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Chen JJ, Hung SH, Liou JY, Chang WC, Hsu KH, Su YP, Chiu FY, Cheng MF. Long stem revision versus short stem revision with plate osteosynthesis for Vancouver type B2 periprosthetic femoral fracture: a comparative study of eighty five cases. INTERNATIONAL ORTHOPAEDICS 2024; 48:1997-2005. [PMID: 38652245 PMCID: PMC11246273 DOI: 10.1007/s00264-024-06181-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Periprosthetic femoral fractures (PPFs) around the hip are challenging complications in orthopaedic surgery, particularly Vancouver type B2 (VTB2) fractures. The surgical management of these fractures is crucial and depends on various factors. Cementless short taper stem with plate osteosynthesis is an alternative surgical technique. This study aims to compare the outcomes of this surgical technique with revision arthroplasty (RA) with long stem in the treatment of VTB2 PPFs. METHODS This retrospective study was conducted in a single medical institute from February 2010 to May 2019. Patients who had received either total hip arthroplasty or bipolar hemiarthroplasty and subsequently developed a VTB2 PPF were included; patients who sustained intra-operative fractures or received a cemented stem previously were excluded from the analysis. The patients were divided into two groups: group I received RA with cementless long stem, while group II underwent RA with cementless short taper stem with plate osteosynthesis. Demographic data, radiographic and functional outcomes, and complications were analyzed between the two groups. RESULTS A total of 85 patients diagnosed with VTB2 PPFs were included in the study. There were no significant differences between the two groups in terms of demographic data, including age, gender, mean follow-up times, estimated blood loss, and operative times. The radiographic results showed that there was no significant difference in the incidence of subsidence and implant stability between the two groups. However, group II tended to have less subsidence and periprosthetic osteolysis. Patients in group II had significantly better functional scores (mean Harris hip score: post-operative: 60.2 in group I and 66.7 in group ii; last follow-up: 77.4 in group 1 and 83.2 in group II (both p < 0.05)). There were no significant differences in the overall complication rate, including infection, dislocation, re-fracture, and revision surgery, between the two groups. CONCLUSIONS Both surgical techniques, cementless long stem and cementless short taper stem with plate osteosynthesis, are effective in the treatment of Vancouver B2 PPFs, with no significant differences in outcomes or complications. However, patients in cementless short taper stem with plate osteosynthesis had better functional scores at both post-operative and the last follow-up.
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MESH Headings
- Humans
- Female
- Periprosthetic Fractures/surgery
- Male
- Aged
- Retrospective Studies
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/instrumentation
- Fracture Fixation, Internal/adverse effects
- Reoperation/methods
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/instrumentation
- Femoral Fractures/surgery
- Bone Plates
- Middle Aged
- Hip Prosthesis/adverse effects
- Aged, 80 and over
- Prosthesis Design
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Affiliation(s)
- Jian-Jiun Chen
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Shipai Rd Beitou Dist, No. 201, Sec. 2, Taipei City, 112201, Taiwan, Republic of China
- Department of Orthopedic Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Hsin Hung
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Nursing, Chang Jung Christian University, Tainan, Taiwan
| | - Jia-You Liou
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chieh Chang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Shipai Rd Beitou Dist, No. 201, Sec. 2, Taipei City, 112201, Taiwan, Republic of China
- Department of Orthopedic Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuei-Hsiang Hsu
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Shipai Rd Beitou Dist, No. 201, Sec. 2, Taipei City, 112201, Taiwan, Republic of China
- Department of Orthopedic Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Pin Su
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Shipai Rd Beitou Dist, No. 201, Sec. 2, Taipei City, 112201, Taiwan, Republic of China
- Department of Orthopedic Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Yao Chiu
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Shipai Rd Beitou Dist, No. 201, Sec. 2, Taipei City, 112201, Taiwan, Republic of China
- Department of Orthopedic Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Fai Cheng
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Shipai Rd Beitou Dist, No. 201, Sec. 2, Taipei City, 112201, Taiwan, Republic of China.
- Department of Orthopedic Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Kutzner KP, Maurer SM, Meinecke I, Heers G, Bosson D. Survivorship, complications and patient-reported outcomes in calcar-guided short-stem THA: prospective mid-term multicenter data of the first 879 hips. Arch Orthop Trauma Surg 2023; 143:1049-1059. [PMID: 35076767 PMCID: PMC9925563 DOI: 10.1007/s00402-022-04354-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/06/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Short stems are a bone and soft-tissue preserving alternative to conventional stems. The aim of this multicenter study is to present the mid-term outcomes of a calcar-guided short stem. MATERIALS AND METHODS This is a prospective case series of the first 879 total hip arthroplasties performed on 782 patients across 5 centers using identical calcar-guided short stems. In a mid-term follow-up (6 years), rates and reasons for complications and revisions were documented. The Harris Hip Score (HHS) was obtained; patients reported pain and satisfaction using a visual analog scale. RESULTS A total of 43 patients died in the study cohort for non-related reasons; 26 patients (3.0%) required at least 1 revision after the index procedure. The survival rate for endpoint stem revision at mid-term was 98.4%. The main reasons for stem revision were aseptic loosening and early periprosthetic fractures. Sex had no influence on stem survival. Older patients or those with a high body mass index showed increased risk for stem revision during follow-up. Dorr type A morphology revealed a significantly lower risk of stem revision than Dorr type B or C (p = 0.0465). The HHS, satisfaction, and load pain at mid-term were 96.5 (SD 8.0), 9.7 (SD 0.9), and 0.5 (SD 1.9), respectively. CONCLUSIONS This short stem produced highly satisfactory outcomes at mid-term, with 98.4% implant survival for any cause of stem revision and low complication rates. Long-term results are required to further evaluate these promising mid-term results.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany. .,Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Steven Mark Maurer
- grid.477516.60000 0000 9399 7727Department of Orthopedic Surgery, Bürgerspital Solothurn, Schöngrünstr. 38, 4500 Solothurn, Switzerland
| | - Ingmar Meinecke
- Helios Park-Clinic Leipzig, Strümpellstr. 41, 04289 Leipzig, Germany
| | - Guido Heers
- Department of Orthopedic Surgery and Arthroplasty, Vitos Orthopaedic Clinic Kassel, Wilhelmshöher Allee 345, 34131 Kassel, Germany
| | - Dominique Bosson
- grid.418680.30000 0004 0417 3996Clinique de Genolier, Route du Muids 3, 1272 Genolier, Switzerland
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Kaku N, Pramudita JA, Yamamoto K, Hosoyama T, Tsumura H. Stress distributions of the short stem and the tapered wedge stem at different alignments: a finite element analysis study. J Orthop Surg Res 2022; 17:530. [PMID: 36494735 PMCID: PMC9733097 DOI: 10.1186/s13018-022-03425-6] [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: 09/20/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The mechanical effects of stem length reduction and stem alignment on the surrounding femur remain unknown. This study directly compared the stress distribution on the surrounding femur of existing tapered wedge stems and short stems and examined the properties of stress distribution at different stem alignments in three dimensions. METHODS Finite element analysis was conducted for standing and walking. The cementless stem was appropriately sized to ensure adequate contact with the medial cortical bone line that contours the medullary cavity. The stem neck axis was aligned with the femoral neck axis in the mid-position and placed in 2° of the varus and valgus, 3° of flexion and extension, and 10° and 40° of anteversion. RESULTS Regardless of stem length, the trend of stress distribution was similar. The short stem generated less stress around the stem than the tapered wedge stem. In the coronal plane, the effect of varus and valgus deflection was small. In the sagittal plane, the stress generated around the stem was higher in the extended position than in the flexed position. In the horizontal plane, the stress generated around the stem was higher when the stem anteversion was smaller. CONCLUSIONS Depending on the design, short stems can reduce the stress on the surrounding bone, compared to a longer tapered wedge with similar stress distribution. Additionally, a short stem can reduce the effect of the varus position. Stems should be placed to achieve stable initial fixation while noting that stresses increase with extension and reduced anteversion.
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Affiliation(s)
- Nobuhiro Kaku
- grid.412334.30000 0001 0665 3553Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu City, Oita 879-5593 Japan
| | - Jonas A. Pramudita
- grid.260969.20000 0001 2149 8846Department of Mechanical Engineering, College of Engineering, Nihon University, 1 Nakagawara, Tokusada, Tamura, Koriyama, Fukushima 963-8642 Japan
| | - Kansei Yamamoto
- grid.260969.20000 0001 2149 8846Department of Mechanical Engineering, College of Engineering, Nihon University, 1 Nakagawara, Tokusada, Tamura, Koriyama, Fukushima 963-8642 Japan
| | - Tsuguaki Hosoyama
- grid.412334.30000 0001 0665 3553Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu City, Oita 879-5593 Japan
| | - Hiroshi Tsumura
- grid.412334.30000 0001 0665 3553Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-Machi, Yufu City, Oita 879-5593 Japan
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