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Baldwin TJ, Deckard ER, Buller LT, Meneghini RM. Incidence and Predictors of Subsidence Using Modular, Tapered, Fluted Titanium Femoral Stems in Aseptic Revision Total Hip Arthroplasty. J Arthroplasty 2024; 39:1304-1311. [PMID: 37924992 DOI: 10.1016/j.arth.2023.10.057] [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: 09/05/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Tapered, fluted titanium (TFT) femoral stems have become the gold standard in revision total hip arthroplasty (rTHA). However, there is a paucity of data on TFT stem subsidence rates following aseptic rTHA. Subsidence can lead to instability, mechanical failure, leg-length discrepancy, and may require revision surgery. This study evaluated the incidences and predictors of TFT subsidence in aseptic rTHA. METHODS A total of 102 TFT femoral stems of 4 designs were retrospectively reviewed. Stem subsidence was measured on digital radiographs taken immediately after surgery and at standard clinical follow-up. Patient characteristics, risk factors for subsidence, revision etiologies, and implant characteristics were recorded. Patient-reported outcome measures were also evaluated for a subset of cases. RESULTS Overall, 12% of stems subsided >1 cm, and subsidence was minimal (<3 mm) in ≥64% of cases. From immediate postoperative to 1-month radiographic follow-up, 79% of stems subsided a mean of 2.9 mm (range, 0.1 to 12 mm). Beyond 1 month, subsidence was minimal for ≥77% of cases. In multivariate analyses, women and less femoral implant canal fill were associated with greater subsidence (P ≤ .034). The TFT stem design was not associated with early subsidence (P = .816). There were no modular junction fractures. There were 2 fractures and 2 subsidence-related revisions for aseptic loosening that occurred postoperatively. CONCLUSIONS The amount of subsidence in TFT stems was low and was detectable in the early (less than 1 year) postoperative period. Maximizing TFT stem fill within the femoral canal appears to reduce the risk of subsidence without increasing femoral fracture rates and should be the goal with implantation of these devices. LEVEL OF EVIDENCE IV-Case Series, No Control Group.
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Affiliation(s)
- Thomas J Baldwin
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - Leonard T Buller
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana Joint Replacement Institute, Indianapolis, Indiana
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Żarnowska I, Wilk B, Chilińska M, Kołodziejczyk K, Garlewicz R, Zlotorowicz M. Bone Quality Assessment Before Total Hip Arthroplasty: The Role of Densitometry. Cureus 2024; 16:e55480. [PMID: 38571835 PMCID: PMC10989206 DOI: 10.7759/cureus.55480] [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: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Background Total hip arthroplasty (THA) is effective in the treatment of hip osteoarthritis. Radiographic evaluation, standard in THA planning, is sufficient in examining hip anatomy, although it may not precisely assess bone quality. A routinely implemented method in bone quality assessment is densitometry. The technique allows for a measurement of bone mineral density (BMD). Methodology In the study, we included 26 participants who qualified for THA. All the patients were preoperatively examined with radiographs and densitometry of the affected hip. On the preoperative anteroposterior radiograph, we measured the canal-to-calcar isthmus ratio (CC ratio) and the cortical index (CI). Intraoperatively, during the THA procedure, we measured the thickness of the cortical bone and the diameter of the femoral neck in the line of neck resection. Results The examination with Pearson's correlation coefficient revealed that BMD significantly positively correlates with the intraoperatively measured diameter of the femoral neck (r = 0.5, P = 0.009), and with the measured thickness of the cortical bone (r = 0.47, P = 0.015), CI significantly positively correlates with the intraoperatively measured diameter of the femoral neck (r = 0.6, P = 0.001), and with the CC ratio (r = 0.44, P = 0.024), the intraoperatively measured diameter of the femoral neck significantly positively correlates with the intraoperatively measured thickness of the cortical bone (r = 0.59, P = 0.001). All of the other correlations were not statistically significant. Conclusions BMD measurements can be used in THA planning as they positively correlate with intraoperative measurements. The radiological parameters (CC ratio and CI) may not be as precise in bone quality assessment.
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Affiliation(s)
- Iga Żarnowska
- Department of Internal Medicine, Warsaw Southern Hospital, Warsaw, POL
| | - Bartłomiej Wilk
- Department of Orthopedics and Traumatology, Medical University of Warsaw, Warsaw, POL
| | - Milena Chilińska
- Department of Spine Disorders and Orthopaedics, Gruca Teaching Hospital, Otwock, POL
| | - Kamil Kołodziejczyk
- Department of Orthopedics, Pediatric Orthopedics, and Traumatology, Gruca Teaching Hospital, Otwock, POL
| | - Rafał Garlewicz
- Department of Orthopedics, Pediatric Orthopedics, and Traumatology, Gruca Teaching Hospital, Otwock, POL
| | - Marcin Zlotorowicz
- Department of Orthopedics, Pediatric Orthopedics, and Traumatology, Gruca Teaching Hospital, Otwock, POL
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Chun YS, Lee HH, Lim YW, Kim YS, Kwon SY, Kim SC. Incidence and outcomes of intraoperative periprosthetic acetabular fractures during cementless total hip arthroplasty: a prospective three-dimensional computer tomography-based study. INTERNATIONAL ORTHOPAEDICS 2024; 48:667-674. [PMID: 37723316 DOI: 10.1007/s00264-023-05988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE Unlike periprosthetic femoral fractures, periprosthetic acetabular fractures during total hip arthroplasty (THA) have not been evaluated in detail. We prospectively evaluated the incidence, patterns, risk factors, and clinical outcomes of intraoperative periprosthetic acetabular fractures using pre- and postoperative computer tomography (CT). METHODS In this prospective single-centre study, we evaluated 234 consecutive patients (250 hips) who underwent THA and three-dimensional CT before and after the surgery. We assessed the incidence, pattern of fractures, outcomes for each fracture pattern, reoperation and revision rates, Harris hip score, and visual analog scale (VAS) for pain. Multivariate regression models were used to identify risk factors for periprosthetic acetabular fractures. RESULTS In total, 43 periprosthetic acetabular fractures (17.2%) were identified via CT. Fractures occurred most frequently at the superolateral wall. Early cup migration occurred in three hips. None of the patients underwent revision surgery for acetabular loosening. Regression modeling showed that rheumatoid arthritis was a significant predictor of periprosthetic acetabular fractures. CONCLUSIONS Periprosthetic acetabular fractures are not infrequent during cementless THA and are more common in patients with rheumatoid arthritis.
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Affiliation(s)
- You-Seung Chun
- Department of Orthopaedic Surgery, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Chunbo-Ro 271, Uijeongbu, Gyeonggi-Do, South Korea
| | - Hwan-Hee Lee
- Department of Orthopaedic Surgery, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daeheung-Ro 64, Daejeon, South Korea
| | - Young-Wook Lim
- Department of Orthopaedic Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpodae-Ro 222, Seocho-Gu, Seoul, South Korea
| | - Yong-Sik Kim
- Department of Orthopaedic Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpodae-Ro 222, Seocho-Gu, Seoul, South Korea
| | - Soon-Yong Kwon
- Department of Orthopaedic Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpodae-Ro 222, Seocho-Gu, Seoul, South Korea
| | - Seung-Chan Kim
- Department of Orthopaedic Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Tongil-Ro 1021, Eunpyeong-Gu, Seoul, South Korea.
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Woerner M, Koehn A, Morris P, Weber M, Renkawitz T, Grifka J, Craiovan B. Influence of avascular necrosis of the femoral head on hip prosthesis integration: a radiological analysis. Acta Radiol 2024; 65:76-83. [PMID: 37376763 DOI: 10.1177/02841851231183707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Avascular osteonecrosis of the femoral head (AVN) often results in total hip arthroplasty (THA). The cause for increased THA revision rates among patients with AVN is not yet fully understood. PURPOSE To perform a comparative radiological analysis of implant integration between patients with AVN and osteoarthritis (OA). MATERIAL AND METHODS After a matched pair analysis of 58 patients, 30 received THA due to OA, 28 due to AVN. X-ray images were evaluated after one week ("baseline") and on average 37.58 months postoperatively ("endline"). The prosthesis was grouped into 10 regions of interest (ROI): seven femoral and three acetabular. Incidence, width, and extent of "radiolucent lines" were measured within each zone. RESULTS Between baseline and endline, width and extent progressed more noticeably in all femoral and acetabular zones among patients with AVN. In femoral ROI 1, the width increased in 40% of AVN cases compared to 6.7% of OA cases. For acetabular ROI 3, the width increased in 26.7% of AVN cases compared to no perceived changes in the OA group. No signs of prosthetic loosening were found in the AVN group. CONCLUSION The increase of width and extent of radiolucent lines over time in patients with AVN could be a sign of lack of osteointegration. However, prosthetic loosening in absence of clinical symptoms cannot be deduced from radiological findings after medium-term postoperative follow-up. Further long-term studies are required to monitor how radiolucent lines develop in respect to long-term implant loosening. Dependent on bone quality, individually adapted reaming and broaching of the implant site are recommended.
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Affiliation(s)
- Michael Woerner
- Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany
| | - Anna Koehn
- Department of Orthopedics, Regensburg University Medical Center, Bad Abbach, Germany
| | - Patrick Morris
- Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany
| | - Markus Weber
- Department of Orthopedics, Regensburg University Medical Center, Bad Abbach, Germany
| | - Tobias Renkawitz
- Department of Orthopedics, Heidelberg University, Heidelberg, Germany
| | - Joachim Grifka
- Department of Orthopedics, Regensburg University Medical Center, Bad Abbach, Germany
| | - Benjamin Craiovan
- Endoprothetik im Zentrum Orthopädie und Unfallchirurgie, Philipps-Universität Marburg Fachbereich Medizin, Marburg, Germany
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Klasan A, Bayan A, Holdaway I, Farrington WJ. Liner type has no impact on bone mineral density changes around a 3D printed trabecular titanium acetabular component. Orthop Traumatol Surg Res 2023; 109:103136. [PMID: 34715391 DOI: 10.1016/j.otsr.2021.103136] [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: 09/01/2020] [Revised: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Three-dimensional printing of implants allows the ability to produce implants and interfaces which theoretically better mimic "normal" bone behaviour, leading to a possible reduction in stress shielding thus maintaining bone mineral density (BMD). This issue was not investigated in vivo using bone scan and different bearings; therefore, we did a prospective study aiming to answer: 1) is there a loss of BMD around the 3D printed trabecular titanium cup, when compared to the native hip?; 2) does liner type influence the BMD changes around the acetabulum when a 3D printed trabecular titanium cup is used? HYPOTHESIS BMD changes around the acetabulum are not influenced by the liner type, and the cup will be associated with a reduction in BMD when compared to the native hip. MATERIAL AND METHODS This is a prospective observational study of patients receiving a primary total hip arthroplasty. A 3D printed trabecular titanium uncemented acetabular component was used in all cases. All patients received a ceramic femoral head, with either a ceramic or polyethylene acetabular liner. BMD measurements using DXA were performed at 6 weeks, 6, 12 and 24 months after surgery to evaluate remodeling changes. The 3 acetabular regions of interest (ROI) of DeLee and Charnley were used for serial comparisons of peri-acetabular BMD. The study was powered as a non-inferiority study with the principle variables compared using a two-step repeated analysis of variance. RESULTS A total of 48 consecutive patients were included in the study, with all patients completing their 2 year follow-up. There were no failures, revisions or complications within this cohort. We found no statistically significant difference in the BMD change scores between the operated and the native hip in any of the 3 ROI zones. We found no differences in BMD scores when comparing ceramic to polyethylene acetabular liners, head sizes and BMI. DISCUSSION This study shows a similar pattern of BMD behaviour around a 3D printed cup when compared to the contralateral native hip. We were unable to show a clinical or radiological difference between the bearing material, head size, or BMI when used with this type of acetabular component. LEVEL OF EVIDENCE III; prospective comparative study.
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Affiliation(s)
- Antonio Klasan
- North Shore Hospital, 124, Shakespeare Road, Takapuna, 0620 Auckland, New Zealand; Kepler University Hospital Linz, Krankenhausstr. 9, 4020 Linz, Austria; Johannes-Kepler University Linz, Altenbergerstr. 69, 4040 Linz, Austria.
| | - Ali Bayan
- North Shore Hospital, 124, Shakespeare Road, Takapuna, 0620 Auckland, New Zealand
| | - Ian Holdaway
- Auckland City Hospital, 2, Park Road, Grafton, 1023 Auckland, New Zealand
| | - William J Farrington
- North Shore Hospital, 124, Shakespeare Road, Takapuna, 0620 Auckland, New Zealand
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Gaujac N, Sariali E, Grimal Q. Does the bone mineral density measured on a preoperative CT scan before total hip arthroplasty reflect the bone's mechanical properties? Orthop Traumatol Surg Res 2023; 109:103348. [PMID: 35688378 DOI: 10.1016/j.otsr.2022.103348] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION No method exists to quantify the bone quality and factors that will ensure osteointegration of total hip arthroplasty (THA) implants. A preoperative CT scan can be used to evaluate the bone mineral density (BMD) when planning a THA procedure. The aim of this study was to validate BMD measurement as a marker of bone quality based on a preoperative CT scan. HYPOTHESIS BMD reflects the bone's mechanical properties for the purposes of preoperative THA planning. METHODS Patients who underwent primary THA for hip osteoarthritis or dysplasia with cementless implants and 3D preoperative plan were enrolled prospectively. The cortical BMD was calculated on CT scans used in the preoperative planning process. During the surgical procedure, the femoral head and neck were collected. These bone samples were subsequently scanned with a calibrated micro-CT scanner. The BMD was derived from the micro-CT scan and used as input for a finite element model to determine the bone's mechanical properties. Correlations between BMD, apparent moduli of elasticity and porosity were calculated. RESULTS The values of cortical BMD measured on the micro-CT and CT scan were significantly correlated (cc=0.52). The mean angular cortical BMD measured with the micro-CT scan was 1472.33mg/cm3 (SD: 357.53mg/cm3, 980.64-2830.6mg/cm3). There was no significant correlation between cortical BMD and the various apparent moduli of elasticity, except for Eyy and Gzy. Cortical BMD and porosity were inversely correlated with a Spearman coefficient of -0.41 (CI95: [-0.71; -0.02], p=0.03). There was also an inverse correlation between the apparent moduli of elasticity (independent of their orientation) and porosity (p<0.01). DISCUSSION BMD provides information about porosity, which is a major factor when evaluating the bone's mechanical properties before THA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nicolas Gaujac
- Department of Orthopaedic Surgery, Hôpital La Pitié Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Elhadi Sariali
- Department of Orthopaedic Surgery, Hôpital La Pitié Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Quentin Grimal
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, 15, rue de l'Ecole de Médecine, 75006 Paris, France
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Siemssen N, Friesecke C, Wolff C, Beller G, Wassilew K, Neuner B, Schönfeld H, Pruß A. [A clinical radiological score for femoral head grafts : Establishment of the Tabea FK score to ensure the quality of human femoral head grafts]. DER ORTHOPADE 2021; 50:471-480. [PMID: 32642941 PMCID: PMC8589819 DOI: 10.1007/s00132-020-03941-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Transplantation of cancellous tissue from human femoral heads (FK) is an established method in the reconstruction of bony defects in orthopedic and trauma surgery. Standardized rating systems with respect to the morphological quality of this tissue are not available. MATERIALS AND METHODS In 91/105 patients who had been a regular, clinically-indicated surgery (arthroplasty of the hip joint) the respective femoral head (FK) was taken under standardized conditions. Using a checklist defined clinical and radiological criteria of FK are judged in terms of their quality (cysts, necrosis, calcification, deformities, osteoporosis) and divided by the Tabea FK score into three classes (best/middle/poor quality). This was followed by a blinded repeated scoring, now as macroscopic assessment of three sawed layers from the same femoral head. The femoral heads are examined by peripheral quantitative computed tomography (pQCT) and a standardized histological examination of the bony tissue. We evaluated the accordance of the Tabea FK score with complementary assessments by calculation of sensitivity and specificity. RESULTS Femoral heads from 91/105 patients (ages: 68.4 ± 9.9 , n = 60 women, n = 31 men) were explanted and included in the study. The correlation between the primary radiologic clinical score (Tabea FK score) and the macroscopic second review of the sawn FK with respect to middle/best and poor/middle quality was classified as good (sensitivity 77% and 81%, respectively; specificity 76% and 84%, respectively). The correlation of histology and macroscopic second review was worse and in relation to discrimination of middle/best and poor/middle quality had a sensitivity of 85% and 54%, respectively, and a specificity of 66% and 97%, respectively. The pQCT showed a sensitivity of 82% only in discrimination of middle/best, while sensitivity in discrimination of poor/middle and poor/middle + best, respectively, was <10%. DISCUSSION The corresponding correlation between the primary and the second clinical score was evaluated as good. This emphasizes the long-standing skills of operationally active orthopedic surgeons to classify the quality of cancellous bone correctly already on the basis of X‑ray images and intraoperative findings. In this respect, the introduction of the Tabea FK score as a quality assurance tool in the routines of bone banks can be recommended.
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Affiliation(s)
- Nicolaus Siemssen
- Abteilung für Endoprothetik und Gelenkchirurgie, Krankenhaus Tabea GmbH & Co. KG, Kösterbergstr. 32, 22587, Hamburg, Deutschland
| | - Christian Friesecke
- Abteilung für Endoprothetik und Gelenkchirurgie, Krankenhaus Tabea GmbH & Co. KG, Kösterbergstr. 32, 22587, Hamburg, Deutschland
| | - Christine Wolff
- Abteilung für Endoprothetik und Gelenkchirurgie, Krankenhaus Tabea GmbH & Co. KG, Kösterbergstr. 32, 22587, Hamburg, Deutschland
| | - Gisela Beller
- Zentrum für Muskel- und Knochenforschung, Charité - Universitätsmedizin Berlin, CBF, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Katharina Wassilew
- Fachbereich Pathologie, Deutsches Herzzentrum Berlin (DHZB), Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Bruno Neuner
- Klinik für Anästhesiologie m.S. operative Intensivmedizin, Charité - Universitätsmedizin Berlin, CCM, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Helge Schönfeld
- Univ.-Gewebebank, Institut für Transfusionsmedizin, Charité - Universitätsmedizin Berlin, CCM, Charitéplatz 1, 10117, Berlin, Deutschland.
- Institut für Laboratoriumsmedizin, Klinische Chemie und Pathobiochemie, Charité - Universitätsmedizin Berlin, CVK, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - Axel Pruß
- Univ.-Gewebebank, Institut für Transfusionsmedizin, Charité - Universitätsmedizin Berlin, CCM, Charitéplatz 1, 10117, Berlin, Deutschland
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Lin CC, Yang CC, Yu TC. Comparison of Mid-term Survivorship and Clinical Outcomes between Bipolar Hemiarthroplasty and Total Hip Arthroplasty with Cementless Stem: A Multicenter Retrospective Study. Orthop Surg 2019; 11:221-228. [PMID: 30977594 PMCID: PMC6594502 DOI: 10.1111/os.12440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/11/2018] [Accepted: 04/15/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare the clinical outcome between bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) using a U2 HA cementless hip stem, and the results of elderly femoral neck fracture patients who underwent BHA with a cementless hip stem. Methods A multicenter retrospective study enrolled 96 BHA and 115 THA cases using U2 HA cementless hip stems with mean age (BHA: 67.9 years; THA: 64.1 years), body height (BHA: 160.4 cm; THA: 160.7 cm) and weight (BHA: 62.7 kg; THA: 64.5 kg) recorded. Mean follow‐up durations were, respectively, 7.1 (BHA) and 7.8 (THA) years. Survivorship analyses and Oxford hip scores were compared. Results Both the BHA and the THA groups revealed high survival rates at 5‐year (100%) and 10‐year (100.0% and 90.1%) follow‐up. The THA group achieved better joint performance and pain relief. The cementless HA stems had survived perfectly for 10 years for elderly femoral neck fracture patients following BHA. Conclusions The U2 HA cementless hip stem provides an effective solution for both BHA and THA surgeries, and for elderly femoral neck fracture patients undergoing BHA. According to the findings of the current study, THA may be inadequate for addressing avascular necrosis, and pain control is a considerable concern for patients who have undergone BHA.
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Affiliation(s)
- Chen-Chiang Lin
- Department of Orthopaedic Surgery, National Taiwan University Hospital (Yulin Branch), Yulin, Taiwan
| | - Chang-Chen Yang
- Department of Orthopaedic Surgery, Tzu-Chi Hospital Dalin Branch, Chiayi, Taiwan
| | - Tzai-Chiu Yu
- Department of Orthopaedic Surgery, Taipei Tzu-Chi Hospital, New Taipei City, Taiwan
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Grant TW, Lovro LR, Licini DJ, Warth LC, Ziemba-Davis M, Meneghini RM. Cementless Tapered Wedge Femoral Stems Decrease Subsidence in Obese Patients Compared to Traditional Fit-and-Fill Stems. J Arthroplasty 2017; 32:891-897. [PMID: 27793497 DOI: 10.1016/j.arth.2016.09.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/01/2016] [Accepted: 09/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Femoral component stability and resistance to subsidence is critical for osseointegration and clinical success in cementless total hip arthroplasty. The purpose of this study was to radiographically evaluate the anatomic fit and subsidence of 2 different proximally tapered, porous-coated modern cementless femoral component designs. METHODS A retrospective cohort study of 126 consecutive cementless total hip arthroplasties was performed. Traditional fit-and-fill stems were implanted in the first 61 hips with the remaining 65 receiving morphometric tapered wedge stems. Preoperative bone morphology was radiographically assessed by the canal flare index. Canal fill in the coronal plane, subsidence, and the sagittal alignment of stems was measured digitally on immediate and 1-month postoperative radiographs. RESULTS Demographics and canal flare indices were similar between groups. The percentage of femoral canal fill was greater in the tapered wedge compared to the fit-and-fill stem (P = .001). There was significantly less subsidence in the tapered wedge design (0.3 mm) compared to the fit-and-fill design (1.1 mm) (P = .001). Subsidence significantly increased as body mass index (BMI) increased in the fit-and-fill stems, a finding not observed in the tapered wedge design (P = .013). CONCLUSION An anatomically designed morphometric tapered wedge femoral stem demonstrated greater axial stability and decreased subsidence with increasing BMI than a traditional fit-and-fill stem. The resistance to subsidence, irrespective of BMI, is likely due to the inherent axial stability of a tapered wedge design and may be the optimal stem design for obese patients.
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Affiliation(s)
- Tanner W Grant
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Luke R Lovro
- IU Health Saxony Hospital, Orthopedics, Indiana University Health Physicians Orthopedics and Sports Medicine, Fishers, Indiana
| | - David J Licini
- IU Health Bloomington Hospital, Orthopedics, Indiana University Health Southern Indiana Physicians, Bloomington, Indiana
| | - Lucian C Warth
- IU Health Saxony Hospital, Orthopedics, Indiana University Health Physicians Orthopedics and Sports Medicine, Fishers, Indiana
| | - Mary Ziemba-Davis
- IU Health Saxony Hospital, Orthopedics, Indiana University Health Physicians Orthopedics and Sports Medicine, Fishers, Indiana
| | - Robert M Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; IU Health Saxony Hospital, Orthopedics, Indiana University Health Physicians Orthopedics and Sports Medicine, Fishers, Indiana
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Craiovan B, Woerner M, Winkler S, Springorum HR, Grifka J, Renkawitz T, Keshmiri A. Decreased femoral periprosthetic bone mineral density: a comparative study using DXA in patients after cementless total hip arthroplasty with osteonecrosis of the femoral head versus primary osteoarthritis. Arch Orthop Trauma Surg 2016; 136:709-13. [PMID: 26891850 DOI: 10.1007/s00402-016-2423-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Trabecular properties in osteonecrosis of the femoral head (ONFH) are altered for bone volume and structure in the femoral head and proximal femoral canal. We analysed the periprosthetic bone mineral density (BMD) as a correlate to bony ingrowth in patients with ONFH who received a cementless THA. MATERIALS AND METHODS We performed a matched-pair analysis of 100 patients with ONFH (n = 50) and primary osteoarthritis (n = 50) who received the same, unilateral cementless THA. We compared the periprosthetic BMD 5 years after surgery by means of dual energy X-ray absorptiometry (DXA) analysing the seven femoral regions of interest (ROIs) according to Gruen. RESULTS Within the ONFH group, significantly lower BMD values were found in the ROI 1 and 7 (p < 0.05). No statistically significant difference was found for ROIs 2-6. CONCLUSIONS An altered periprosthetic bone stock in the proximal femur in patients with prior ONFH might be a possible risk factor for premature loosening of the femoral stem in THA. Surgeons need to consider coating and fixation philosophy of cementless implants when choosing the right stem for patients with ONFH.
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Affiliation(s)
- Benjamin Craiovan
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Michael Woerner
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Sebastian Winkler
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Hans-Robert Springorum
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Tobias Renkawitz
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Armin Keshmiri
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
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