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Onoi Y, Hayashi S, Fujishiro T, Kuroda Y, Nakano N, Hiranaka T, Kuroda R, Matsumoto T. The medullary cavity morphology of the proximal femur influences the fixation pattern of the rectangular tapered short stem in total hip arthroplasty. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05500-5. [PMID: 39198309 DOI: 10.1007/s00402-024-05500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 08/14/2024] [Indexed: 09/01/2024]
Abstract
INTRODUCTION This study aimed to evaluate differences in the pattern of fixation with a rectangular tapered short stem (Fitmore stem) due to proximal femoral medullary cavity morphology based on periprosthetic bone mineral density (BMD) and radiological findings. MATERIALS AND METHODS We analyzed 105 consecutive patients (Dorr type A, 18; Dorr type B, 66; Dorr type C, 21) who underwent total hip arthroplasty using a Fitmore stem. Periprosthetic BMD was measured using dual-energy X-ray absorptiometry from 1 to 24 months postoperatively and radiological analysis was performed. Clinical outcomes were evaluated using the Harris hip score (HHS) and the University of California Los Angeles (UCLA) activity score preoperatively and 24 months postoperatively. RESULTS At 24 months postoperatively, Dorr type C had significantly decreased BMD changes in Gruen zones 2, 6, and 7 compared to Dorr types A and B, and conversely, significantly increased BMD changes in zone 4 (p < 0.05). Dorr type C had significantly greater subsidence than the other types (p < 0.01) and significantly higher cortical hypertrophy in zone 3 (p < 0.01). Stress shielding was not significantly different between Dorr types. The preoperative and postoperative HHS and UCLA activity scores showed no significant differences between the Dorr types. CONCLUSIONS In Dorr type C, BMD significantly decreased in the proximal femur with a rectangular tapered short stem, suggesting that the stem was fixed at the distal part. Careful observation of this prosthesis over time is needed in patients with Dorr type C.
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Affiliation(s)
- Yuma Onoi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Shahin M, Massé V, Belzile É, Bédard L, Angers M, Vendittoli PA. Midterm results of titanium conical Wagner stem with challenging femoral anatomy: Survivorship and unique bone remodeling. Orthop Traumatol Surg Res 2023; 109:103242. [PMID: 35158103 DOI: 10.1016/j.otsr.2022.103242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/04/2021] [Accepted: 08/31/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Complex anatomy of the proximal femur makes total hip arthroplasty (THA) more challenging. Short, straight, fluted and conical titanium stem like the Wagner Cone can be helpful to address small femoral canal, increased femoral neck version, important leg length discrepancy or proximal femoral deformity. The outcome in these patients is less assured and associated with high rate of complications. Therefore, we did a retrospective study aiming to answer: 1) can the Wagner Cone stem provide acceptable mid- to long-term implant survivorship; 2) help minimizing perioperative adverse events; 3) produce favorable clinical outcome measured by WOMAC score; and 4) be associated with a favorable radiographic femoral bone remodeling at the last follow-up? HYPOTHESIS Wagner Cone stem is an advantageous solution for the distorted proximal femur in complex THA. PATIENTS AND METHOD Our cohort was derived from the patient registries where medical records of 88 patients (103 hips) who underwent primary THA using the Wagner prosthesis were retrospectively reviewed. Then, data was analyzed for patients' demographics and surgical data, and comparing preoperative, immediate postoperative and last follow-up data. Eleven patients (12 hips) were excluded (7 hips followed up less than 2 years or lost to follow-up, 3 hips that had the Wagner stem for revision and 2 Wagner stems inserted for periprosthetic fracture). This left 77 patients (91 hips) with Wagner cone stems implanted for more than 2 years between March 2003 and February 2017 by 7 surgeons in 3 academic hospitals. Implant revision, reoperations, WOMAC score and radiographic analyses were recorded at last follow-up. RESULTS After a mean follow-up of 7.8 (range, 2.0-16.2) years, Wagner stem survivorship was 98.9% (95% CI: 94 to 100%) with one (1.1%) stem revision for failure of osteointegration. Five (5.5%) acetabular revisions, one for aseptic loosening, 2 for adverse reaction to metal debris and 2 for infection. One (1.1%) sciatic neuropathy and 4 (4.4%) intraoperative fractures were encountered. The mean WOMAC score was 90.5±11.4 (59-100). Radiographic analysis showed clear signs of stem osseointegration and hypertrophic bone remodeling in 82 cases (92.1%). CONCLUSIONS Used in complex cases with proximal distorted femurs, the Wagner Cone stem demonstrated a low complication rate, a high-rate consistent adaptive bone remodeling, excellent clinical results, and midterm survival. It is a safe, reliable and advantageous option in complex primary THA. However, the contribution of the underlying cause of the secondary osteoarthritis on the long-term survival of the stem remains to be demonstrated. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Maged Shahin
- Surgery Department, Montreal University, Hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - Vincent Massé
- Surgery Department, Montreal University, Hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada; Clinique Orthopédique Duval, 1487, boulevard des Laurentides, H7M 2Y3 Laval, Québec, Canada
| | - Étienne Belzile
- Division of Orthopaedic Surgery, CHU de Québec, Université Laval, 1401 18(e), rue, Quebec, G1J 1Z4 QC, Canada; Personalized Arthroplasty Society, 3525, Piedmont road NE, Building 5 suite 300, 30305 Atlanta, GA, USA
| | - Luc Bédard
- Division of Orthopaedic Surgery, CHU de Québec, Université Laval, 1401 18(e), rue, Quebec, G1J 1Z4 QC, Canada
| | - Michèle Angers
- Division of Orthopaedic Surgery, CHU de Québec, Université Laval, 1401 18(e), rue, Quebec, G1J 1Z4 QC, Canada
| | - Pascal-André Vendittoli
- Surgery Department, Montreal University, Hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada; Clinique Orthopédique Duval, 1487, boulevard des Laurentides, H7M 2Y3 Laval, Québec, Canada; Personalized Arthroplasty Society, 3525, Piedmont road NE, Building 5 suite 300, 30305 Atlanta, GA, USA.
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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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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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