PMC8211593 DOI: 10.1007/s00402-020-03519-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Coxarthrosis is a common disease of the adult hip joint. Elderly patients have mainly been treated with total hip arthroplasty (THA); however, younger patients are increasingly affected. Short-stem prostheses were developed for this special patient group. There have been few studies on the clinical outcomes of this type of prosthesis. This study compared the mid-term results of a short-stem prosthesis and a standard-stem prosthesis 8 years after implantation. METHODS According to our clinical registry, patients who received a short-stem prosthesis before 2011 were identified. Patients in the standard-stem prosthesis group were matched based on the sex, age, height, weight, and degree of arthrosis. At the follow-up time, the modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity score and visual analog scale (VAS) pain score were collected and compared with the preoperative values. RESULTS Fifty-five patients could be matched and analyzed for both groups. No patients needed revision surgery. In both groups, there were significant improvements at the follow-up time. The pre- and postoperative mHHSs, UCLA scores, and VAS scores were 41.9 and 95 (p < 0.0001), 3.75 and 7.9 (p < 0.0001), and 7.6 and 0.9 (p < 0.0001), respectively, in the short-stem group and 44.8 and 96.25 (p < 0.0001), 3.6 and 7.7 (p < 0.0001), and 7.7 and 0.9 (p < 0.0001), respectively, in the control group, with no significant differences between the groups at the follow-up time. CONCLUSION The short-stem prosthesis provides mid-term results comparable to those of a standard-stem prosthesis. In both groups, excellent patient-reported outcomes were achieved after an average of 8 years. LEVEL OF EVIDENCE IV.
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Manrique J, Paskey T, Tarabichi M, Restrepo C, Foltz C, Hozack WJ. Total Hip Arthroplasty Through the Direct Anterior Approach Using a Bikini Incision Can Be Safely Performed in Obese Patients. J Arthroplasty 2019; 34:1723-1730. [PMID: 31003782 DOI: 10.1016/j.arth.2019.03.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/16/2019] [Accepted: 03/25/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Direct anterior approach (DAA) total hip arthroplasty can be performed through a traditional vertical incision or a horizontal (bikini) incision. The purpose of this study is to compare the 2 approaches, performed by a single surgeon past the learning curve, in terms of (1) overall wound complications and (2) patient-reported esthetics at the 6-month follow-up. METHODS A case-control retrospective study was conducted. Eighty-six bikini DAA patients were matched 3:1 to 230 conventional DAA patients for gender, age, body mass index (BMI), and American Society of Anesthesiologists score. Outcomes evaluated included wound complications, acute periprosthetic joint infection, transfusion, length of surgery, and dysesthesia. A subgroup analysis was also performed on obese patients, BMI greater than 30 kg/m2. Furthermore, the patients rated cosmesis of the incision at 6 months using a Patient Scar Assessment Scale and the Vancouver Scar Assessment Scale. RESULTS Bikini patients had lower rates of delayed wound healing compared to conventional incision (2.3% vs 6.1%, P = .087). This difference was statistically significant (0% vs 16.6%, P < .05) in obese patients. There was no difference in terms of incision cosmesis between the 2 incision types. CONCLUSION Our study demonstrates that the DAA total hip arthroplasty can be performed safely through an alternative horizontal bikini incision with complication rates equivalent to conventional incision DAA and to those in other approaches when performed by surgeons in a high volume, efficient hip replacement institution. In patients whose BMI is >30, a potential benefit of the horizontal incision may be lower wound complications. This study design should be performed at other institutions and ideally at a multi-institution level to evaluate if results can be corroborated. Our opinion is that the horizontal bikini incision should be utilized but only after mastery of the DAA approach using the conventional vertical incision.
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Affiliation(s)
- Jorge Manrique
- Rothman Orthopaedic Institute, Philadelphia, PA; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA
| | | | | | | | - Carol Foltz
- Rothman Orthopaedic Institute, Philadelphia, PA
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Jacquel A, Le Viguelloux A, Valluy J, Saffarini M, Bonin N. A shortened uncemented stem offers comparable positioning and increased metaphyseal fill compared to a standard uncemented stem. J Exp Orthop 2019; 6:28. [PMID: 31240502 PMCID: PMC6593034 DOI: 10.1186/s40634-019-0197-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/14/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Shortened stems are increasingly used in uncemented total hip arthroplasty (THA) as they represent a compromise between the metaphyseal anchorage of short stems and the facilitated axial alignment of standard stems. The purpose of this study was to compare the metaphyseal canal-fill ratio (CFR) and axial alignment of a shortened double-tapered stem with those of a standard stem. The hypothesis was that the shortened stem would achieve greater metaphyseal fill and comparable axial alignment. METHODS The authors reviewed routine follow-up anteroposterior radiographs taken 2 months after THA to evaluate metaphyseal fill and axial alignment of a shortened stem (n = 96) and a standard stem (n = 101). The CFR was calculated at the level of the tip and superior margin of the lesser trochanter. Stem alignment was defined as the angle between the stem axis and the proximal anatomic femoral axis. Stems were classified as being in varus or valgus alignment if they deviated by more than 3° from the anatomic axis of the femur. RESULTS Hips implanted with shortened and standard stems had comparable demographics and axial alignment (1.1° ± 1.7° vs 0.8° ± 1.2°; p = 0.331). However, varus alignment was observed in 5% of shortened stems compared to only 1% of standard stems, though this difference was not significant (p = 0.111). The femoral CFR was greater using shortened stems than using standard stems, both at the level of the tip of the lesser trochanter (0.91 ± 0.05 vs 0.85 ± 0.08; p < 0.001) and at its superior margin (0.76 ± 0.06 vs 0.72 ± 0.07; p < 0.001). CONCLUSIONS Compared to the standard stem, the shortened stem had increased metaphyseal filling and equivalent alignment. These findings suggest that shortened stems could provide adequate metaphyseal fixation and correct alignment. Further studies remain necessary to evaluate how shortened stems perform in terms of osseointegration, clinical outcomes and survival.
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Affiliation(s)
- Alexandre Jacquel
- Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon-Ortho-Clinic, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Augustin Le Viguelloux
- Centre Hospitalier William Morey, 4 Rue Capitaine Drillien, 71100, Chalon Sur Saône, France
| | - Jeremy Valluy
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland
| | - Mo Saffarini
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland.
| | - Nicolas Bonin
- Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon-Ortho-Clinic, 8 Avenue Ben Gourion, 69009, Lyon, France
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Tatani I, Panagopoulos A, Diamantakos I, Sakellaropoulos G, Pantelakis S, Megas P. Comparison of two metaphyseal-fitting (short) femoral stems in primary total hip arthroplasty: study protocol for a prospective randomized clinical trial with additional biomechanical testing and finite element analysis. Trials 2019; 20:359. [PMID: 31208433 PMCID: PMC6580512 DOI: 10.1186/s13063-019-3445-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 05/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Total hip replacement has recently followed a progressive evolution towards principles of bone- and soft-tissue-sparing surgery. Regarding femoral implants, different stem designs have been developed as an alternative to conventional stems, and there is a renewed interest towards short versions of uncemented femoral implants. Based on both experimental testing and finite element modeling, the proposed study has been designed to compare the biomechanical properties and clinical performance of the newly introduced short-stem Minima S, for which clinical data are lacking with an older generation stem, the Trilock Bone Preservation Stem with an established performance record in short to midterm follow-up. METHODS/DESIGN In the experimental study, the transmission of forces as measured by cortical surface-strain distribution in the proximal femur will be evaluated using digital image correlation (DIC), first on the non-implanted femur and then on the implanted stems. Finite element parametric models of the bone, the stem and their interface will be also developed. Finite element predictions of surface strains in implanted composite femurs, after being validated against biomechanical testing measurements, will be used to assist the comparison of the stems by deriving important data on the developed stress and strain fields, which cannot be measured through biomechanical testing. Finally, a prospective randomized comparative clinical study between these two stems will be also conducted to determine (1) their clinical performance up to 2 years' follow-up using clinical scores and gait analysis (2) stem fixation and remodeling using a detailed radiographic analysis and (3) incidence and types of complications. DISCUSSION Our study would be the first that compares not only the clinical and radiological outcome but also the biomechanical properties of two differently designed femoral implants that are theoretically classified in the same main category of cervico-metaphyseal-diaphyseal short stems. We can hypothesize that even these subtle variations in geometric design between these two stems may create different loading characteristics and thus dissimilar biomechanical behaviors, which in turn could have an influence to their clinical performance. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number, ID: ISRCTN10096716 . Retrospectively registered on May 8 2018.
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Affiliation(s)
- I Tatani
- Orthopaedic Department, University Hospital of Patras, Patras, Greece
| | - A Panagopoulos
- Orthopaedic Department, University Hospital of Patras, Patras, Greece.
| | - I Diamantakos
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
| | - G Sakellaropoulos
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Sp Pantelakis
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
| | - P Megas
- Orthopaedic Department, University Hospital of Patras, Patras, Greece
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Tian S, Goswami K, Manrique J, Blevins K, Azboy I, Hozack WJ. Direct Anterior Approach Total Hip Arthroplasty Using a Morphometrically Optimized Femoral Stem, a Conventional Operating Table, Without Fluoroscopy. J Arthroplasty 2019; 34:327-332. [PMID: 30448326 DOI: 10.1016/j.arth.2018.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Our experience with direct anterior approach total hip arthroplasty (THA) suggests that it can be performed successfully with a morphometrically optimized metaphyseal-diaphyseal engaging femoral stem (NOT a short stem), a regular operating room table (NOT a special custom table), and WITHOUT intraoperative fluoroscopy. We report our minimum 2-year results. METHODS A retrospective review of a single-surgeon series of primary direct anterior approach THAs was performed. All procedures were performed on a regular table, without fluoroscopy, using a cementless tapered femoral stem. Clinical, functional, and radiographic outcomes were evaluated at a minimum of 2 years. RESULTS In total, 1017 primary THAs were performed. The preoperative Harris Hip Score was 40.7 ± 5.1 and improved to 95.3 ± 4.2 at minimum 2-year follow-up. There were 3 dislocations (0.3%) and 15 revisions (1.5%): 7 for infection (0.7%), 4 for periprosthetic fractures (0.4%), 2 for instability (0.2%), 1 for loosening (0.1%), and 1 for pain (0.1%). Five patients (0.5%) required blood transfusion. One patient developed deep vein thrombosis and pulmonary embolism. No intraoperative fractures, perforation, or THA-related mortality occurred. Neutral stem alignment was confirmed in 98.3%. Mean cup inclination was 38.8° ± 5.1° and anteversion was 16.2° ± 3.5°. The mean leg-length discrepancy was corrected from 1.2 ± 0.2 cm preoperatively to 0.2 ± 0.1 cm postoperatively. CONCLUSION Using a morphometrically optimized metaphyseal-diaphyseal engaging tapered femoral stem instead of a short stem reduces component malposition and minimizes risk of loosening. Combining the use of this implant design and the technique and elements described in our cohort demonstrated to have excellent results at 2 years. The patients will need continued follow-up to demonstrate further durability of this device and technique compared to others performing direct anterior THA.
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Affiliation(s)
- Shaoqi Tian
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA; Affiliated Hospital of Qingdao University, Qingdao, China
| | - Karan Goswami
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jorge Manrique
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA
| | - Kier Blevins
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ibrahim Azboy
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - William J Hozack
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Attenello J, Chan S, Naito K, Saruwatari M, Saito S, Andrews S, Nakasone C. Early perioperative complication rates and subsidence with the Tribute ® short cementless, tapered stem in primary total hip arthroplasty. J Orthop 2019; 16:118-122. [PMID: 30723362 DOI: 10.1016/j.jor.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/08/2019] [Indexed: 12/28/2022] Open
Abstract
This study examined early perioperative complications and subsidence following total hip arthroplasty (THA) with a short femoral stem. A retrospective review of 207 consecutive patients (247 hips) having undergone THA via the direct anterior approach produced only six perioperative complications: two intraoperative fractures, three perioperative femur fractures and one dislocation. Subsidence greater than 5 mm was observed in four hips but subsidence did not progress greater than 3 mm at the latest follow-up. Based on these results, cementless THA though the direct anterior approach with a short femoral stem provides a clinical and radiographic advantage while maintaining low complication rates.
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Affiliation(s)
- John Attenello
- Department of Orthopaedic Surgery, University of Hawai'i, Honolulu, HI, USA
| | - Sean Chan
- John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St, Honolulu, HI, 96813, USA
| | - Kelvin Naito
- Department of Orthopedics, Straub Clinic & Hospital, 888 S King Street, Honolulu, HI, 96813, USA
| | - Michele Saruwatari
- John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St, Honolulu, HI, 96813, USA
| | - Sean Saito
- John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St, Honolulu, HI, 96813, USA
| | - Samantha Andrews
- Department of Orthopedics, Straub Clinic & Hospital, 888 S King Street, Honolulu, HI, 96813, USA
| | - Cass Nakasone
- Department of Orthopaedic Surgery, University of Hawai'i, Honolulu, HI, USA.,Department of Orthopedics, Straub Clinic & Hospital, 888 S King Street, Honolulu, HI, 96813, USA
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Giardina F, Castagnini F, Stea S, Bordini B, Montalti M, Toni A. Short Stems Versus Conventional Stems in Cementless Total Hip Arthroplasty: A Long-Term Registry Study. J Arthroplasty 2018; 33:1794-1799. [PMID: 29395723 DOI: 10.1016/j.arth.2018.01.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/26/2017] [Accepted: 01/05/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Short stems in total hip arthroplasty (THA) have recently gained increasing popularity, allowing mini-invasive exposures and bone-sparing approaches. However, long-term studies and recommendations for the routine use are not available. The aim of this report was to compare the survival rates and the reasons for revision of short stems versus conventional stems in cementless THAs, in a registry-based population. METHODS The Registry of Prosthetic Orthopedic Implants (RIPO) was inquired about cementless THAs performed since 2000 to 2016. The stems were divided into short (<12 cm) and conventional ones, and then, classified according to the classification by Feyen and Shimmin: short stems with neck-retaining osteotomy (group A: 1684 hips), short stems with standard osteotomy (group B: 2727 THAs), and conventional stems (group C: 57,359 cases). Demographics, survivorships, and reasons for revision were investigated and compared. RESULTS Short stems were preferentially implanted in younger patients and normal morphologies. Short and conventional stems showed comparable survival rates at long-term follow-up (>90% at 15 years). The rates of stem aseptic loosening, intraoperative fractures, and periprosthetic fractures were similar in the 3 groups. Group B had higher rates of revisions due to primary instability (early dislocations and impingement-related events; P < .05). Revisions due to pain were nonsignificantly higher in group B. CONCLUSION Short stems are reliable implants at long-term follow-up. The comparison with conventional stems showed no additional risk of premature aseptic loosening and intraoperative and periprosthetic fractures. However, the high rate of revisions due to pain and, mostly, primary instability should be investigated in clinical trials.
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Affiliation(s)
- Federico Giardina
- Hip and Knee Surgery Department, Rizzoli Orthopedic Institute, Bologna, Italy
| | | | - Susanna Stea
- Medical Technology Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Maurizio Montalti
- Hip and Knee Surgery Department, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Aldo Toni
- Hip and Knee Surgery Department, Rizzoli Orthopedic Institute, Bologna, Italy
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Is a short stem suitable for patients with hip dysplasia? A report on technical problems encountered during femoral reconstruction. Hip Int 2018; 28:315-323. [PMID: 29048691 DOI: 10.5301/hipint.5000562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION A wide variety of stems have been used for the treatment of osteoarthritis secondary to advanced hip dysplasia. Since evidence for using short stems in dysplastic hips is limited, we planned to analyse the technical problems encountered when reconstructing the proximal femur of patients with osteoarthritis secondary to congenital dysplasia of the hip treated with total hip arthroplasty (THA) using a type 2B short stem. METHODS We prospectively analysed 17 patients (22 hips) treated with primary THA performed with a single-branded short uncemented stem with metaphyseal fixation (MiniHip™; Corin). We excluded cases in which other type of stems were used, or in which retrospective data was only available. Mean follow-up was 41.22 months (minimum 24). We analysed clinical outcome using the modified Harris Hip Score (mHHS) and pain using the visual analogue scale (VAS). Radiographs were examined in order to determine causes of complications and revision surgery. RESULTS All patients showed statistically significant improvement when preoperative and postoperative values for mHHS (54.19 vs. 94.57; p = 0.0001) and for pain VAS (8.71 vs. 0.71; p = 0.0003) were compared. No cases of thigh pain, instability or infection were found. 1 case of acetabular cup loosening and 1 case of periprosthetic fracture were diagnosed at 8 months and 45 days, respectively. Overall survival was 84.7% at 5 years (CI 95%, 64.4-105.3) with revision for any reason as an end point. When stem performance was separately evaluated, it showed a survival rate of 100% at 5 years with revision for aseptic loosening as an end point. CONCLUSIONS THA with a type 2B short stem for the treatment of dysplastic osteoarthritis showed very few technical intraoperative problems, being a useful alternative for femoral reconstruction.
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Khemka A, Mograby O, Lord SJ, Doyle Z, Al Muderis M. Total Hip Arthroplasty by the Direct Anterior Approach Using a Neck-preserving Stem: Safety, efficacy and learning curve. Indian J Orthop 2018; 52:124-132. [PMID: 29576639 PMCID: PMC5858205 DOI: 10.4103/ortho.ijortho_314_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The concept of femoral neck preservation in total hip replacement (THR) was introduced in 1993. It is postulated that retaining cortical bone of the femoral neck offers triplanar stability, uniform stress distribution, and accommodates physiological anteversion. However, data on safety, efficacy and learning curve are lacking. MATERIALS AND METHODS We prospectively assessed all patients who were operated for a THR with a short neck preserving stem (MiniHip) between 2012 and 2014. The safety and learning curve were assessed by recording operative time; stem size; and adverse events including periprosthetic fracture; paresthesia; and limb length discrepancy (LLD). The cohort was divided into equal groups to assess the learning curve effect, and the cumulative sums (CUSUM) test was performed to monitor intraoperative neck fractures. For assessment of efficacy, Oxford Hip Score (OHS) and Short Form-36 (SF-36) scores were compared preoperatively and postoperatively. RESULTS 138 patients with median age 62 years (range 35-82 years) were included with a median followup of 42 months (range 30-56 months). The minimum followup was 2.5 years. The OHS, SF-36 (physical and mental component) scores improved by a mean score of 26, 28, and 27 points, respectively. All patients had LLD of <10 mm (1.9 mm ± 1.3). Adverse events included intraoperative neck fracture (n = 6), subsidence (n = 1), periprosthetic fracture (n = 1), paresthesia (n = 12), and trochanteric bursitis (n = 2). After early modification of the technique to use a smaller finishing broach, the CUSUM test demonstrated acceptable intraoperative neck fracture risk. The second surgery group had a reduced risk of intraoperative neck fracture (5/69 vs. 1/69 P = 0.2), reduced operative time (66 vs. 61 min, P = 0.06), and increased stem size (5 vs. 6, P = 0.09) although these differences were not statistically significant. CONCLUSIONS The MiniHip stem is safe alternative to standard THR with good functional outcomes but with a learning curve for the surgical technique, implants sizing, and the risk of intraoperative neck fractures.
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Affiliation(s)
- Aditya Khemka
- Department of Research, School of Medicine, University of Notre Dame, Fremantle, New South Wales, Australia,Department of Orthopaedics, Norwest Private Hospital, Bella Vista, Fremantle, New South Wales, Australia,Address for correspondence: Dr. Aditya Khemka, Department of Research, School of Medicine, University of Notre Dame Australia, Darlinghurst, Sydney, New South Wales, Australia. E-mail:
| | - Omar Mograby
- Department of Research, School of Medicine, University of Notre Dame, Fremantle, New South Wales, Australia
| | - Sarah J Lord
- Department of Research, School of Medicine, University of Notre Dame, Fremantle, New South Wales, Australia,National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Zelda Doyle
- Department of Epedemiology, Rural Clinical School, University of Notre Dame, Fremantle, New South Wales, Australia
| | - Munjed Al Muderis
- Department of Research, School of Medicine, University of Notre Dame, Fremantle, New South Wales, Australia,Department of Orthopaedics, Norwest Private Hospital, Bella Vista, Fremantle, New South Wales, Australia,Department of Orthopaedics, The Australian School of Advanced Medicine, Macquarie University, New South Wales, Australia
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Baert IAC, Lluch E, Van Glabbeek F, Nuyts R, Rufai S, Tuynman J, Struyf F, Meeus M. Short stem total hip arthroplasty: Potential explanations for persistent post-surgical thigh pain. Med Hypotheses 2017; 107:45-50. [PMID: 28915961 DOI: 10.1016/j.mehy.2017.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 12/22/2022]
Abstract
Short stem uncemented femoral implants were developed with the aim of preserving proximal bone stock for future revisions, improving biomechanical reconstruction, aiding insertion through smaller incisions and potentially decreasing or limiting the incidence of thigh pain. Despite all the advantages of short stem designs, it remains unclear whether they are able to limit post-surgical thigh pain. In patients with short stem hip arthroplasty and persistent thigh pain, it is of the utmost importance to understand the potential etiologies of this chronic pain for selecting the appropriate treatment strategy. Therefore, this manuscript explores the hypothetical etiologies of persistent thigh pain in short stem total hip arthroplasty, including both peripheral factors (structural or biomechanical causes) and central factors (involvement of the central nervous system). First, intrinsic causes (e.g. aseptic femoral loosening and prosthetic joint infection) and extrinsic sources (e.g. muscle pathology or spinal pathology) of persistent thigh pain related to hip arthroplasty are explained. In addition, other specific peripheral causes for thigh pain related to the short stem prosthetic reconstruction (e.g. stem malalignment and micro-motion) are unraveled. Second, the etiology of persistent thigh pain after short stem hip arthroplasty is interpreted in a broader concept than the biomechanical approach where peripheral structural injury is believed to be the sole driver of persistent thigh pain. Over the past decades evidence has emerged of the involvement of sensitization of central nervous system nociceptive pathways (i.e. central sensitization) in several chronic pain disorders. In this manuscript it is explained that there might be a relevant role for altered central nociceptive processing in patients with persistent pain after joint arthroplasty or revision surgery. Recognition of a potential role for centrally-mediated changes in pain processing in total hip replacement surgery has important implications for treatment. Comprehensive treatment addressing peripheral factors as well as neurophysiological changes occurring in the nervous system may help to improve outcomes in patients with short stem hip arthroplasty and chronic thigh pain. Working within a biopsychosocial approach in orthopaedic surgery, specifically in relation to total hip arthroplasty, could be very important and may lead to more satisfaction. Further research is warranted.
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Affiliation(s)
- Isabel A C Baert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Pain in Motion Research Group, Belgium(1).
| | - Enrique Lluch
- Pain in Motion Research Group, Belgium(1); Departments of Human Physiology and Rehabilitation Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Francis Van Glabbeek
- Department of Orthopaedic Surgery and Traumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Rudy Nuyts
- Department of Orthopaedic Surgery and Traumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Salim Rufai
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Joanna Tuynman
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Pain in Motion Research Group, Belgium(1); Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Amendola RL, Goetz DD, Liu SS, Callaghan JJ. Two- to 4-Year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern. Clin Orthop Relat Res 2017; 475:375-383. [PMID: 27417852 PMCID: PMC5213930 DOI: 10.1007/s11999-016-4974-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Short stem cementless femoral components were developed to aid insertion through smaller incisions, preserve metaphyseal bone, and potentially decrease or limit the incidence of thigh pain. Despite some clinical success, the senior author (DDG) believed a higher percentage of his patients who had received a cementless short stem design were experiencing thigh pain, which, coupled with concerns about bone ingrowth fixation, motivated the review of this case series. QUESTIONS/PURPOSES (1) What is the proportion of patients treated with a short stem cementless THA femoral component that develop thigh pain and what are the hip scores of this population? (2) What are the radiographic results, specifically with respect to bone ingrowth fixation and stress shielding, of this design? (3) Are there particular patient or procedural factors that are associated with thigh pain with this short stem design? METHODS Two hundred sixty-one primary THAs were performed in 238 patients by one surgeon between November 2010 and August 2012. During this time period, all patients undergoing primary THA by this surgeon received the same cementless short titanium taper stem. Seven patients (eight hips) died and five patients (five hips) were lost to followup, leaving 226 patients (248 hips) with a mean followup of 3 years (range, 2-5 years). Patients rated their thigh pain during activity or rest at final followup on a 10-point visual analog scale. Harris hip scores (HHS) were obtained at every clinic appointment. Thigh pain was evaluated at the final followup or by contacting the patient by phone. Radiographs were evaluated for bone-implant fixation, bone remodeling, and osteolysis. An attempt was made to correlate thigh pain with patient demographics, implant specifications, or radiographic findings. RESULTS Seventy-six percent of hips (180 of 238) had no thigh pain, 16% of hips (37 of 238) had mild thigh pain, and 9% (21 of 238) had moderate or severe thigh pain. Preoperatively, mean HHS was 47 (SD, 16) and at last followup, mean HHS was 88 (SD, 13). There were two femoral revisions, one for severe thigh pain and the other for infection. All but two components demonstrated bone ingrowth fixation (99%). Femoral stress shielding was mild in 64% of hips (135 of 212), moderate in 0.5% (one of 212), and severe in no hips. There is an inverse linear relationship between age and severity of thigh pain (r = -0.196; p < 0.0024). CONCLUSIONS Although reliable fixation was achieved and good HHS were attained, the frequency and severity of thigh pain with this short cementless stem were concerning. The surgeon has subsequently abandoned this short stem design and returned to a conventional length stem. Future study direction might investigate the biomechanical grounds for the thigh pain associated with this stem design. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Richard L Amendola
- Department of Orthopaedics, University of Iowa, 200 Hawkins Drive, UIHC, Iowa City, IA, 52242, USA.
| | - Devon D Goetz
- Des Moines Orthopaedic Surgeons, West Des Moines, IA, USA
| | - Steve S Liu
- Department of Orthopaedics, University of Iowa, 200 Hawkins Drive, UIHC, Iowa City, IA, 52242, USA
| | - John J Callaghan
- Department of Orthopaedics, University of Iowa, 200 Hawkins Drive, UIHC, Iowa City, IA, 52242, USA
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Shin YS, Suh DH, Park JH, Kim JL, Han SB. Comparison of Specific Femoral Short Stems and Conventional-Length Stems in Primary Cementless Total Hip Arthroplasty. Orthopedics 2016; 39:e311-7. [PMID: 26913760 DOI: 10.3928/01477447-20160222-04] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/01/2015] [Indexed: 02/03/2023]
Abstract
There are several reported disadvantages with conventional-length femoral stems in cementless total hip arthroplasty (THA). Therefore, various efforts have been made to develop a specific femoral short stem to improve physiologic bone remodeling at the femoral aspect of a cementless THA. However, there are potential disadvantages with specific femoral short stems, such as malalignment, inadvertent subsidence, and potential proximal femoral fracture. Therefore, the authors quantitatively compared radiographic and clinical outcomes as well as component-specific complications between 2 groups of patients following primary cementless THA. A matched comparison was made between specific femoral short stems (n=50) and conventional-length femoral stems (n=50) in cementless THA procedures performed between January 2008 and January 2012. Patients were matched for age, sex, body mass index, height, surgical approach, and surgeon. No significant differences were found between the 2 groups in mean postoperative radiographic outcomes, functional outcomes, or complications. Both groups showed satisfactory performance at 5-year follow-up. Specific femoral short stems resulted in a higher incidence of malalignment and subsidence and a lower incidence of thigh pain and proximal bone resorption compared with conventional-length femoral stems. Although longer follow-up is required, specific femoral short stems may have clinical and radiographic advantages with equivalent perioperative complications relative to conventional-length femoral stems. However, this technique requires proper patient selection in combination with careful preoperative planning and meticulous surgical technique.
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Early clinical and functional results of short modular femoral metaphyseal stem hip arthroplasty: a pilot study. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Comparison of Patient-Reported Outcome from Neck-Preserving, Short-Stem Arthroplasty and Resurfacing Arthroplasty in Younger Osteoarthritis Patients. Adv Orthop 2015; 2015:817689. [PMID: 26101669 PMCID: PMC4460199 DOI: 10.1155/2015/817689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/05/2015] [Indexed: 01/19/2023] Open
Abstract
Hip resurfacing has been considered a good treatment option for younger, active osteoarthritis patients. However, there are several identified issues concerning risk for neck fractures and issues related to current metal-on-metal implant designs. Neck-preserving short-stem implants have been discussed as a potential alternative, but it is yet unclear which method is better suited for younger adults. We compared hip disability and osteoarthritis outcome scores (HOOS) from a young group of patients (n = 52, age 48.9 ± 6.1 years) who had received hip resurfacing (HR) with a cohort of patients (n = 73, age 48.2 ± 6.6 years) who had received neck-preserving, short-stem implant total hip arthroplasty (THA). Additionally, durations for both types of surgery were compared. HOOS improved significantly preoperatively to last followup (>1 year) in both groups (p < 0.0001, η (2) = 0.69); there were no group effects or interactions. Surgery duration was significantly longer for resurfacing (104.4 min ± 17.8) than MiniHip surgery (62.5 min ± 14.8), U = 85.0, p < 0.0001, η (2) = 0.56. The neck-preserving short-stem approach may be preferable to resurfacing due to the less challenging surgery, similar outcome, and controversy regarding resurfacing implant designs.
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Abstract
The growing numbers of short stem hip implants have redefined total hip arthroplasty with new stem geometries and possible functional differences. Several systematic reviews have reported good clinical results with this new class of stems, although kinematic alterations are still unclear in many aspects. The good clinical results obtained at the authors' institution led to the current study. The authors hypothesized that the geometric alignment of the prosthetic components may be closer to the anatomy of the healthy hip joint, thus leading to better function and clinical satisfaction. An examination via finite element analysis was chosen to model the hip joint and virtually implant a short and a standard straight stem. Findings indicated that anchoring of the short stem allowed favorable positioning in the proximal femur, with the femoral head already in the center of the cup. This positioning was not possible for the straight stem, which required further reduction of the femur by a significant translation into the cup, leading to abnormal soft-tissue balancing. The results from the simulation showed an absolute average deviation of ligamentous fiber strains of 6% for the short stem in 30° of flexion and extension versus 29% and 36% for the standard straight stem in 30° of flexion and extension, respectively. A femoral neck guided orientation of the short stem implant seems to allow a more anatomical reconstruction and thus a more balanced hip in terms of the modeled soft tissues. In contrast, the straight stem alters the head position and induces nonphysiological capsular strains.
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