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Freitag T, Fuchs M, Friedrich D, Bieger R, Reichel H, Oltmanns M. The Migration Pattern of a Short-Tapered Femoral Stem Correlates with the Occurrence of Cortical Hypertrophies: A 10-Year Longitudinal Study Using Ein Bild Röntgen Analyse-Femoral Component Analysis. J Clin Med 2024; 13:3616. [PMID: 38930145 DOI: 10.3390/jcm13123616] [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: 05/28/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Shorter hip stems have shown promising mid-term results but lack long-term data. High rates of distal cortical hypertrophy (CH) have been described, suggesting a more diaphyseal load transmission. This study aimed to determine patient-specific and surgery-related factors influencing CH and their impact on 10-year outcomes. Methods: It included 100 consecutive total hip arthroplasties (THAs) using the Fitmore stem (Zimmer, Warsaw, Indiana), with clinical and radiographic follow-ups at 1, 2, 5, and at least 10 years post-surgery. Results: No revisions were performed due to aseptic loosening after a mean of 11.6 years (range: 10-13.5 years). CH was observed in 26% of hips, primarily in Gruen zones 3 and 5. There was no significant difference in the Harris Hip Score between patients with and without CH. Larger stem sizes and greater axial subsidence significantly correlated with CH occurrence (OD 1.80, (1.13-1.92), p = 0.004; OD 1.47, (1.04-2.08), p = 0.028). The Fitmore stem demonstrated excellent survival rates and favorable outcomes over 10 years. Conclusions: Despite a lower CH rate compared to other studies, significant correlations with stem size and subsidence were identified. This study underscores the importance of patient selection and achieving high primary stability to maintain the metaphyseal anchoring concept.
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Affiliation(s)
- Tobias Freitag
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Michael Fuchs
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - David Friedrich
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Ralf Bieger
- Center for Knee, Hip and Shoulder Surgery, Schoen Clinic München Harlaching, Harlachinger Strasse 51, 81547 Munich, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Moritz Oltmanns
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
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Outcome of the Wagner Cone femoral component for difficult anatomical conditions during total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:117-124. [PMID: 36224431 DOI: 10.1007/s00264-022-05608-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Total hip arthroplasty (THA) in patients with small or unusual proximal femoral anatomy is challenging due to sizing issues, control of version, and implant fixation. The Wagner Cone is a monoblock, fluted, tapered stem with successful outcomes for these patients; however, there is limited information on subsidence, a common finding with cementless stems. METHODS We retrospectively reviewed our cases using the modified Wagner Cone (Zimmer, Warsaw, IN) implanted over a 13-year period (2006-2019) in patients with small or abnormal proximal femoral anatomy. We performed 144 primary THAs in 114 patients using this prosthesis. Mean follow-up was 4.5 ± 3.4 years (range, 1-13 years). Common reasons for implantation were hip dysplasia (52%) and osteoarthritis in patients with small femoral proportions (22%). Analysis of outcomes included assessment of stem subsidence and stability. RESULTS Survival was 98.6% in aseptic cases; revision-free survival was 97.9%. Femoral subsidence occurred in 84 cases (58%). No subsidence progressed after 3 months. Of those that subsided, the mean distance was 2.8 ± 2.0 mm. There was less subsidence in stems that stabilized prior to six weeks (2.2 ± 1.4 mm) compared to those that continued until 12 weeks (3.9 ± 1.6, p = 0.02). Harris Hip, UCLA, and WOMAC scores significantly improved from pre-operative evaluation (p < 0.001*, p < 0.003*, p ≪ 0.001*); there was no difference in outcome between patients with and without subsidence (p = 0.430, p = 0.228, p = 0.147). CONCLUSION The modified Wagner Cone demonstrates excellent clinical outcomes in patients with challenging proximal femoral anatomy. Subsidence is minor, stops by 3 months, and does not compromise clinical outcome.
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Good mid-term results with the trident peripheral self-locking cup: a clinical evaluation and migration measurement with EBRA. Arch Orthop Trauma Surg 2021; 141:327-332. [PMID: 33164141 PMCID: PMC7886724 DOI: 10.1007/s00402-020-03639-5] [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: 05/06/2020] [Accepted: 10/15/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The most common cause of failure in total hip arthroplasty (THA) is aseptic loosening. Uncemented cup migration analysis by means of Einzel-Bild-Roentgen-Analyse (EBRA) has shown to be a good predictive indicator for early implant failure if the cup migrates more than 2 mm within 4 years after surgery. In this study, we performed a migration analysis of an uncemented peripheral self-locking (PSL) press-fit cup after 4 years follow-up. MATERIALS AND METHODS We retrospectively reviewed all patients who received a trident PSL press-fit cup at our department between 2004 and 2017. A total of 636 patients were identified. As inclusion criteria for radiological analysis, a minimum follow-up of 2 years was defined. We reviewed medical histories and performed radiological analysis using EBRA software. EBRA measurements and statistical investigations were performed by two independent investigators. RESULTS A total of 149 cups in 146 patients (female 82; male 64) met our inclusion criteria. Mean age at surgery was 65 years (33-89). We found a significant improvement in the WOMAC score pre- to postoperative (p < 0.0001). EBRA migration analysis showed a mean total migration of 0.6 mm (0.0-8.2) over our follow-up period of 4 years. Of the investigated cups, 69.8% showed a migration rate smaller than 2 mm in the investigated follow-up. CONCLUSION The acetabular cup used in our study provides low migration at final follow-up. Therefore, a good long-term outcome can be expected for the PSL cup. TRIAL REGISTRATION Trial registration number is 20181024-1875 and date of registration is 2018-10-24.
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Outcome and EBRA migration analysis of a reconstruction cage in acetabular revision arthroplasty: a clinical and radiological study. Arch Orthop Trauma Surg 2021; 141:509-516. [PMID: 33354743 PMCID: PMC7900083 DOI: 10.1007/s00402-020-03722-x] [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: 09/18/2020] [Accepted: 12/06/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Restoration cages and bone allografts have been proposed to manage severe acetabular bone defects. We aimed to investigate the migration behaviour of a restoration cup and impacted allograft bone in severe acetabular defects with Einzel-Bild-Röntgen-Analyse (EBRA). METHODS Applying a retrospective study design, 64 cases treated between 2009 and 2016 were reviewed. We determined the preoperative Charlson Comorbidity Index (CCI), pre- to postoperative WOMAC score, blood loss and functional outcome. From preoperative x rays, the acetabular deficiencies were classified according to Paprosky. Cup migration analyses were performed with EBRA. RESULTS Mean age at surgery was 73 (range: 38-93) years. According to the classification by Paprosky et al., 50% (n = 32) of our patients showed a type III B and 28.1% (n = 18) a type III A defect. Radiological follow-up for migration analysis was 35 (range: 4-95) months. Migration analysis showed a mean cup migration of 0.7 mm (range: 5.7-9.6) medial and 1.8 mm (range: 1.7-12.6) cranial. CONCLUSION In conclusion, acetabular restoration cages in combination with bone impaction grafting showed a low revision rate at a mean follow-up of 35 months. Mean cup migration revealed low rates after 2 years and suggested a stable postoperative implant position.
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Two-year radiologic assessment of the Pinnacle cup-a migration analysis with EBRA. Arch Orthop Trauma Surg 2021; 141:149-154. [PMID: 33128095 PMCID: PMC7815589 DOI: 10.1007/s00402-020-03648-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/15/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The most common cause of failure in total hip arthroplasty (THA) is aseptic loosening. Uncemented cup migration analysis by EBRA (Einzel-Bild-Roentgen-Analyse) has shown to be a good predictive indicator for early implant failure if the cup migrates more than 1 milimeter (mm) within the first 2 years after surgery. In this study, we investigated the migration behaviour of an uncemented press-fit cup after 2 years follow-up. MATERIALS AND METHODS Applying a retrospective study design, we reviewed all consecutive patients who received an uncemented press-fit cup at our Department between 2013 and 2018. A total of 484 patients were identified. We reviewed medical histories and performed radiological measurements using EBRA-Cup software. EBRA measurements and statistical investigations were performed by two independent investigators. RESULTS A total of 165 cups in 159 patients (female: 90; male: 69) met our inclusion criteria. Mean age at surgery was 66.7 (range 18.4-90.5) years. EBRA migration analysis showed a mean total migration of 0.7 mm (range 0.0-6.3) over our follow-up period of 2 years. Of the investigated cups, 53.2% showed less than 1 mm migration in the investigated follow-up period. CONCLUSION In conclusion, the Pinnacle cup used in our study provides low mean migration at final follow-up. Based on the assumption of secondary stabilization, good long-term outcome of the Pinnacle cup can be expected. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION Number: 20181024-1875; Date: 2018-09-20.
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Bone remodelling and integration of two different types of short stem: a dual-energy X-ray - absorptiometry study. INTERNATIONAL ORTHOPAEDICS 2020; 44:839-846. [PMID: 32219497 DOI: 10.1007/s00264-020-04545-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Different kinds of bone preserving hip stems have been created to assure a more physiological distribution of the strengths on the femur. The aim of this research is to evaluate the density reaction of the periprosthetic bone while changing the conformation of the prosthetic implant on dual-energy X-ray - absorptiometry (DXA). METHODS This is a prospective, single-centre study assessing bone remodelling changes after implantation of two short hip stems, dividing the patients in two groups according to the implant used: 20 in group A, Metha (B-Braun), and 16 in group B, SMF (Smith and Nephew). All participants had a pre-operative and a post-operative (24 months) DXA evaluating the changes in bone mass density (BMD) occurred in the five Gruen's zones. RESULTS Compared to the pre-operative value, differences in BMD percentage were statistically significant only in ROI 4 (p < 0.05), with an increase in both groups (9 and 18%, respectively). The average increase in BMD was of 7.3% and 7.2% in the 2 groups. CONCLUSION According to our study, both stems have proved able to provide good load distribution across the metaphyseal region favouring proper system integration. Nonetheless, is certainly needed to perform other studies with longer follow-up and bigger populations to give strength to these conclusions.
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Morosato F, Traina F, Cristofolini L. Effect of different motor tasks on hip cup primary stability and on the strains in the periacetabular bone: An in vitro study. Clin Biomech (Bristol, Avon) 2019; 70:137-145. [PMID: 31491739 DOI: 10.1016/j.clinbiomech.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/03/2019] [Accepted: 08/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excessive prosthesis/bone motions and the bone strains around the acetabulum may prevent osteointegration and lead to cup loosening. These two factors depend on post-operative joint loading. We investigated how Walking (which is often simulated) and Standing-Up from seated (possibly more critical) influence the cup primary stability and periacetabular strains. METHODS Twelve composite hemipelvises were used in two test campaigns. Simplified loading conditions were adopted to simulate Walking and Standing-Up. For each motor task, a single-direction force was applied in load packages of increasing amplitude. Stable and unstable uncemented cups were implanted. Digital image correlation was used to measure implant/bone motions (three-dimensional translations and rotations, both permanent and inducible), and the strain distribution around the acetabulum. FINDINGS When stable implants were tested, higher permanent cranial translations were found during Walking (however the resultant migrations were comparable with Standing-Up); higher rotations were found for Standing-Up. When unstable implants were tested, motions were 1-2 order of magnitude higher. Strains increased significantly from stable to unstable implants. The peak strains were in the superior aspect of the acetabulum during Walking and in the superior-posterior aspect of the acetabulum and at the bottom of the posterior column during Standing-Up. INTERPRETATION Different cup migration trends were caused by simulated Walking and Standing-Up, both similar to those observed clinically. The cup mobilization pattern depended on the different simulated motor tasks. Pre-clinical testing of new uncemented cups could include simulation of both motor tasks. Our study could also translate to indication of what tasks should be avoided.
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Affiliation(s)
- Federico Morosato
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Francesco Traina
- Second Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
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Kabelitz M, Fritz Y, Grueninger P, Meier C, Fries P, Dietrich M. Cementless Stem for Femoral Neck Fractures in a Patient’s 10th Decade of Life: High Rate of Periprosthetic Fractures. Geriatr Orthop Surg Rehabil 2018; 9:2151459318765381. [PMID: 29623237 PMCID: PMC5881960 DOI: 10.1177/2151459318765381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/28/2018] [Accepted: 02/15/2018] [Indexed: 01/22/2023] Open
Abstract
Background: Subsidence of cementless femoral stems in hemiarthroplasty (HA) and increased fracture rates are ongoing concerns of orthopedic surgeons when treating fractures in very old patients. Additionally, bone cement implantation syndrome may result in perioperative cardiac or pulmonary complications, especially in older patients, leading to morbidity and mortality. This study was performed to analyze possible subsidence and intraoperative fractures in a cohort of very old patients treated with cementless stems. Methods: We retrospectively analyzed a consecutive cohort of patients aged ≥90 years with femoral neck fractures treated by uncemented HA and an anterior minimally invasive approach. Immediate full-weight bearing was allowed postoperatively. Pelvic radiographs were examined for subsidence immediately postoperatively and 6 weeks later. Results: We treated 109 patients (74% women; mean age, 93 years; range, 90-102 years) by HA from January 2010 to March 2016. The 30-day mortality rate was 16%, and the morbidity rate was 47%. There were 11 (12%) intraoperative fractures: 8 (Vancouver B2) had to be addressed immediately during the primary operation, while 3 (1 Vancouver B1 and 2 Vancouver AG) were treated conservatively. One periprosthetic femoral fracture (Vancouver B1) was documented during follow-up. In 17 patients, subsidence of >2.0 mm (median, 3.9 mm; range, 2.5-9.0 mm) was documented. Conclusion: Early subsidence was low in this very old cohort treated with an uncemented stem and not showing a periprosthetic fracture. The risk of intraoperative periprosthetic fractures was high. The use of uncemented implants in osteoporotic bone continues to be an intervention with high risk and should only be performed by experienced surgeons. Level of Evidence: Level III, Therapeutic study.
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Affiliation(s)
- Method Kabelitz
- Department for Surgery, City Hospital Waid Zurich, Zurich, Switzerland
| | - Yannick Fritz
- Department for Surgery, City Hospital Waid Zurich, Zurich, Switzerland
| | | | - Christoph Meier
- Department for Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Patrick Fries
- Department for Surgery, City Hospital Waid Zurich, Zurich, Switzerland
| | - Michael Dietrich
- Department for Surgery, City Hospital Waid Zurich, Zurich, Switzerland
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Variability associated with assessing changes in position of a canine uncemented femoral stem prosthesis. Vet Comp Orthop Traumatol 2017; 28:409-16. [DOI: 10.3415/vcot-15-03-0044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/15/2015] [Indexed: 11/17/2022]
Abstract
SummaryObjective: Evaluate variability associated with assessing changes in the position of uncemented femoral stems.Methods: Stem level, canal fill, stem angle, and version angle were measured on craniocaudal horizontal beam (CCHB) and open leg lateral (OLL) radiographic projections of the femur of 20 dogs that had uncemented total hip replacement. Intraobserver and inter -observer repeatability were determined on immediate postoperative (PO) images. Differences in position were calculated between the first (3 months – R1) and second (6 months – R2) re-evaluation (R1-R2) time points, and between PO and R1.Results: The measurement process was very repeatable. For R1-R2, the stem appeared to subside 0.8 ± 1.4 mm for measurements based on the greater trochanter on the CCHB images, but there was a wide range (-3.9 to 2 mm; positive values indicate proximad movement). Measurements based on the inter-trochanteric crest on the OLL images had the same mean, and also a wide range (-4.4 to 2.1 mm; negative values indicate proximad movement). For PO-R1, the stem appeared to subside 1.8 ± 2.0 mm (CCHB, based on the greater trochanter, range -7.7 to 2.2 mm), 1.6 ± 1.5 mm (CCHB, based on the intertrochanteric crest, range -0.7 to 4.3 mm); and 2.1 ± 2.1 mm (OLL, based on the intertrochanteric crest, range -1.6 to 6.8 mm).Conclusion: The position of a stable stem can appear different on subsequent re-evaluations, but this may be due to variability associated with inconsistency of positioning of the patient and limb.Clinical significance: Documenting subsidence in individual patients should not rely on calculations based on a single measurement.
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Preoperative digital planning versus postoperative outcomes in total hip arthroplasty using a calcar-guided short stem: frequent valgization can be avoided. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:643-651. [PMID: 28391517 DOI: 10.1007/s00590-017-1948-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/30/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Modern total hip arthroplasty is largely dependent on the successful preservation of hip geometry. Thus, a successful implementation of the preoperative planning is of great importance. The present study evaluates the accuracy of anatomic hip reconstruction predicted by 2D digital planning using a calcar-guided short stem of the newest generation. METHODS A calcar-guided short stem was implanted in 109 patients in combination with a cementless cup using the modified anterolateral approach. Preoperative digital planning was performed including implant size, caput-collum-diaphyseal angle, offset, and leg length using mediCAD II software. A coordinate system and individual scale factors were implemented. Postoperative outcome was evaluated accordingly and was compared to the planning. RESULTS Intraoperatively used stem sizes were within one unit of the planned stem sizes. The postoperative stem alignment showed a minor and insignificant (p = 0.159) mean valgization of 0.5° (SD 3.79°) compared to the planned caput-collum-diaphyseal angles. Compared to the planning, mean femoral offset gained 2.18 (SD 4.24) mm, while acetabular offset was reduced by 0.78 (SD 4.36) mm during implantation resulting in an increased global offset of 1.40 (SD 5.51) mm (p = 0.0094). Postoperative femoroacetabular height increased by a mean of 5.00 (SD 5.98) mm (p < 0.0001) compared to preoperative measures. DISCUSSION Two-dimensional digital preoperative planning in calcar-guided short-stem total hip arthroplasty assures a satisfying implementation of the intended anatomy. Valgization, which has been frequently observed in previous short-stem designs, negatively affecting offset, can be avoided. However, surgeons have to be aware of a possible leg lengthening.
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Abrahams JM, Kim YS, Callary SA, De Ieso C, Costi K, Howie DW, Solomon LB. The diagnostic performance of radiographic criteria to detect aseptic acetabular component loosening after revision total hip arthroplasty. Bone Joint J 2017; 99-B:458-464. [DOI: 10.1302/0301-620x.99b4.bjj-2016-0804.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/08/2016] [Indexed: 12/31/2022]
Abstract
Aims This study aimed to determine the diagnostic performance of radiographic criteria to detect aseptic acetabular loosening after revision total hip arthroplasty (THA). Secondary aims were to determine the predictive values of different thresholds of migration and to determine the predictive values of radiolucency criteria. Patients and Methods Acetabular component migration to re-revision was measured retrospectively using Ein-Bild-Rontgen-Analyse (EBRA-Cup) and manual measurements (Sutherland method) in two groups: Group A, 52 components (48 patients) found not loose at re-revision and Group B, 42 components (36 patients) found loose at re-revision between 1980 and 2015. The presence and extent of radiolucent lines was also assessed. Results Using EBRA, both proximal translation and sagittal rotation were excellent diagnostic tests for detecting aseptic loosening. The area under the receiver operating characteristic (ROC) curves was 0.94 and 0.93, respectively. The thresholds of 2.5 mm proximal translation or 2° sagittal rotation (EBRA) in combination with radiolucency criteria had a sensitivity of 93% and specificity of 88% to detect aseptic loosening. The sensitivity, specificity, positive predictive value and negative predictive value (NPV) of radiolucency criteria were 41%, 100%, 100% and 68% respectively. Manual measurements of both proximal translation and sagittal rotation were very good diagnostic tests. The area under the ROC curve was 0.86 and 0.92 respectively. However, manual measurements had a decreased specificity compared with EBRA. Radiolucency criteria had a poor sensitivity and NPV of 41% and 68% respectively. Conclusion This study shows that EBRA and manual migration measurements can be used as accurate diagnostic tools to detect aseptic loosening of cementless acetabular components used at revision THA. Radiolucency criteria should not be used in isolation to exclude loosening of cementless acetabular components used at revision THA given their poor sensitivity and NPV. Cite this article: Bone Joint J 2017;99-B:458–64.
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Affiliation(s)
- J. M. Abrahams
- Royal Adelaide Hospital, Level
4 Bice Building, North Terrace, Adelaide, SA, Australia
and PhD Candidate, Discipline of Orthopaedics
and Trauma, The University of Adelaide, Adelaide, SA, Australia
| | - Y. S. Kim
- Dongguk University Gyeongju Hospital, Gyeongju, Gyeongsangbuk-do, South
Korea
| | - S. A. Callary
- Royal Adelaide Hospital, Level
4 Bice Building, Royal Adelaide Hospital, North
Terrace, Adelaide, SA, Australia
and Discipline of Orthopaedics and Trauma, University
of Adelaide, Adelaide, SA, Australia
| | | | - K. Costi
- Royal Adelaide Hospital, Level
4 Bice Building, North Terrace, Adelaide, SA, Australia
| | - D. W. Howie
- The University of Adelaide, Adelaide, SA, Australia
and Clinical Director, Department of Orthopaedics and
Trauma, Royal Adelaide Hospital, Level
4 Bice Building, North Terrace, Adelaide, SA, Australia
| | - L. B. Solomon
- The University of Adelaide, Adelaide, SA, Australia
and Orthopaedic Consultant, Department of Orthopaedics
and Trauma, Royal Adelaide Hospital Level 4
Bice Building, North Terrace, Adelaide, SA, Australia
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Wronka KS, Cnudde PHJ. Midterm results following uncemented, modular, fully porous coated stem used in revision total hip arthroplasty: Comparison of two stem systems. J Orthop 2016; 13:298-300. [PMID: 27408508 DOI: 10.1016/j.jor.2016.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/14/2016] [Accepted: 06/24/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Aim of this study was to evaluate stem subsidence and survivorship of implant following implantation of Revitan (Zimmer) and MP (Waldemar Link) stems. METHODS Retrospective case series with clinical and radiological follow-up of 1-10 years. RESULTS 47 Revitan and 57 MP stems were analyzed. In 12 cases there was subsidence of the stem present. Two Revitan stems and one MP stem were revised as a result of subsidence. Failure rate was 4.3% for Revitan, 1.8% for MP stem and difference was not statistically significant. CONCLUSION There is no significant difference in subsidence or survivorship between Revitan and MP stems.
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Affiliation(s)
- Konrad Sebastian Wronka
- ST6 Trauma and Orthopaedics, Prince Philip Hospital, Llanelli, Carmarthenshire SA14 8QF, United Kingdom
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Boettner F, Sculco P, Lipman J, Renner L, Faschingbauer M. A novel method to measure femoral component migration by computed tomography: a cadaver study. Arch Orthop Trauma Surg 2016; 136:857-63. [PMID: 26983723 DOI: 10.1007/s00402-016-2442-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Radiostereometric analysis (RSA) is the most accurate technique to measure implant migration. However, it requires special equipment, technical expertise and analysis software and has not gained wide acceptance. The current paper analyzes a novel method to measure implant migration utilizing widely available computer tomography (CT). METHODS Three uncemented total hip replacements were performed in three human cadavers and six tantalum beads were inserted into the femoral bone similar to RSA. Six different 28 mm heads (-3, 0, 2.5, 5.0, 7.5 and 10 mm) were added to simulate five reproducible translations (maximum total point migration) of the center of the head. Implant migration was measured in a 3-D analysis software (Geomagic Studio 7). Repeat manual reconstructions of the center of the head were performed by two investigators to determine repeatability and accuracy. RESULTS The accuracy of measurements between the centers of two head sizes was 0.11 mm with a CI 95 % of 0.22 mm. The intra-observer repeatability was 0.13 mm (CI 95 % 0.25 mm). The interrater-reliability was 0.943. CONCLUSION CT based measurement of head displacement in a cadaver model were highly accurate and reproducible.
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Clement ND, S. Patrick-Patel R, MacDonald D, Breusch SJ. Total hip replacement: increasing femoral offset improves functional outcome. Arch Orthop Trauma Surg 2016; 136:1317-1323. [PMID: 27484875 PMCID: PMC4990628 DOI: 10.1007/s00402-016-2527-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to assess the independent effect of radiographic measures of implant position, relative to pre-operative anatomical assessment, on the functional outcome of total hip arthroplasty according to change in the Oxford hip score (OHS) 1 year post surgery. METHODS A prospective cohort study was preformed to assess whether improvement in functional outcome (change in OHS at 1 year) and the relationship with femoral offset and length, and acetabular offset and height. After a power calculation 359 patients were recruited to the study and radiographic measures were performed by blinded observers. Regression analysis was used to assess the independent effect of the four radiographic measurements after adjusting for confounding variables. RESULTS There was a significant (p < 0.001) decrease in acetabular offset [5.3 mm, 95 % confidence interval (CI) 4.4-6.2] and increase in femoral offset (6.1 mm, 95 % CI 5.4-6.8). Hence there was no significant change in overall offset. Femoral offset was the only radiographic measure to be achieved statistical significance (r = 0.198, 95 % CI 0.063-0.333, p = 0.004) in relation to clinical outcome, with increasing offset being associated with a greater improvement in the OHS. On combining femoral and acetabular offset increasing offset was associated with a greater improvement in the OHS (r = 0.10, 95 % CI 0.01-0.19, p = 0.04). CONCLUSION This study supports the long-held biomechanical theory of medialisation of the acetabular component with compensatory increased femoral offset results in improved functional outcome.
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Affiliation(s)
- N. D. Clement
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA UK
| | | | - D. MacDonald
- University of Edinburgh, Little France, Edinburgh, EH16 4SB UK
| | - S. J. Breusch
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA UK
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Scheerlinck T, Polfliet M, Deklerck R, Van Gompel G, Buls N, Vandemeulebroucke J. Development and validation of an automated and marker-free CT-based spatial analysis method (CTSA) for assessment of femoral hip implant migration: In vitro accuracy and precision comparable to that of radiostereometric analysis (RSA). Acta Orthop 2015; 87:139-45. [PMID: 26634843 PMCID: PMC4812075 DOI: 10.3109/17453674.2015.1123569] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE We developed a marker-free automated CT-based spatial analysis (CTSA) method to detect stem-bone migration in consecutive CT datasets and assessed the accuracy and precision in vitro. Our aim was to demonstrate that in vitro accuracy and precision of CTSA is comparable to that of radiostereometric analysis (RSA). MATERIAL AND METHODS Stem and bone were segmented in 2 CT datasets and both were registered pairwise. The resulting rigid transformations were compared and transferred to an anatomically sound coordinate system, taking the stem as reference. This resulted in 3 translation parameters and 3 rotation parameters describing the relative amount of stem-bone displacement, and it allowed calculation of the point of maximal stem migration. Accuracy was evaluated in 39 comparisons by imposing known stem migration on a stem-bone model. Precision was estimated in 20 comparisons based on a zero-migration model, and in 5 patients without stem loosening. RESULTS Limits of the 95% tolerance intervals (TIs) for accuracy did not exceed 0.28 mm for translations and 0.20° for rotations (largest standard deviation of the signed error (SD(SE)): 0.081 mm and 0.057°). In vitro, limits of the 95% TI for precision in a clinically relevant setting (8 comparisons) were below 0.09 mm and 0.14° (largest SD(SE): 0.012 mm and 0.020°). In patients, the precision was lower, but acceptable, and dependent on CT scan resolution. INTERPRETATION CTSA allows detection of stem-bone migration with an accuracy and precision comparable to that of RSA. It could be valuable for evaluation of subtle stem loosening in clinical practice.
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[Accuracy of hip stem migration measurement on plain radiographs: reliability of bony and prosthetic landmarks]. DER ORTHOPADE 2015; 43:934-9. [PMID: 25223758 DOI: 10.1007/s00132-014-3014-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND In Germany, more than 150,000 total hip arthroplasties (THA) are performed annually. Early implant migration is supposed to be the best indicator for mechanical failure of femoral stems. Therefore, radiological evaluation of hip stems is routinely done by analyzing plain radiographs of THA. OBJECTIVES The purpose of this study was to evaluate the accuracy of implant migration measurement on plain radiographs. MATERIAL AND METHODS Two observers analyzed 44 anterior-posterior radiographs of the pelvis in 22 pain-free patients at least 2 years after implantation of an anatomical hip stem. The evaluation was performed on digital as well as conventional plain radiographs. Intraobserver reliability was analyzed by double measurements of each radiograph and the evaluation of the consecutive series of each patient. The anatomical structures of interest were the greater trochanter and the minor trochanter. Furthermore, the tip of the prosthesis, the shoulder of the implant, and the center of rotation were determined. RESULTS The conventional measurement technique proved higher accuracy compared to the digital measurement technique. The best anatomical structure was the greater trochanter in the conventional technique and the minor trochanter in the digital technique. The best reference structure with regard to the implant was the shoulder of the prosthesis for both techniques. CONCLUSION The recommended reference structures for the evaluation of implant migration on plain radiographs are the greater trochanter and the shoulder of the implant for the conventional measurement technique and the minor trochanter and the shoulder of the implant for the digital technique. Migration of an implant should not assumed before a determined difference of 2 mm.
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Abstract
BACKGROUND AND PURPOSE 2D analysis of metal-on-metal (MoM) hip arthroplasty (HA) has been conducted in several large series on conventional radiographs with the use of Ein Bild Roentegen Analyse (EBRA) software, but there have been no comparisons with 3D analysis in the literature. The main aim of this study was to quantify the agreement in measurements of cup version of large-diameter MoM hips obtained by EBRA and by 3D computed tomography (3D-CT). The secondary aim was to quantify the agreement for cup inclination. Lastly, we wanted to determine the inter- and intra-observer reliability of both methods. PATIENTS AND METHODS 87 MoM hips in 81 patients were analyzed for cup inclination and version in 2D on conventional radiographs using EBRA software. The results were compared with 3D measurements using CT. RESULTS Cup version was underestimated by EBRA when compared to 3D-CT, by 6° on average with the pelvis supine and by 8° on average with the pelvis orientated to the anterior pelvic plane (APP). For inclination, the mean difference was no more than 1°. 53% of hips were within a 10° safe zone of 45° inclination and 20° version when measured by 3D-CT with the pelvis supine (and 54% with the pelvis in the APP). The proportion was only 24% when measured by EBRA. Inter- and intra-observer reliability of cup version is poorer using 2D analysis than when using 3D-CT. INTERPRETATION Errors in version in 2D were due to the difficulty in delineating the cup rim, which was obscured by a large-diameter metal head of the same radio-opacity. This can be overcome with 3D analysis. The present study demonstrates that measurements using EBRA have poor agreement and are less reliable than those with 3D-CT when measuring cup version and inclination in MoM hips.
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Affiliation(s)
- Kinner Davda
- Imperial College, Charing Cross Hospital, London, UK
| | - Niall Smyth
- Hospital For Special Services, New York City, NY, USA
| | - Justin P Cobb
- Imperial College, Charing Cross Hospital, London, UK
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Tandara AA, Capeller LJ, Jarczok MN, Mayrhofer P, Jung M, Daecke W. A software tool for prediction of prosthesis failure at the carpometacarpal joint of the thumb. J Hand Surg Eur Vol 2015; 40:364-9. [PMID: 25190607 DOI: 10.1177/1753193414548644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 12/16/2013] [Indexed: 02/03/2023]
Abstract
Early recognition of prosthesis failure is difficult. A tool that helps to identify faulty prosthesis - a cause of early implant loosening - is needed. The aim of this study was to detect early implant loosening by applying a software program EBRA (Ein-Bild-Röntgen-Analyse). EBRA was applied to the radiographs of a series of 76 patients, with a total of 102 thumb carpometacarpal joint de la Caffinière prostheses, with an average follow-up of 14.5 months (range 0.5-24). The data were used to draw graphs of cup migration and inclination over time. Corresponding regression lines of migration and inclination in relation to time were made up to the point of loosening. The gradient of regression was calculated for all implants. The gradient of regression on the x and y axes differed significantly between stable and loose implants. Loose and stable implants showed significantly different cup migration on the x and y axes over time. EBRA proved to be a reliable tool to visualize cup migration in the trapeziometacarpal joint and to predict implant failure.
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Affiliation(s)
- A A Tandara
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - L J Capeller
- Surgical Outpatient-Clinic Wiesloch, Wiesloch, Germany
| | - M N Jarczok
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - P Mayrhofer
- Geometry and CAD, Leopold-Franzens-University Innsbruck, Innsbruck, Austria
| | | | - W Daecke
- Frankfurt Höchst Clinic, Frankfurt, Germany
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19
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Functional outcomes after total hip arthroplasty for the acute management of acetabular fractures: 1- to 14-year follow-up. J Orthop Trauma 2015; 29:151-9. [PMID: 24978942 DOI: 10.1097/bot.0000000000000164] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study reports the complications and functional outcomes in patients treated acutely with combined open reduction internal fixation (ORIF) and immediate total hip arthroplasty (THA) for displaced comminuted acetabular fractures. DESIGN Single surgeon retrospective case series. SETTING Level 1 trauma center. PATIENTS Thirty-three consecutive patients (18 women; mean age, 66 years) from 1996 to 2011 with an average follow-up of 5.6 years (range, 1-14.3 years) were included in this study. INTERVENTION ORIF and immediate THA. MAIN OUTCOME MEASUREMENTS Oxford Hip Score and reoperation. METHODS All patients had at least 1 year of telephone or clinical follow-up. Postoperative complications, reoperations, and available radiographs were reviewed. RESULTS Six patients died of causes unrelated to their injuries or surgery; before death, these patients had well-functioning hips. There was a 15% complication rate. At last follow-up, 94% of hips remained in situ and were functioning well. The average Oxford Hip Score at final follow-up was 17 (range, 12-32), with 93% of patients reporting good to excellent function. There was no statistical association between fracture type, age, or fixation type and outcome. CONCLUSIONS Acute ORIF and immediate THA for selected acetabular fractures is a safe viable treatment option with good to excellent functional outcomes and may reduce the need for 2 separate operations in many patients. Functional outcomes are equivalent to those after primary THA for osteoarthritis. This study does not address at which age acute THA is a cost-effective treatment option. LEVEL OF EVIDENCE Therapeutic level IV. See Instructions for authors for a complete description of levels of evidence.
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Höhle P, Schröder SM, Pfeil J. Comparison between preoperative digital planning and postoperative outcomes in 197 hip endoprosthesis cases using short stem prostheses. Clin Biomech (Bristol, Avon) 2015; 30:46-52. [PMID: 25434789 DOI: 10.1016/j.clinbiomech.2014.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/31/2014] [Accepted: 11/12/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preservation of hip geometry is important for treatment success in endoprosthesis implantation. Digital planning can be used to estimate postoperative hip geometry. This study examined whether digital planning accurately predicts surgical outcomes for two femoral neck resecting short stem implants, Mayo® (Zimmer) and Metha® (Aesculap). METHODS Preoperative digital planning of the short stem and acetabular cup was performed for 191 patients (197 endoprostheses) with hip osteoarthritis. Digital planning was done with mediCAD II (Hectec) to evaluate types of prosthesis stems and sizes, leg lengthening and offset, and angle of stem inclination within the femur. The predicted values for these parameters were compared to the postoperative measurements. A double coordinate system was developed to measure pelvic and femoral distances separately. Individual scale factors were applied to minimize measurement bias. FINDINGS Implantation of the planned short stem prostheses resulted in a mean femoro-acetabular leg lengthening of 4.2mm (SD 5.8mm) and a mean femoro-acetabular offset-reduction of 4.2mm (SD 5.9mm) in comparison with preoperative planning. Implantation of both stems resulted in increased valgization compared to planning (Metha®, mean 5.4° (SD 3.7°); Mayo®, mean -3.2° (SD 3.4°)). INTERPRETATION Differences between preoperative planning and postoperative outcomes were greater for femoro-acetabular than for cup-related leg length and offset. On average, leg length was longer than predicted and there was loss of femoro-acetabular offset. Compared with the planning, valgization of the implanted stems was frequently observed.
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Affiliation(s)
- Philip Höhle
- Department of Trauma and Orthopaedic Surgery, Hand and Reconstructive Surgery, Hospital Worms, Worms, Germany.
| | - Simon M Schröder
- Department of Trauma, Hand and Reconstructive Surgery, GPR Hospital, Rüsselsheim, Germany.
| | - Joachim Pfeil
- Department of Orthopaedics and Orthopaedic Surgery, St. Josefs Hospital, Wiesbaden, Germany.
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22
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Francés A, Claramunt R, Cebrian JL, Marco F, Lópiz Y, Rullanç RM, Ros A, López-Durán L. Biomechanical assays for the study of the effects of hip prostheses: application to the reconstruction of bone defects with femoral allografts. Musculoskelet Surg 2013; 97:123-30. [PMID: 23275030 DOI: 10.1007/s12306-012-0234-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 11/30/2012] [Indexed: 11/25/2022]
Abstract
There is a need to study and validate the mechanical behavior of the bone-implant total hip prosthesis and the treatment of its complications with experimental studies due to the limitations showed by numerical methods. Epoxy resin replicas of a femur (stereolithography) and a mechanical validation were performed. We studied three cases: intact femur (Case 1); non-defective femur with non-cemented LD primary stem (Case 2); and femur with a cavitary defect, short cemented stem over an impacted allograft (Case 3). The test pieces were connected to 7 strain gauges. Three assays per piece were carried out with a vertical and oblique load (load-unload curves after a sequence between 0 and 145.9 N). We measured the k coefficient (distance from the natural state of the strains) and stability of the stem (flexion-compression by strain gauges 1, 2, 5, and 7 and transversal lengthening by strain gauges 3, 4, and 6). Results of the strain gauge analysis revealed linearity of results in all cases, and more so in load than in unload. Gauge 7 (proximal) revealed shortening in all cases. Gauges 2 and 5 provided qualitatively similar data due to a significant increase in rigidity. K coefficients were obtained with a nonsignificant difference when each of the test pieces was compared with Case 2. The results were reproducible in all 7 gauges. Observation of the load-unload curves in all the test pieces assayed shows that there are no variations in the pattern of behavior (when comparing the stability of a primary stem and a stem in the simulated reconstructed femoral defect. If these reconstructions are considered theoretically appropriate for giving primary stability to the stem--a sine qua non for the success of replacement surgery--then our study is novel.
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Affiliation(s)
- Alberto Francés
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, C/Río Pisuerga n° 16, Boadilla del Monte, 28669, Madrid, Spain.
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23
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Nakasone S, Takao M, Nishii T, Sakai T, Sugano N. Incidence and natural course of initial polar gaps in Birmingham Hip Resurfacing cups. J Arthroplasty 2012; 27:1676-82. [PMID: 22503330 DOI: 10.1016/j.arth.2012.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 02/27/2012] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to retrospectively investigate the incidence of initial polar gaps and their effect on clinical results in Birmingham Hip Resurfacing cups. A total of 151 hips in 134 patients who underwent hip resurfacing at a mean age of 50 years were examined. The mean follow-up period was 7 years. A polar gap was identified in 47 hips (31%) with a mean width of 2.1 mm. Gaps of 2 mm or more were identified in 21 hips, 6 of which showed reductions in cup inclination during the initial 3 months. After 3 months, no progressive cup migration was observed. There was no cup revision. All gaps were filled with bone within 2 years of surgery. The initial polar gaps had no significant influence on the stability of hydroxyapatite-coated Porocast cobalt-chromium hemispherical monoblock cups (Midland Medical Technologies Ltd, Birmingham, UK), although gaps of 2 mm or more had a higher risk of early migration.
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Affiliation(s)
- Satoshi Nakasone
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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24
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Fottner A, Steinbrück A, Volkmer E, Haasters F, Mazoochian F, Jansson V. [Implant position of total hip arthroplasty shafts. Establishment of a new method for comparison between planned and achieved shaft positions]. DER ORTHOPADE 2012; 41:552-9. [PMID: 22732771 DOI: 10.1007/s00132-012-1961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND One of the main goals of the preoperative planning of hip prostheses is adequate shaft positioning with reconstruction of leg length and offset. The purpose of this study was to compare the planned and achieved shaft positions using a modified program for migration measurement. METHODS In 60 cases of total hip replacement the preoperative planning was compared with the postoperative radiograph using a modified version of the well-established EBRA-FCA program. The results of this new measurement were compared to conventional measurements. In 25 cases the intraobserver and interobserver reliability was determined. RESULTS The novel measurements correlated best with the measured distance between the greater trochanter and the center of rotation and yielded the best intraobserver and interobserver reliability. In general, cementless stems had a slightly more proximal position (0.65 mm) compared to cemented stems. CONCLUSIONS The modified program for migration measurement facilitates a reproducible and fast comparison of the planned and achieved shaft positions thus implementing an early and objective control of postoperative shaft position.
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Affiliation(s)
- A Fottner
- Orthopädischen Klinik und Poliklinik, Klinikum der Ludwig-Maximillians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
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Dhillon M, Bachhal V, Chouhan D, Kumar V. Comment on: Markmiller M, Weiss T, Kreuz P, Rüter A, Konrad G. Partial weightbearing is not necessary after cementless total hip arthroplasty. Int Orthop. 2011 Aug;35(8):1139-43. INTERNATIONAL ORTHOPAEDICS 2011; 36:895; author reply 897. [PMID: 22139196 DOI: 10.1007/s00264-011-1415-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 11/03/2011] [Indexed: 11/29/2022]
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Fottner A, Steinbrück A, Sadoghi P, Mazoochian F, Jansson V. Digital comparison of planned and implanted stem position in total hip replacement using a program form migration analysis. Arch Orthop Trauma Surg 2011; 131:1013-9. [PMID: 21222126 DOI: 10.1007/s00402-010-1256-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Indexed: 11/29/2022]
Abstract
AIM One main goal in primary total hip replacement is the reconstruction of preoperative biomechanical conditions by adequate implant positioning. Our aim was to compare the planned and effectively implanted stem position in using a program for digital migration measurement. PATIENTS We examined 120 cases with this new method based on a modification of the EBRA-FCA program and compared these results to direct plain radiographic methods. In addition, the intra- and inter-observer reliability was determined in 50 cases. RESULTS We observed a rate of correct prediction of 80% for the size of the stem. The new method revealed a good correlation (0.95 and 0.64 for the position along the stem axis and 0.84 for the stem angle) to direct plain radiographic methods. Regarding the intraclass correlation coefficient for intra- and inter-observer reliability, the results were superior (0.97 vs. 0.81-0.84 and 0.90 vs. 0.74-0.88) compared with direct plain radiographic methods. CONCLUSION We concluded that the comparison of the planned and implanted stem position using a modified EBRA-FCA method is more reproducible than direct radiographic measurements.
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Affiliation(s)
- Andreas Fottner
- Department of Orthopaedic Surgery, Ludwig-Maximilians-University Munich, Campus Grosshadern, Marchioninistr 15, 81377 Munich, Germany.
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Zilkens C, Djalali S, Bittersohl B, Kälicke T, Kraft CN, Krauspe R, Jäger M. Migration pattern of cementless press fit cups in the presence of stabilizing screws in total hip arthroplasty. Eur J Med Res 2011; 16:127-32. [PMID: 21486725 PMCID: PMC3352209 DOI: 10.1186/2047-783x-16-3-127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to evaluate the initial acetabular implant stability and late acetabular implant migration in press fit cups combined with screw fixation of the acetabular component in order to answer the question whether screws are necessary for the fixation of the acetabular component in cementless primary total hip arthroplasty. One hundred and seven hips were available for follow-up after primary THA using a cementless, porous-coated acetabular component. A total of 631 standardized radiographs were analyzed digitally by the "single-film-x-ray-analysis" method (EBRA). One hundred and one (94.4 %) acetabular components did not show significant migration of more than 1 mm. Six (5.6%) implants showed migration of more than 1 mm. Statistical analysis did not reveal preoperative patterns that would identify predictors for future migration. Our findings suggest that the use of screw fixation for cementless porous-coated acetabular components for primary THA does not prevent cup migration.
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Affiliation(s)
- C Zilkens
- Deputy Chief, Department of Orthopaedics, Heinrich-Heine University Medical School, Moorenstr. 5, 40225 Duesseldorf, Germany.
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Davis ET, Heaver CE, Pynsent PB, Pearson AM, Treacy RBC. A comparison of subsidence of Exeter standard and long stems. Hip Int 2010; 20:131-5. [PMID: 20544650 DOI: 10.1177/112070001002000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2010] [Indexed: 02/04/2023]
Abstract
The survivorship of the polished, double taper Exeter stem is related to subsidence within the cement mantle. Long Exeter stems have altered geometry which may influence subsidence characteristics. Using digitised x-rays and appropriate computer software we measured the subsidence of 35 standard and 40 long stem Exeter implants. Measurements were taken from initial postoperative radiographs and repeated at intervals up to 5 years. Long stem implants were used in cemented revisions without the use of impaction bone grafting. Subsidence rates of the standard length stems in our study were comparable to that in published literature. Long stems did not replicate this subsidence pattern and had subsided less at 6, 12 and 24 months. However, the 205mm long stem, which has a fully tapered design, did follow the subsidence characteristics of the standard stem. Subsidence of long stem Exeter implants does not mirror that of the standard length stem. Loss of the fully tapered geometry of the longer stem implants may account for this finding. We suggest that whenever possible, the 205mm long stem should be used if the biomechanical principles of the standard Exeter stem are to be utilised.
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Vandenbussche E, Saffarini M, Hansen U, Taillieu F, Mutschler C, Augereau B, Gregory TM. Measurement of femoral head penetration in polyethylene using a 3-dimensional CT-scan technique. Acta Orthop 2010; 81:563-9. [PMID: 20860445 PMCID: PMC3214744 DOI: 10.3109/17453674.2010.519163] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Current techniques for measuring in vivo polyethylene wear suffer from a range of problems, resulting in an unacceptable lack of repeatability and/or insufficient accuracy when they are used to measure the low wear rates associated with new, highly crosslinked polyethylene. We describe an improved CT method for measurement of 3D femoral head penetration in PE acetabular cups that has sufficient accuracy and repeatability to allow assessment of the wear potential of modern implants. METHOD The accuracy and repeatability of the CT-scan method was determined by blindly repeating measurements on a precisely calibrated 28-mm prosthetic head and by comparing them with direct metrological measurements on 10 acetabular specimens with in vitro wear from machining, and on 8 explanted acetabular specimens with in vivo wear. RESULTS The intra- and interobserver errors in femoral head diameter were 0.036 mm (SD 0.044) and 0.050 mm (SD 0.022), respectively. CT estimated femoral head penetration in both all-poly and metal-backed acetabular components with accuracy ranging from 0.009 to 0.245 mm (mean 0.080; SD 0.067). INTERPRETATION We found that the CT method is rapid, is accurate, and has repeatability and ease of availability. Using a slice thickness of 0.0625 mm, this method can detect wear—and also the threshold for the wear rate that causes osteolysis—much earlier than previous methods.
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Affiliation(s)
- Eric Vandenbussche
- Department of Orthopaedic Surgery, Université Paris Descartes, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Ulrich Hansen
- Department of Mechanical Engineering, Imperial College, London, UK
| | - Fabienne Taillieu
- Department of Radiology, Université Paris Descartes, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Céline Mutschler
- Department of Radiology, Université Paris Descartes, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Bernard Augereau
- Department of Orthopaedic Surgery, Université Paris Descartes, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
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Macheras GA, Kateros K, Koutsostathis SD, Tsakotos G, Galanakos S, Papadakis SA. The Trabecular Metal Monoblock acetabular component in patients with high congenital hip dislocation: a prospective study. ACTA ACUST UNITED AC 2010; 92:624-8. [PMID: 20435996 DOI: 10.1302/0301-620x.92b5.23256] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Between November 1997 and December 2000 we performed 27 total hip replacements in 22 patients with high congenital dislocation of the hip using porous tantalum monoblock acetabular components implanted in the true acetabular bed. Clinical and radiological evaluation was performed at regular intervals for a mean of 10.2 years (8.5 to 12). The mean Harris Hip Score improved from 48.3 (15 to 65) pre-operatively to 89.5 (56 to 100) at the final follow-up. The mean Oxford Hip Score was 49.5 (35 to 59) pre-operatively and decreased to 21.2 (12 to 48) at one year and 15.2 (10 to 28) at final follow-up. Migration of the acetabular component was assessed with the EBRA software system. There was a mean migration of 0.68 mm (0.49 to 0.8) in the first year and a mean 0.89 mm (0.6 to 0.98) in the second year, after excluding one initial excessive migration. No revision was necessary for any reason, no acetabular component became loose, and no radiolucent lines were observed at the final follow-up. The porous tantalum monoblock acetabular component is an implant offering adequate initial stability in conjunction with a modulus of elasticity and porosity close to that of cancellous bone. It favours bone ingrowth, leading to good mid-term results.
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Affiliation(s)
- G A Macheras
- Department of Orthopaedics, KAT General Hospital, Athens, Greece.
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Kostakos AT, Macheras GA, Frangakis CE, Stafilas KS, Baltas D, Xenakis TA. Migration of the trabecular metal monoblock acetabular cup system. J Arthroplasty 2010; 25:35-40. [PMID: 19056211 DOI: 10.1016/j.arth.2008.09.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 07/22/2008] [Accepted: 09/07/2008] [Indexed: 02/01/2023] Open
Abstract
Fifty-one primary total hip arthroplasties were performed using Trabecular Metal Monoblock Acetabular Cup System (Zimmer Inc, Warsaw, IN). In a 2-year prospective study, its behavior was closely monitored by clinical, radiologic, and component migration assessment by Ein-Bild-Röntgen-Analyse method. There were no complications. The mean Harris hip score was improved from 41 to 95. A polar gap at the postoperative radiograph was noted at 25% of the arthroplasties, most of which subsequently filled with bone within 6 months. The mean total absolute migration was 0.67 mm. The implant showed excellent early clinical and radiographic behavior. The 2-year migration rate study, as index of long-term survival and success, showed very good early implant stability and, in all cases except one, superior to the available studies for similar design acetabular cups.
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Shen B, Yang J, Wang L, Zhou ZK, Kang PD, Pei FX. Midterm results of hybrid total hip arthroplasty for treatment of osteoarthritis secondary to developmental dysplasia of the hip-Chinese experience. J Arthroplasty 2009; 24:1157-63. [PMID: 19729269 DOI: 10.1016/j.arth.2009.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 07/04/2009] [Indexed: 02/07/2023] Open
Abstract
This study was designed to evaluate the midterm results of hybrid total hip arthroplasty in a consecutive series of 45 Chinese patients with osteoarthritis secondary to dysplastic hip. The average follow-up was 6.6 years. A total of 24 hips were classified as dysplasia, 20 hips as low dislocation, and 13 hips as high dislocation. The preoperative Harris score was 46.19 +/- 18.01, which improved to 91.78 +/- 3.52 at the final follow-up. The rate of polyethylene liner wear was 0.27 mm/y. Osteolysis was identified around 5 acetabular components and 13 femoral components. With the use of loosening or revision as the end point for failure, the survival rate was 1.0. We suggest that hybrid total hip arthroplasty in Chinese developmental dysplasia of hip patients has favorable results at midterm follow-up, even though their lifestyle includes more deep flexion of the hip. There is no significant difference of postoperative Harris score with increasing severity of dysplasia.
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Affiliation(s)
- Bin Shen
- Department of Orthopaedic Surgery, West China Hospital of Sichuan University, Chengdu, PR China
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33
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Digas G. New polymer materials in total hip arthroplasty. ACTA ORTHOPAEDICA. SUPPLEMENTUM 2009. [DOI: 10.1080/17453674078540521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Haverkamp D, De Man FHR, Slegt R, Besselaar PP, Marti RK. Cemented hip revision surgery in severe acetabular defects using a semirigid acetabular reinforcement ring--a 5- to 25-year follow-up study. J Arthroplasty 2009; 24:246-55. [PMID: 18834699 DOI: 10.1016/j.arth.2008.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 05/25/2008] [Accepted: 07/01/2008] [Indexed: 02/01/2023] Open
Abstract
Between 1978 and 1998, a total of 38 consecutive acetabular component revisions were performed in 38 patients. Average age was 67 years, and 87% of patients had severe uncontained segmental acetabular defects of more than 50%. We describe the operative technique of acetabular component revisions performed with bone grafting and a steel, semirigid acetabular reinforcement ring (Eichler), and long-term results are presented. After an average of 11.2 years follow-up, 1 cup was revised after 0.8 years for mechanical loosening, but the ring remained stably fixed. Remodeling (partial) of autografts occurred in all cases. The average HHS was 72.5. The Eichler reinforcement ring is a viable option for segmental acetabular defects in revision hip surgery, allows for restoration of pelvic bone, and makes future revisions feasible.
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Affiliation(s)
- Daniël Haverkamp
- Academic Medical Centre, Orthopaedic Research Centre Amsterdam, The Netherlands
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Qiu X, Yang J, Shen B, Zhou Z, Zhang H, Pei F. Mid-term results using a cementless hip prosthesis in young Chinese patients: a five- to seven-year follow-up study. INTERNATIONAL ORTHOPAEDICS 2008; 33:1507-12. [PMID: 19050881 DOI: 10.1007/s00264-008-0705-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 10/10/2008] [Accepted: 10/28/2008] [Indexed: 02/05/2023]
Abstract
A retrospective study was undertaken to evaluate the clinical and radiographic outcomes of 74 cementless total hip arthroplasties (THA) in 69 young Chinese patients. The Asian size and MMA AML stems with smoothly tapered tip were used, and the patients were followed up for at least five years. The mean Harris hip score was 45.4 preoperatively and 95.3 at the last follow-up. The incidence of thigh pain was 5.4%, and was related to the short stature of the patient (<160 cm) (P = 0.030). Six patients (6 hips, 8.1%) had acetabular osteolysis in zone 2; reoperation was performed in one patient because of osteolysis and wear of the polyethylene liner. The survival rate of the metal acetabular and femoral components was 100% (95% confidence interval, 0.95-1.0). Primary THA with this AML prosthesis had an acceptable mid-term result in young Chinese patients.
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Affiliation(s)
- XueYong Qiu
- Department of Orthopaedics, West China Hospital, Joint Replacement Center of West China, Sichuan University, 17 Guo Xue Xiang, 610041, Chengdu, Sichuan Province, People's Republic of China
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The B, Flivik G, Diercks RL, Verdonschot N. A new method to make 2-D wear measurements less sensitive to projection differences of cemented THAs. Clin Orthop Relat Res 2008; 466:684-90. [PMID: 18264857 PMCID: PMC2505227 DOI: 10.1007/s11999-007-0077-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 11/12/2007] [Indexed: 01/31/2023]
Abstract
Wear curves from individual patients often show unexplained irregular wear curves or impossible values (negative wear). We postulated errors of two-dimensional wear measurements are mainly the result of radiographic projection differences. We tested a new method that makes two-dimensional wear measurements less sensitive for radiograph projection differences of cemented THAs. The measurement errors that occur when radiographically projecting a three-dimensional THA were modeled. Based on the model, we developed a method to reduce the errors, thus approximating three-dimensional linear wear values, which are less sensitive for projection differences. An error analysis was performed by virtually simulating 144 wear measurements under varying conditions with and without application of the correction: the mean absolute error was reduced from 1.8 mm (range, 0-4.51 mm) to 0.11 mm (range, 0-0.27 mm). For clinical validation, radiostereometric analysis was performed on 47 patients to determine the true wear at 1, 2, and 5 years. Subsequently, wear was measured on conventional radiographs with and without the correction: the overall occurrence of errors greater than 0.2 mm was reduced from 35% to 15%. Wear measurements are less sensitive to differences in two-dimensional projection of the THA when using the correction method.
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Affiliation(s)
- Bertram The
- Department of Orthopaedic Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Gunnar Flivik
- Department of Orthopaedic Surgery, Lund University Hospital, Lund, Sweden
| | - Ron L. Diercks
- Department of Orthopaedic Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Nico Verdonschot
- Department of Orthopaedic Biomechanics, Radboud University Nijmegen, Nijmegen, The Netherlands
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Zhang H, Cheng JQ, Shen B, Yang XN, Shi R, Pei FX. Cementless total hip arthroplasty in Chinese patients with osteonecrosis of the femoral head. J Arthroplasty 2008; 23:102-11. [PMID: 18165038 DOI: 10.1016/j.arth.2006.12.098] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 12/24/2006] [Indexed: 02/01/2023] Open
Abstract
This study was designed to evaluate the midterm (> or = 5 years) clinical and radiographic outcomes of the cementless total hip arthroplasty in 64 Chinese patients (72 hips), which revealed that the mean Harris hip score increased from an average of 44.0 points before operation to 92.4 points at the last follow-up. Excellent results were achieved in 60 hips (83%). No loosening of the components was observed radiographically. No revision of the femoral components was required. Only one focal area of pelvic osteolysis in 1 hip (1%), which requires a revision, and some small focal areas of femoral osteolysis in 12 hips (17%) were observed. The mean linear wear rate was 0.125 mm/y. The survival rate of the acetabular and femoral components for radiographic loosening was 100% (95% confidence interval, 0.93-1.0) and for revision was 98.61% (95% confidence interval, 0.95-1.0). This study indicated that the cementless total hip arthroplasty in patients with osteonecrosis of the femoral head has a satisfactory midterm clinical and radiographic outcomes, but the long-term effect should be further studied.
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Affiliation(s)
- Hui Zhang
- Department of Orthopaedics, West China Hospital, Joint Replacement Center of West China, Sichuan University, Chengdu, Sichuan, PR China
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38
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Kelly SJ, Robbins CE, Bierbaum BE, Bono JV, Ward DM. Use of a hydroxyapatite-coated stem in patients with Dorr Type C femoral bone. Clin Orthop Relat Res 2007; 465:112-6. [PMID: 17704696 DOI: 10.1097/blo.0b013e318156bf96] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Type C bone, as described by Dorr, exhibits both cellular and structural compromise, which presents a challenge for fixation of a total hip arthroplasty (THA). We evaluated the performance of the Omnifit HA stem, a hydroxyapatite-coated titanium alloy stem, by retrospectively reviewing the clinical and radiographic data of 15 patients with femoral Type C bone who received the stem during primary THA between 1991 and 1994. The patients were followed a minimum of 9 years (mean, 11.5 years; range, 9-14 years). The average age at surgery was 54 years and the average body mass index was 28. Eight of the patients were men. The median Harris hip score was 94.5 points. Radiographically, two independent reviewers identified all patients as Type C bone. The average canal to calcar isthmus ratio was 0.74 (range, 0.65-0.95). At most recent followup, four patients demonstrated proximal osteolysis. Using plain radiography we detected no patients with distal osteolysis or subsidence. At 9 to 14 years, the stem has performed well in a selected series of patients with poor bone quality and the outcomes compare favorably with previously reported findings using this design of stem in other bone types. These results support the decision to use a hydroxyapatite-coated stem in patients with Type C bone.
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Howie DW, Neale SD, Stamenkov R, McGee MA, Taylor DJ, Findlay DM. Progression of acetabular periprosthetic osteolytic lesions measured with computed tomography. J Bone Joint Surg Am 2007; 89:1818-25. [PMID: 17671023 DOI: 10.2106/jbjs.e.01305] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A better understanding of the factors associated with the size and/or progression of osteolytic lesions has been hampered by a lack of sensitivity of radiographic measurement techniques. METHODS We retrospectively analyzed quantitative computed tomography scans that had been made with use of a high-resolution multi-slice scanner with a metal artifact-suppression protocol. The scans had been made to determine the volume of osteolytic lesions around thirty-five cementless Harris-Galante acetabular components that had been in situ for at least ten years. Repeat scans of thirty hips allowed for the measurement of progression in the size of osteolytic lesions over a one-year period. Associations between the volume of osteolytic lesions, progression in the size of the lesions, polyethylene wear since the time of implantation, change in component position, and patient-related variables (age, gender, body mass index, activity level, walking limitations, joint pain, and function) were determined. RESULTS In sixteen of the thirty hips that had repeat computed tomography scans, the lesions progressed in size during the study period. The median size of the lesions in these sixteen hips was 10.3 cm(3) at the time of the initial scan, compared with 13.3 cm(3) at a median of fifteen months later (p = 0.001). Osteolytic lesions measuring >10 cm(3) in volume on the initial scan were 2.5 times (95% confidence interval 1.3 to 4.8 times) more likely to progress in size over one year than smaller lesions were. Patients with greater polyethylene wear rates, higher activity levels, no walking limitations, and larger prosthetic femoral head dimensions (26 or 28 mm) had significantly larger osteolytic lesions (p < 0.0001, p = 0.009, p = 0.006, and p = 0.028, respectively). Progression in the size of the osteolytic lesions over one year was significantly associated with larger initial osteolytic lesions (p = 0.002), greater polyethylene wear rates (p = 0.009), and larger (26 or 28-mm) prosthetic femoral head dimensions (p = 0.019). CONCLUSIONS There is considerable variation in the rates of progression of the size of osteolytic lesions around stable acetabular components. Lesion size and the progression of lesion size are generally related to polyethylene wear rates, higher patient activity levels, and larger-diameter femoral heads. Osteolytic lesions measuring >10 cm(3) in volume are associated with a high rate of progression.
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Affiliation(s)
- Donald W Howie
- Department of Orthopaedics and Trauma, Level 4, Bice Building, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, Australia
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Stihsen C, Pabinger C, Radl R, Rehak P, Windhager R. Migration of the Duraloc cup after 5 years. INTERNATIONAL ORTHOPAEDICS 2007; 32:791-4. [PMID: 17609953 PMCID: PMC2898953 DOI: 10.1007/s00264-007-0405-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 05/18/2007] [Accepted: 05/22/2007] [Indexed: 11/27/2022]
Abstract
The Duraloc cup is a frequently used metal-backed, porous-coated, hemispherical, press-fit acetabular component. Published data on loosening rates are contradictory. In this study we investigated migration patterns with computer-assisted Einzel-Bild-Roentgen-Analyse (EBRA) of 67 Duraloc 100 cups. Cup migration and clinical scores were analysed over a 5-year follow-up period. Median total migration of the Duraloc 100 cup was 1.21 mm at 5 years. Seventy-five percent of implants were radiologically stable at 2 years and 90% at 4 years. One cup loosened aseptically at 60 months, requiring revision. Cup diameters > or = 54 mm migrated significantly more than cups < 54 mm in diameter (p = 0.029 at 4 years). There was a significant correlation between high polyethylene wear and further migrating cups within the first post-operative year (p = 0.035 at 12 months). Our analysis revealed significantly higher wear in males (p = 0.029 at 4 years). Radiological loosening at two years could be calculated using receiver-operating characteristic curve analysis, and 1.2 mm as an adequate threshold value (sensitivity = 100%, specificity = 89%).
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Affiliation(s)
- Christoph Stihsen
- Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | | | - Roman Radl
- Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Peter Rehak
- Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - Reinhard Windhager
- Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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41
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Einsiedel T, Gebhard F, Bregolato I, Hiemeier A, Kinzl L, Schultheiss M. Proximal cement fixation in total hip arthroplasty--first results with a new stem design. INTERNATIONAL ORTHOPAEDICS 2007; 32:295-306. [PMID: 17431622 PMCID: PMC2323424 DOI: 10.1007/s00264-006-0316-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 12/02/2006] [Accepted: 12/03/2006] [Indexed: 10/23/2022]
Abstract
Stem loosening and stress-shielding are problems encountered in cemented hip arthroplasty. Could proximal stem fixation by partial cementing solve the problem? More physiological transmission of forces with only proximal cement fixation seems to be possible with this recent development (Z-stem, Option 3000, Mathys Orthopaedics, Bettlach, Switzerland). In a prospective clinical trial, this new implant was used for total hip arthroplasty in human patients. One hundred and thirty-three (133) total hip replacements in 123 patients were performed between April 1996 and January 2003. All of them were followed up regularly; 53 were analysed with the EBRA-FCA method (Einzel Bild Röntgen Analyse--femoral component analysis), whereas the rest were analysed using conventional follow-up X-rays. Eighty-six (86) patients with 95 hips could be examined in August 2004 to obtain mid-term results. At this stage, the mean follow-up time was 61 months (5.08 years), with a maximum of 100 months (8.33 years). Up to October 2004, nine cases needed a revision. The clinical data collected reported an average Harris Hip Score of 89.3 (good). The EBRA-FCA analysis reported a mean subsidence of less than 1.5 mm after the first two years, under the EBRA threshold of predicted loosening. At the latest follow-up (at an average of 61 months), there was an average stable subsidence of 2.4 mm in general. Eight (8) patients presented with subsidence of more than 5 mm. The results of the new implant seem to be encouraging. Finally, comparing our results to other fixation concepts will require longer follow-up periods.
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Affiliation(s)
- Thomas Einsiedel
- Department of Trauma, Hand and Reconstructive Surgery, University of Ulm, Steinhövelstrasse 9, 89075 Ulm, Germany.
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42
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Hendrich C, Sauer U, Kirschner S, Schmitz H, Martell JM. High long-term loosening rate of conical screw cups. Acta Orthop 2006; 77:886-92. [PMID: 17260196 DOI: 10.1080/17453670610013178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Acetabular screw cups seem to give high primary stability. We analyzed the migration and loosening behavior of a first-generation screw cup in a longterm follow-up. PATIENTS AND METHODS We examined 92 uncemented titanium alloy conical screw cups prospectively. Implant migration was assessed with a digital high-precision method (EBRA) with an accuracy of 1.0 mm. RESULTS After mean 11 (0.5-18) years, 87 patients were available for examination and 5 patients had died. 32 implants had been revised and 7 cases showed radiographic evidence of loosening. The 10-year survival rate was 71%. Migration of more than 1 mm occurred in 53 hips. Implant survival was strongly associated with an annual migration of greater than 0.2 mm. INTERPRETATION The long-term behavior of this cup is not satisfactory. In spite of extraordinarily high primary implant stability, secondary osseointegration of this cup often fails. The annual migration rate represents a valid parameter for prediction of implant survival.
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43
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Macheras GA, Papagelopoulos PJ, Kateros K, Kostakos AT, Baltas D, Karachalios TS. Radiological evaluation of the metal-bone interface of a porous tantalum monoblock acetabular component. ACTA ACUST UNITED AC 2006; 88:304-9. [PMID: 16498001 DOI: 10.1302/0301-620x.88b3.16940] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Between January 1998 and December 1998, 82 consecutive patients (86 hips) underwent total hip arthroplasty using a trabecular metal monoblock acetabular component. All patients had a clinical and radiological follow-up evaluation at six, 12 and 24 weeks, 12 months, and then annually thereafter. On the initial post-operative radiograph 25 hips had a gap between the outer surface of the component and the acetabular host bed which ranged from 1 to 5 mm. All patients were followed up clinically and radiologically for a mean of 7.3 years (7 to 7.5). The 25 hips with the 1 to 5 mm gaps were studied for component migration at two years using the Einzel-Bild-Roentgen-Analyse (EBRA) digital measurement method. At 24 weeks all the post-operative gaps were filled with bone and no acetabular component had migrated. The radiographic outcome of all 86 components showed no radiolucent lines and no evidence of lysis. No acetabular implant was revised. There were no dislocations or other complications. The bridging of the interface gaps (up to 5 mm) by the trabecular metal monoblock acetabular component indicates the strong osteoconductive, and possibly osteoinductive, properties of trabecular metal.
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Affiliation(s)
- G A Macheras
- Department of Orthopaedics, First IKA Hospital Athens, 1 Zaimi Street, 15127, Athens, and Orthopaedic Department, School of Medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece.
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Hendrich C, Mehling I, Sauer U, Kirschner S, Martell JM. Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips. J Bone Joint Surg Am 2006; 88:387-94. [PMID: 16452752 DOI: 10.2106/jbjs.d.02373] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Studies of acetabular reconstruction with use of cement and bulk bone graft have demonstrated increasing rates of cup failure in patients with dysplastic hips seven years after total hip arthroplasty. Comparable data on the long-term results of bulk bone-grafting done in conjunction with cementless implants are limited. The aim of this study was to review the clinical and radiographic results of autologous bulk bone-grafting in conjunction with a cementless cup. METHODS From 1987 to 1992, forty-seven patients (forty women and seven men, with an average age of 50.4 years) who had developmental dysplasia of the hip underwent fifty-six total hip arthroplasties and received a structural graft in combination with a cementless Harris-Galante type-I cup. All patients were followed prospectively. In fifty-five hips, implant migration was measured with single-image radiographic analysis. RESULTS After an average duration (and standard deviation) of 10.2 +/- 2.9 years, three patients (four hips) had died. In the surviving patients, four implants had been revised and two had radiographic evidence of loosening. With use of revision and loosening as end points, the eleven-year survival rates were 91.6% and 88.9%, respectively. Of the fifty implants that had no loosening, fourteen had measurable cup migration, thirty-five had no migration, and one implant could not be measured. All migrations but one were progressive. With loosening used as the end point, the survival rate at eleven years was 100% for the implants with no migration; however, the survival rate for the cups that had migrated was 69.3% (p = 0.0012). CONCLUSIONS The eleven-year survival rate for the spherical press-fit cups in combination with bulk bone-grafting is satisfactory, given the complexity of these reconstructions. However, the difference between the survival of the implants that had migrated and those that had not was significant. We expect that the thirteen implants with progressive acetabular migration at the time of the latest follow-up are at risk for loosening, which will increase the revision rate for this series in the coming years.
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Affiliation(s)
- C Hendrich
- Orthopädisches Krankenhaus Schloss Werneck, Balthasar-Neumann-Platz 1, 97440 Werneck, Germany.
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The B, Mol L, Diercks RL, van Ooijen PMA, Verdonschot N. Correction of error in two-dimensional wear measurements of cemented hip arthroplasties. Clin Orthop Relat Res 2006; 442:180-6. [PMID: 16394758 DOI: 10.1097/01.blo.0000185032.94102.2b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The irregularity of individual wear patterns of total hip prostheses seen during patient followup may result partially from differences in radiographic projection of the components between radiographs. A method to adjust for this source of error would increase the value of individual wear curves. We developed and tested a method to correct for this source of error. The influence of patient position on validity of wear measurements was investigated with controlled manipulation of a cadaveric pelvis. Without correction, the error exceeded 0.2 mm if differences in cup projection were as small as 5 degrees. When using the described correction method, cup positioning differences could be greater than 20 degrees before introducing an error exceeding 0.2 mm. For followup of patients in clinical practice, we recommend using the correction method to enhance accuracy of the results.
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Affiliation(s)
- Bertram The
- Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, The Netherlands.
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46
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Girard J, Touraine D, Soenen M, Massin P, Laffargue P, Migaud H. [Measurement of head penetration on digitalized radiographs: reproducibility and accuracy]. ACTA ACUST UNITED AC 2005; 91:137-42. [PMID: 15908883 DOI: 10.1016/s0035-1040(05)84291-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF THE STUDY Wear of the acetabular component of total hip arthroplasty (THA) is incriminated as the cause of loosening and bone resorption. Consequently, an accurate evaluation of wear can contribute to the prediction of mechanical failure of the arthroplasty. Among the different methods proposed, digitalized imaging using a high-resolution scanner associated with data processing procedures appears to be a simple easily accessible technique. A system based on this concept has been introduced in orthopedics. To our knowledge, there has been no report on the system's reproducibility and accuracy. MATERIAL AND METHODS Thirty-nine radiography series for THA served as the basis for the evaluation of intra- and interobserver reproducibility. We evaluated the error induced by digitalization, the error induced by digitalized measurement, the accuracy of the measurements as a function of the material constituting the bearing, the intra- and interobserver reproducibility for repeated measures of THA wear (six observers and two observations). All measurements were done after digitalization and analyzed with a specimen designed software. RESULTS The inter and intra-observer coefficients of concordance were 0.6 and 0.58 respectively, i.e. moderate reproducibility. Depending on the prosthetic material, the error and accuracy of the system varied from 0.112 to 0.44 mm and 0.28 to 1.29 mm respectively. To obtain valid inter-observer reproducibility, the number of observers had to be limited to three (coefficient = 0.82). The type of implant had an influence on measurement error. The error was 0.342 for polyethylene cups and 0.118 for press-fit metal back cups. Likewise, for a metallic head measuring 22.2 mm, the error was 0.138 mm while for a ceramic head or metal head measuring 28 mm, the error was 0.28 mm and 0.112 mm respectively. DISCUSSION AND CONCLUSION The accuracy and error depend directly on the type of implant. The accuracy was better for metallic heads associated with metal-backed cups. To obtain satisfactory interclass correlation, the number of observers should be three. The proposed digitalized measurement system should be relatively accurate and reproducible. Its use can be recommended for the evaluation of wear after five years of follow-up, limiting the number of observers to three.
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Affiliation(s)
- J Girard
- Service d'Orthopédie C, Hôpital Salengro, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille Cedex.
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Hendrich C, Sauer U, Albrecht T, Rader CP. Subsidence of titanium straight stems in combination with highly viscous bone cement. INTERNATIONAL ORTHOPAEDICS 2005; 29:96-100. [PMID: 15703935 PMCID: PMC3474517 DOI: 10.1007/s00264-004-0631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Accepted: 12/06/2004] [Indexed: 10/25/2022]
Abstract
Varying results and a high rate of subsidence have been reported for the straight femoral stem (M.E. Muller) made of titanium alloy. We examined subsidence in 135 titanium-alloy straight stems implanted with high viscosity cement after 68.8+/-11.5 months using a digital high-precision method (EBRA-FCA). One revised implant showed a subsidence of 14.6 mm and another 2.5 mm over 5 years. A third implant without migration was found to be loose. The 122 implants without loosening showed a mean subsidence of 0.1+/-0.1 mm, and focal osteolysis was seen in two. Altogether, we found subsidence of the titanium stems very small. The small subsidence may be related to the use of high viscosity bone cement.
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Affiliation(s)
- Christian Hendrich
- Department of Orthopaedics, Würzburg University, König-Ludwig-Haus, Brettreichstr. 11, 97074 Würzburg, Germany.
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