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Schwarz GM, Synek A, Senck S, Kandathil SA, Holzleitner M, Trieb K, Huber S, Pahr D, Hofstaetter JG, Hirtler L. Three-Dimensional Osseointegration Patterns of Cementless Femoral Stems: An ex Vivo Study with High-Resolution Imaging and Histological Evaluation. J Bone Joint Surg Am 2024; 106:941-949. [PMID: 38512965 DOI: 10.2106/jbjs.23.00526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Osseointegration is essential for the long-term survival of cementless femoral stems and is dependent on periprosthetic bone quality and correct implantation technique. The aim of this study was to evaluate the 3-dimensional long-term fixation patterns of, and bone microarchitecture around, cementless hip stems. METHODS Four specimens with varying degrees of bone quality and fixation characteristics from body donors who had received Alloclassic Zweymüller hip stems during their lifetime (mean time in situ at the time of death: 12.73 years) were evaluated with use of radiographs, high-resolution computed tomography (CT) scans, and hard-tissue histology. The CT voxel size was 85 µm, and the following parameters were calculated: total bone volume, total bone volume fraction, trabecular bone volume, trabecular bone volume fraction, cortical bone volume, cortical bone volume fraction, and cortical thickness. Bone-implant contact and canal fill index values for each Gruen zone of the specimens were calculated with use of histological samples. RESULTS Femoral stems with apparently good cortical contact on clinical radiographs showed higher values for cortical bone volume, trabecular bone volume, and cortical thickness in the high-resolution CT analysis than femoral stems with apparently weak cortical contact on clinical radiographs. Based on the histological evaluation, the mean bone-implant contact ranged from 22.94% to 57.24% and the mean canal fill index ranged from 52.33% to 69.67% among the specimens. CONCLUSIONS This study demonstrated different osseointegration patterns of cementless femoral stems on the basis of radiographs, high-resolution CT scans, and histological evaluation. Femora with high cortical bone volume and cortical thickness were associated with higher canal fill indices, whereas femora with low cortical bone volume and cortical thickness had lower canal fill indices and showed a characteristic corner-anchorage pattern. CLINICAL RELEVANCE Osseointegration patterns and thus the long-term survival of cementless femoral stems are dependent on cortical bone volume and cortical thickness.
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Affiliation(s)
- Gilbert M Schwarz
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
- Center for Anatomy and Cell Biology, Medical University Vienna, Vienna, Austria
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna, Vienna, Austria
| | - Alexander Synek
- Institute for Lightweight Design and Structural Biomechanics, Technical University of Vienna, Austria
| | - Sascha Senck
- Research Group Computed Tomography, University of Applied Sciences Upper Austria, Wels, Austria
| | - Sam A Kandathil
- Center for Anatomy and Cell Biology, Medical University Vienna, Vienna, Austria
| | - Martin Holzleitner
- Research Group Computed Tomography, University of Applied Sciences Upper Austria, Wels, Austria
| | - Klemens Trieb
- Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stephanie Huber
- Center for Anatomy and Cell Biology, Medical University Vienna, Vienna, Austria
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna, Vienna, Austria
| | - Dieter Pahr
- Institute for Lightweight Design and Structural Biomechanics, Technical University of Vienna, Austria
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Jochen G Hofstaetter
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna, Vienna, Austria
- 2nd Department, Orthopaedic Hospital Vienna Speising, Vienna, Austria
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Medical University Vienna, Vienna, Austria
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Nakai T, Takeda Y, Niitsu S, Fujihara Y, Okahisa S, Tachibana T, Fukunishi S. Comparative Study for Postoperative Initial Fixation Patterns of Two Different Types of Cementless Short Stem Using Three-Dimensional Templating Software. Clin Orthop Surg 2024; 16:23-33. [PMID: 38304207 PMCID: PMC10825261 DOI: 10.4055/cios23100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 02/03/2024] Open
Abstract
Background While cementless short stems have become popular in total hip arthroplasty (THA), Metha is a relatively recent development that differs from other short stems in its initial fixation concept of partial collum-sparing metaphyseal anchorage. The purpose of this study was to quantify the contact state between Metha and the femur. Additionally, we investigated the difference in contact points between Meta and Fitmore, which is one of the more popular curved short stems. Methods We conducted a retrospective review of 42 hips that underwent THA using Metha and 41 hips using Fitmore. Stem-to-femur contact was evaluated by density mapping using a three-dimensional digital template system to quantify the contact condition according to the modified Gruen zone. The criterion for the stem-to-bone contact boundary was defined as a computed tomography value of 543 Hounsfield. Results Quantitative evaluation of Metha according to the modified Gruen zones showed the ratio of surface area with high cortical contact in each zone. The results were 4.6% ± 5.7% in zone 1, 0.9% ± 2.3% in zone 2, 19.1% ± 12.9% in zone 3, 1.4% ± 3.2% in zone 5, 29.6% ± 16.4% in zone 6, and 25.1% ± 17.7% in zones 7. Evaluation of Fitmore for the same zones was as follows: 1.6% ± 2.4%, 18.5% ± 16.9%, 20.8% ± 17.4%, 12.7% ± 12.8%, 3.7% ± 5.8%, and 13.3% ± 10.3%. Comparing the two groups, the contact area was significantly greater for Metha in zones 1, 6 and 7 and Fitmore in zones 2 and 5 (p < 0.05). Conclusions It is possible for Metha to achieve metaphyseal anchoring by contacting the cortical bone at the proximal femur, thus avoiding proximal offloading. To the best of our knowledge, no previous studies have quantitatively reported stem-to-cortical bone contact conditions in curved short stems.
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Affiliation(s)
- Takuya Nakai
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan
| | - Yu Takeda
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Saori Niitsu
- Department of Orthopedic Surgery, Goshi Hospital, Hyogo, Japan
| | - Yuki Fujihara
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Shohei Okahisa
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Shigeo Fukunishi
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan
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Kato D, Takegami Y, Seki T, Osawa Y, Takemoto G, Okamoto M, Iida H, Imagama S. Differences in peri-hip articular pain after total hip arthroplasty between taper wedge stem and fit-and-fill stem. J Orthop 2023; 35:58-63. [PMID: 36387764 PMCID: PMC9661431 DOI: 10.1016/j.jor.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Total hip arthroplasty (THA) for hip disorders helps to alleviate pain and improve active daily life. When determining the effects of medical therapy and the subsequent clinical results, patient quality of life (QOL) also needs to be assessed. Recently, patient-reported outcomes (PRO) have become important as evaluation criteria. This study aimed to evaluate patient QOL and various PRO between different types of cementless stems and to clarify the relationship between PRO and stem-cortical bone contact. Methods The study comprised 138 consecutive patients undergoing cementless THA for hip osteoarthritis. We assessed three different types of PRO: the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), patient's joint perception, and peri-hip articular joint pain (PHAP). We measured the state of contact between femur and implant by density mapping. Results No significant difference was noted in PRO between stem types based on the JHEQ and patient's joint perception. PHAP occurred more frequently in the patients with a taper wedge stem versus a fit-and-fill stem. In both groups, distal contact was associated with PHAP but not with JHEQ results and patient's joint perception. Conclusion The difference in PHAP between the two stem types groups was significant, with postoperative PHAP being higher with the taper wedge stem because of the more distal contact between the taper wedge stem and femur cortical bone.
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Affiliation(s)
- Daisaku Kato
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Genta Takemoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Masanori Okamoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroki Iida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
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Kobayashi K, Osaki M, Kidera K, Ait-Si-Selmi T, Ramos-Pascual S, Saffarini M, Bonnin MP. Stem-bone contact patterns of a long straight tapered uncemented stem for primary THA. Arch Orthop Trauma Surg 2022; 142:4063-4073. [PMID: 35013767 DOI: 10.1007/s00402-021-04273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Despite excellent long-term survival, total hip arthroplasty (THA) can fail due to aseptic loosening, dislocations, sepsis and periprosthetic fractures, all of which remain considerably burdensome. Aseptic loosening is one of the main causes of THA failure, often due to osteolysis, stress shielding and/or lack of primary stability. This study aimed to investigate stem-bone contact patterns of a long straight-tapered uncemented stem following primary THA, and to determine whether these contact patterns are related to preoperative femoral morphology and whether they influence postoperative outcomes. MATERIALS AND METHODS The authors reviewed a continuous series of 60 hips (55 patients) that underwent primary THA using the Corail® stem (DePuy, Leeds, UK). Patients were evaluated pre- and post-operatively using the Japanese Orthopaedic Association (JOA) score. Computed-tomography (CT) scans were performed preoperatively to assess femoral bone morphology, and immediate postoperatively to assess stem-bone contact patterns. Postoperative radiographs were performed to calculate the Engh score. Regression analyses were performed to determine associations of postoperative JOA and Engh score with 27 independent variables. RESULTS Forty-nine patients (54 hips) were assessed at 31 ± 8 months, with a JOA score of 92.9 ± 8.1 and an Engh score of 21.2 ± 1.9. Six patients (6 hips) were lost-to-follow-up. There were no revisions and only one complication (recurrent dislocation). Stem-bone contact patterns were associated with preoperative femoral morphology (sagittal CFI [p = 0.006], femoral offset [p = 0.028], and NSA [p = 0.022]), but were not associated with either postoperative JOA or postoperative Engh score. CONCLUSIONS The stem-bone contact patterns of a long straight-tapered uncemented stem are related to preoperative femoral morphology, but do not influence short-term postoperative outcomes. Contact patterns were related to preoperative femoral offset, NSA, and sagittal CFI, but not coronal CFI. Surgeons should, therefore, consider sagittal morphology for surgical planning and templating, in addition to the conventional parameters of coronal morphology.
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Affiliation(s)
- Kyosuke Kobayashi
- Department of Orthopaedic Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kenichi Kidera
- Department of Orthopaedic Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tarik Ait-Si-Selmi
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Artro Institute, Lyon, France
| | | | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Michel P Bonnin
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Artro Institute, Lyon, France
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Demographic Data Reliably Predicts Total Hip Arthroplasty Component Size. J Arthroplasty 2022; 37:S890-S894. [PMID: 35093541 DOI: 10.1016/j.arth.2022.01.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Preoperative radiographic templating for total hip arthroplasty (THA) has been shown to be inaccurate, although essential for streamlining operating room efficiency. Although demographic data have shown to predict total knee arthroplasty component sizes, the unique contour and design among femoral stem implants have limited a similar application for hip arthroplasty. The purpose of this study was to determine whether demographic data may predict cementless THA size independent of the stem design. METHODS A consecutive series of 1,653 index cementless metaphyseal-fitting THAs were reviewed between 2007 and 2019. This included 12 unique femoral component designs, 6 acetabular component designs, 60 femur size-design combinations, and 23 acetabular size-design combinations. Implanted component sizes and patient demographic data were collected, including gender, height, weight, laterality, age, race, and ethnicity. Multivariate linear regressions were formulated to predict implanted femur and acetabular component sizes from the demographic data. RESULTS There was a significant linear correlation between gender, implant model, age, height, and weight for femur (R2 = 0.778; P < .001) and acetabular (R2 = 0.491; P < .001) sizes. Calculated femur and acetabular component sizes averaged within 0.97 and 0.95 sizes of those implants, respectively. Femur and acetabular sizes were predicted within 1 size 79.1% and 78.2% and within 2 sizes 94.3% and 94.6% of the time, respectively. CONCLUSIONS Multivariate regression models were created based on specific demographics data to predict femur and acetabular component sizes. The model allows for simplified preoperative planning and potential cost savings implementation. A free phone application named EasyTJA was constructed for ease of implementation.
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Yoshitani J, Kabata T, Kajino Y, Ohmori T, Ueno T, Ueoka K, Tsuchiya H. The use of density mapping in the analysis of thigh pain after total hip arthroplasty in patients with well-fixed tapered wedge stems. J Orthop Surg (Hong Kong) 2021; 28:2309499020930306. [PMID: 32529916 DOI: 10.1177/2309499020930306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The mechanisms underlying thigh pain in patients with well-fixed cementless femoral components after total hip arthroplasty (THA) remains unclear. We hypothesized that the thigh pain is correlated with the initial contact state of the stem and aimed to investigate the relation between thigh pain and the initial contact state. MATERIALS AND METHODS A total of 209 hips of 184 patients were analysed in this retrospective case-control study. The patients were divided into a thigh pain group (n = 13 hips) and a control group (without thigh pain, n = 196). Post-operative stem contact images were three-dimensionally visualized by a density mapping function using computed tomography data, which quantified the stem contact area according to Gruen zones. Thigh pain was defined as anterior or anterolateral pain upon loading at 3-month post-operatively. RESULTS Thirteen hips (6.2%) had thigh pain; however, all the hips demonstrated stable bony ingrowth radiographically. The thigh pain group had a significantly lower contact area in zone 2 (p = 0.014). The multivariate logistic regression analysis showed that the contact area of zone 2 was negatively correlated with thigh pain [odds ratio (OR): 0.858, p = 0.018], and the canal flare index was negatively correlated with the development of thigh pain (OR: 0.336, p = 0.026). CONCLUSIONS We identified an association between the initial contact state and post-operative thigh pain. Our data demonstrated that proper lateral contact prevents the occurrence of thigh pain in THA using a tapered wedge stem.
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Affiliation(s)
- Junya Yoshitani
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Takaaki Ohmori
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Takuro Ueno
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Ken Ueoka
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
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