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Heijnens LJM, Schotanus MGM, VAN Haaren EH. Excellent survival of two anatomically adapted hydroxyapatite coated cementless Total Hip Arthroplasties. A mean follow-up of 11.3 years. Acta Orthop Belg 2024; 90:35-40. [PMID: 38669646 DOI: 10.52628/90.1.11314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
There are many different types of cementless anatomically adapted Total Hip Arthroplasties (THAs) on the market, the Anatomic Benoist Gerard (ABG) I and II are such types of cementless THAs. In this retrospective single-centre study we evaluated the overall survival with revision for any reason and aseptic loosening as endpoint at more than 11 years follow-up. Between 2000 and 2004, 244 cementless THAs were performed in 230 patients in a primary care hospital. At a mean of 11.3 years follow-up (range 9.8 - 12.8 years) clinical examination, plain radiography and Patient Reported Outcome Measures (PROMs) were obtained and analysed. The PROMs consisted of the Oxford Hip Score (OHS) and the Western Ontario and McMaster University Index (WOMAC). At a mean of 11.3 years follow-up 32 patients (13.1%) had died of unrelated causes. Of the remaining cohort all 198 patients (212 THAs) have been reached for evaluation. There were no patients considered as lost to follow-up. At a mean of 11.3 years 11 patients (11 THAs) have had a revision of either the femoral implant or acetabular component resulting in an overall survival of 95.5%. There was no statistically significant difference (p=0.564) in survival between the ABG I and II THAs. Radiographic there were no changes between the ABG I and II last follow up. The ABG II performed statistically significant better in PROMs. We concluded that both anatomically adapted hydroxyapatite coated cementless THAs show excellent survival at more than 11 years follow-up.
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Kropivšek L, Antolič V, Mavčič B. Surgeon-Stratified Periprosthetic Fracture Risk in a Single-Hospital Cohort of 1531 Uncemented ABG-II Femoral Stems at Primary Total Hip Arthroplasty. Indian J Orthop 2023; 57:1850-1857. [PMID: 37881273 PMCID: PMC10593654 DOI: 10.1007/s43465-023-00996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 09/04/2023] [Indexed: 10/27/2023]
Abstract
Purpose Late periprosthetic fracture risk with uncemented ABG-II femoral stems at primary total hip arthroplasty (THA) has been reported before, but single-hospital surgeon-stratified reports of this implant have never been published. We asked whether periprosthetic fracture rates of ABG-II femoral stems implanted at a single tertiary hospital depended on patients' age, gender and the operating surgeon. Methods The study included 1531 consecutive primary ABG-II femoral stems implanted at a single tertiary hospital between January 1, 2012 and December 31, 2018. The Kaplan-Meier and Cox regression analyses were performed after 3.6-10.6 years of follow-up. Results In the cohort, we recorded 8 intraoperative, 22 early postoperative (within 90 days of implantation) and 26 late periprosthetic fractures (over 90 days postoperatively). The revision rate of ABG-II femoral stems was 5.1/100 component-years for early and 0.3/100 component-years for late periprosthetic fractures. The Kaplan-Meier cumulative probability of periprosthetic fracture was 2.1% at one, 2.3% at 2, 3.2% at 5, and 6.5% at 10 years after the implantation. Higher patient's age at operation was an independent risk factor of subsequent periprosthetic fracture (hazard ratio 1.07, 95% confidence interval 1.03-1.10; p < 0.01), regardless of the operating surgeon. Most of the fractured femora were Dorr type C (stovepipe). Conclusion The study presents the largest published ABG-II femoral stem cohort from a single hospital so far with 9291 component-years of observation. Periprosthetic fracture risk of ABG-II increased with patients' age, had no variability between different surgeons, and was considerably higher from other uncemented femoral stems used at the same hospital. Level of Evidence III.
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Affiliation(s)
- Luka Kropivšek
- Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia
| | - Vane Antolič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia
| | - Blaž Mavčič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia
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Coulomb R, Mansour J, Essig J, Asencio G, Kouyoumdjian P. Clinical results at 10 years of minimum follow-up with the ABG 2 hip arthroplasty, matched with ceramic-on-ceramic bearings. SICOT J 2022; 8:32. [PMID: 35969123 PMCID: PMC9377216 DOI: 10.1051/sicotj/2022032] [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: 03/15/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: The current study aimed as a primary goal is to assess the results of a ceramic-on-ceramic (CoC) bearing hip system matched with ABG (Anatomic Benoist Girard) 2 components in terms of survivorship. Secondary objectives addressed specifically ceramic-related complications as well as specific patterns at the bone-implant interface. Material and methods: This is a retrospective bicentric continuous series involving 147 patients (95 males vs. 52 females) who underwent ABG 2 arthroplasties with CoC bearings. One hundred and twenty-five hips were closely followed-up at a mean period of 11.3 years. Results and discussion: With a mean follow-up of 11.3 years, nine cases (5.7%) underwent revision surgery, four caused by acetabular aseptic loosening, three by deep infections, one ceramic head fracture, and one femoro-acetabular impingement. The global survivorship was 92.2% at 12.7 years. The Harris Hip Score (HHS) mean scores increased post-operatively from 50.1 up to 96.1 points (p < 0.001). All stems featured patterns of radiological osseous integration onto the hydroxyapatite (HA)-coated zones. No radiological wear or osteolysis of ceramic bearings was demonstrated however, five patients reported hip squeaking using this bearing. This study demonstrated excellent results at mid-term follow-up in patients younger than 70 years of age using cementless ABG 2 components coupled with CoC bearings with no increase in complication rate.
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Affiliation(s)
- Remy Coulomb
- University Hospital of Nîmes, Rue du Pr. Robert Debré, 30029 Nimes cedex 9, France
| | - Jad Mansour
- University Hospital of Nîmes, Rue du Pr. Robert Debré, 30029 Nimes cedex 9, France
| | - Jérome Essig
- Clinique Médipole-Garonne, 45, rue Gironis, 31036 Toulouse cedex 1, France
| | - Gérard Asencio
- University Hospital of Nîmes, Rue du Pr. Robert Debré, 30029 Nimes cedex 9, France
| | - Pascal Kouyoumdjian
- University Hospital of Nîmes, Rue du Pr. Robert Debré, 30029 Nimes cedex 9, France - Laboratory of Mechanics and Civil Engineering (LMGC), CNRS-UM1, 860 Rue de St-Priest, 34090 Montpellier, France - Université Montpellier 1, 2 Rue de l'École de Médecine, 34090 Montpellier, France
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Mulford JS, Mathew R, Penn D, Cuthbert AR, De Steiger R. Periprosthetic fracture as a late mode of failure of the Anatomique Benoist Girard II femoral prosthesis. ANZ J Surg 2022; 92:1165-1170. [PMID: 35191171 PMCID: PMC9306843 DOI: 10.1111/ans.17547] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
Aim The Anatomique Benoist Girard (ABG) II femoral implant was a commonly used stem for primary total hip replacement (THR) at our institution (Launceston, Tasmania Australia). We identified peri‐prosthetic fracture as the main cause of late failure. Methods The late periprosthetic fracture rate for ABG II implants was reviewed with national statistics, using Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data. National revision rates for periprosthetic fracture were used to compare ABG II with all other cementless femoral stems. Result ABG II stems accounted for 1% (2719 implants) of all femoral stem implants in Australia during the 12‐year review period, compared to 23% (587 implants) in Launceston Hospitals. Although the Launceston cumulative percent revision rate for the ABG II stem was lower than the National rate at all time points, the reasons for revision were similar. The most common reason for revision of ABG II was fracture (56.8%), followed by loosening (15.3%). This differs from the reasons for revision in other cementless prostheses (loosening 23.9%, fracture 20.8%, dislocation 18.7%). Cumulative percent revision rates from late periprosthetic fracture, were higher for the ABG II stem than other cementless femoral prostheses. Conclusion This review of the AOANJRR has confirmed a local and national higher revision rate of the ABG II stem due to late periprosthetic fracture compared with other cementless stems. Stem design must be considered to reduce the risk of late periprosthetic fracture.
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Affiliation(s)
- Jonathan S Mulford
- Orthopaedic Department, Department of Surgery, Launceston General Hospital, Launceston, Tasmania, Australia.,Launceston Clinical School, School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Ronnie Mathew
- Orthopaedic Department, Department of Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - David Penn
- Orthopaedic Department, Department of Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Alana R Cuthbert
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Richard De Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia.,Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
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Heijnens LJ, Schotanus MG, Verburg AD, van Haaren EH. Disappointing long-term outcome of THA with carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK) as acetabular insert liner: a prospective study with a mean follow-up of 14.3 years. Hip Int 2021; 31:735-742. [PMID: 32340489 DOI: 10.1177/1120700020918157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Insert liner wear of the acetabular component is one of the predictive values for survival of total hip arthroplasties (THAs). This prospective single-centre study was designed to evaluate the follow-up of carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK) insert liner used as bearing in cementless THAs. METHODS 29 healthy patients with an indication for cementless THA were selected for a CFR-PEEK insert liner and followed over time. All patients received a cementless THA with a CFR-PEEK insert liner used as bearing. At different follow-up moments patients were routinely examined and were analysed using the Oxford Hip Score (OHS), the modified Merle d'Aubigne-Postel (MAP) score, and radiologically. At the follow up moments the plain radiographics where assessed for loosening, cyst formations and wear of the CFR-PEEK liners. RESULTS At a mean of 14.3 years follow-up 4 revisions of the acetabular component were performed, resulting in a survival rate of 86.5% (CI 95%, 72.4-96.6). A statistically significant difference in OHS and MAP scores between pre- and postoperative follow-up moments was observed. The acetabular components of the remaining patients showed no radiological abnormalities at 14.3 years follow-up. The overall CFR-PEEK wear was low, with a mean of 0.81 (0.2-1.4) mm wear at 14.3 years follow-up. CONCLUSIONS In this series we found an aseptic loosening with unclear reasons in 4 well-positioned acetabular components, hence we do not recommend routine use of CFR-PEEK insert liners as bearing in cementless THAs. All the remaining THAs and acetabular components were in situ without abnormalities at 14.3 years follow-up.
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Affiliation(s)
- Luc Jm Heijnens
- Department of Orthopaedic Surgery, Zuyderland Medical Centre Sittard, The Netherlands
| | - Martijn Gm Schotanus
- Department of Orthopaedic Surgery, Zuyderland Medical Centre Sittard, The Netherlands
| | - Aart D Verburg
- Department of Orthopaedic Surgery, Zuyderland Medical Centre Sittard, The Netherlands
| | - Emil H van Haaren
- Department of Orthopaedic Surgery, Zuyderland Medical Centre Sittard, The Netherlands
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Toro G, Di Fino C, De Cicco A, Toro G, Paoletta M, Toro A, Tarantino U, Iolascon G, Panni AS. Atypical periprosthetic femoral fractures of the hip: characterisation of three cases. Hip Int 2020; 30:77-85. [PMID: 33267685 DOI: 10.1177/1120700020971726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Long-term use of bisphosphonates (BPs) has been associated with a specific type of tensile side femoral stress fracture known as Atypical Femoral Fracture (AFF). Theoretically periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, emerging evidence correlates prolonged BPs use with the occurrence of a type of PFF with an atypical pattern (atypical PFF, APFF). The aim of the present study is to report 3 cases of APFF treated at a single centre. METHODS Clinical and radiographic records of PFF that occurred between January 2016 and August 2018 were retrospectively reviewed. All patients meeting the American Society for Bone and Mineral Research (ASBMR) criteria for definition of PFF were included. Management strategies for APFF and patient outcomes, including fracture healing and hip function (assessed by the Oxford Hip Score [OHS]) were collected. RESULTS 3 patients in the study period were identified as APFF (1 incomplete, 2 complete). All patients were females with a mean age of 83.3 years. All patients were treated with lateral plating. The application of a contralateral strut allograft resulted in fracture healing in cases of complete fractures. Mean OHS at final follow-up was 34.3. CONCLUSIONS Despite occurring around a hip stem like PFF, APFF had peculiar clinical and radiographic features, making them more similar to AFF. Therefore, the orthopaedic surgeon should also consider the natural history and healing problems associated with AFF prior in order to choose the most appropriate management for APFF.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ciro Di Fino
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Toro
- Unit of Orthopaedics and Traumatology, "Martiri del Villa Malta" Hospital, Sarno, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Aro E, Alm JJ, Moritz N, Mattila K, Aro HT. Good stability of a cementless, anatomically designed femoral stem in aging women: a 9-year RSA study of 32 patients. Acta Orthop 2018; 89:490-495. [PMID: 29987941 PMCID: PMC6202764 DOI: 10.1080/17453674.2018.1490985] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - We previously reported a transient, bone mineral density (BMD)-dependent early migration of anatomically designed hydroxyapatite-coated femoral stems with ceramic-ceramic bearing surfaces (ABG-II) in aging osteoarthritic women undergoing cementless total hip arthroplasty. To evaluate the clinical significance of the finding, we performed a follow-up study for repeated radiostereometric analysis (RSA) 9 years after surgery. Patients and methods - Of the 53 female patients examined at 2 years post-surgery in the original study, 32 were able to undergo repeated RSA of femoral stem migration at a median of 9 years (7.8-9.3) after surgery. Standard hip radiographs were obtained, and the subjects completed the Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index outcome questionnaires. Results - Paired comparisons revealed no statistically significant migration of the femoral stems between 2 and 9 years post-surgery. 1 patient exhibited minor but progressive RSA stem migration. All radiographs exhibited uniform stem osseointegration. No stem was revised for mechanical loosening. The clinical outcome scores were similar between 2 and 9 years post-surgery. Interpretation - Despite the BMD-related early migration observed during the first 3 postoperative months, the anatomically designed femoral stems in aging women are osseointegrated, as evaluated by RSA and radiographs, and exhibit good clinical function at 9 years.
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Affiliation(s)
- Erik Aro
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku;
| | - Jessica J Alm
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku;
| | - Niko Moritz
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku;
| | - Kimmo Mattila
- Department of Diagnostic Imaging, Turku University Hospital, Turku, Finland
| | - Hannu T Aro
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku; ,Correspondence:
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Elmallah RK, Cherian JJ, Meneghini RM, Hozack WJ, Westrich GH, Mont MA. How to Approach a Recalled Dual Modular Hip Implant: An Update. J Arthroplasty 2016; 31:2646-2652. [PMID: 27542855 DOI: 10.1016/j.arth.2016.06.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/08/2016] [Accepted: 06/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study was to provide an update on the "Modular taper junction corrosion and failure: how to approach a recalled total hip arthroplasty implant" (Pivec et al JOA 2014) publication. METHODS We performed a comprehensive review of the literature in English, with search terms referencing to the diagnosis, management, and outcomes of patients who underwent total hip arthroplasty with a recalled dual modular hip implant. RESULTS Based on this review and the new guidelines by the American Academy of Orthopedic Surgeons and the Hip Society, we propose an updated algorithm for the diagnosis and management of patients with these recalled implants. CONCLUSION When encountering patients with these prostheses, it is imperative to take a step-by-step approach to evaluate whether patients are having potential complications. We hope that this has further clarified the appropriate steps that need to be carried out when confronted with these recalled devices.
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Affiliation(s)
- Randa K Elmallah
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jeffrey J Cherian
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Robert M Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - William J Hozack
- Department of Orthopedic surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Geoffrey H Westrich
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Michael A Mont
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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