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Staunton P, Alhojailan K, Desgagne C, Epure L, Zukor D, Huk O, Antoniou J. Acute Periprosthetic Hip Fractures With Short, Uncemented Femoral Stems. J Arthroplasty 2024; 39:S248-S253. [PMID: 38851408 DOI: 10.1016/j.arth.2024.05.087] [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: 12/12/2023] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Uncemented femoral stems in hip arthroplasty have shown excellent long-term results, and several systematic studies indicate satisfactory performance of short stems. However, biomechanical and finite element analysis studies have suggested that shorter stems allow greater micromotion, producing greater strain at the implant-bone interface, which potentially increases the risk for periprosthetic fracture (PPF). We sought to assess this risk within our unit. METHODS Our institution's arthroplasty database was searched for all primary total hip arthroplasties using short femoral stems performed between July 14, 2009 and August 29, 2022. The overall PPF rate and the PPF rate for individual femoral stems were established. Preoperative X-rays for each case were analyzed to characterize individual proximal femoral geometry. A data analysis was performed to identify risk factors for PPF. RESULTS For the time period assessed, 3,192 short femoral stems were implanted. This included 1,561 of stem A and 1,631 of stem B. Women constituted 55.37% of the cohort. The average patient age was 66 years (range, 22 to 95). The PPF rate was 0.6%, with 19 PPFs identified at a follow-up of 3 months. There was a significantly higher fracture rate in stem A (0.96%) compared to stem B (0.25%) (P ≤ .01). Proximal femoral geometry, age, and sex were not determined to be risk factors for PPF in our cohort. Individual surgeons and surgical approaches appeared to confer no increased risk. There was no significant difference in average stem length, but multivariate analysis identified stem type and stem length as an independent risk factor for PPF. CONCLUSIONS Our study identified individual stem and stem length as independent risk factors for PPF within our cohort. PPF is a multifactorial issue, and consensus on emerging risk factors such as implant design will hopefully inform decisions that can provide further risk reduction for individual patients.
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Affiliation(s)
- Peter Staunton
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | - Khalifa Alhojailan
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | | | - Laura Epure
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada
| | - David Zukor
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | - Olga Huk
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | - John Antoniou
- Department of Orthopedics, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
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Naito Y, Hasegawa M, Tone S, Wakabayashi H, Sudo A. Comparison of femoral bone remodeling after total hip arthroplasty with cementless short-tapered wedge stem and fully hydroxyapatite-coated stem. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05484-2. [PMID: 39068617 DOI: 10.1007/s00402-024-05484-2] [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: 05/15/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION We aimed to compare periprosthetic femoral bone remodeling after cementless total hip arthroplasty (THA) using a short-tapered wedge stem and a fully hydroxyapatite (HA)-coated stem. MATERIALS AND METHODS In this retrospective study, 24 primary cementless THA procedures with short-tapered wedge stem and 24 using a fully HA-coated stem were performed. The follow-up duration was 2 years for both groups. Clinical evaluation was performed using the Merle d'Aubigné and Postel scoring systems. Standardized anteroposterior radiographs of the pelvis and femur were obtained. Dual-energy X-ray absorptiometry was performed, and the bone mineral density (BMD) around the stem was assessed in each Gruen zone at the first postoperative week as a baseline value and at 6 weeks, 3 and 6 months, and 1 and 2 years postoperatively. RESULTS The mean Merle d'Aubigné and Postel scores improved significantly postoperatively in both groups. None of the hips showed loosening in either group. Spot welds occurred in zones 1, 2, 6, and 7 in the short-tapered wedge group, and in all zones in the fully HA-coated group. Significant BMD loss occurred only in zone 4 in the short-tapered wedge group, and no significant bone loss occurred in any zone in the fully HA-coated stem group; a significant difference between the two groups was observed only in zone 4 at 2 years after THA. CONCLUSIONS Clinical and radiographical outcomes in both groups were good, and both stems suppressed postoperative BMD loss at 2 years.
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Affiliation(s)
- Yohei Naito
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, 514- 8507, Tsu, Mie, Japan
| | - Masahiro Hasegawa
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, 514- 8507, Tsu, Mie, Japan.
| | - Shine Tone
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, 514- 8507, Tsu, Mie, Japan
| | - Hiroki Wakabayashi
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, 514- 8507, Tsu, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, 514- 8507, Tsu, Mie, Japan
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Patiño Contreras JL, Sebastián Pérez V, Antonio CG, Jorge MS, Javier MM. Third-generation posterior-stabilised cemented system for total knee arthroplasty: Survivorship and outcomes after 20-year follow-up. J Exp Orthop 2024; 11:e12063. [PMID: 38911186 PMCID: PMC11193852 DOI: 10.1002/jeo2.12063] [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: 02/24/2024] [Revised: 05/07/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Total knee arthroplasty is a common procedure due to increased life expectancy and ageing populations, necessitating implants with long-term efficacy. After some initial designs, the third-generation modular posterior-stabilised NexGen® prosthesis aimed to enhance kinematics and reduce complications. This study evaluates the long-term outcomes, survivorship, revision rates and complications of this implant. With promising results observed up to 15 years in previous studies, this investigation aims to assess the implant's performance over extended follow-up periods, aiding in optimal implant selection for improved patient outcomes. Methods We carried out a retrospective study on 263 total knee arthroplasties performed in our centre between 1998 and 2002. Statistical analysis of complications was performed and study of survival using the Kaplan-Meier method and competing risk analysis were calculated. Description of reinterventions and complications were also included. Results Results show a 20-year prosthesis survival rate of 90.8% for revision due to any reason, with an estimated survival of 92.3% considering competitive events. Estimated survivorship at 20 years is 98% for aseptic loosening as the end point, and an estimation of 98.80% considering competitive events. Twenty revisions were performed, with 10 cases due to infection and 10 for noninfectious reasons and three of them due to aseptic loosening. Radiographic analysis revealed radiolucent lines, but no clinical evidence of loosening was observed in these cases. Conclusion This study offers survivorship data from longer follow-up periods, what is difficult to find in the reported literature and showed excellent results of this implant in terms of survivorship and low rates of revision in our cohort. Level of Evidence Level IV.
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Affiliation(s)
| | | | - Checa García Antonio
- Department of Orthopedic SurgeryHospital Universitario Fundación AlcorcónAlcorcónMadridSpain
| | - Montejo Sancho Jorge
- Department of Orthopedic SurgeryHospital Universitario Fundación AlcorcónAlcorcónMadridSpain
| | - Martínez Martín Javier
- Department of Orthopedic SurgeryHospital Universitario Fundación AlcorcónAlcorcónMadridSpain
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Bourget-Murray J, Biniam B, Bhullar RS, Kim P, Gofton W, Beaulé PE, Grammatopoulos G. Early- to mid-term outcome of a short, cementless, titanium, flat, tapered stem for primary total hip arthroplasty: an independent series. Hip Int 2024; 34:327-335. [PMID: 38073478 PMCID: PMC11071641 DOI: 10.1177/11207000231216421] [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: 01/17/2023] [Accepted: 10/10/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION This study aims to: (1) describe perioperative complications amongst patients who underwent primary total hip arthroplasty (THA) using a short cementless, titanium, flat, tapered stem; (2) estimate this stem's early- to mid-term survival; (3) identify factors associated with revision arthroplasty; and (4) describe femoral remodelling at minimum 6 years postoperatively. METHODS A retrospective review of consecutive patients who underwent THA using a Taperloc Microplasty stem (Zimmer-Biomet, Warsaw, Indiana, USA) with minimum 2-year follow-up was performed. Surgeries were performed by 1 of 6, non-designer, arthroplasty surgeons between 2014 and 2018. Outcomes included perioperative complications including revision arthroplasty, and survival. Cox analysis was used to analyse the effect of different factors on risk of revision arthroplasty. Radiographs with 6-year follow-up served to describe femoral remodelling. RESULTS In 1205 patients, followed for 5.1 ± 1.4 years, the incidence of perioperative complication was 5.2% for which 29 patients (2.4%) required revision arthroplasty. The 5- and 7-year survival rates were 97.8% (95% CI, 96.9-98.5) and 97.0% (95% CI, 95.6-98.0), respectively. The only factor associated with revision arthroplasty was proximal femur morphology, as per Dorr classification (HR 1.24 [95%CI, 1.09-1.41]; p = 0.005). During radiographic assessment, 12% of patients showed ⩾25% of relative change in cortical thickness in Gruen zones 3 or 5. We observed calcar remodelling in 50% of radiographs while 10% showed presence of a pedestal sign. CONCLUSIONS The 7-year survivorship of the Taperloc Microplasty stem is within National Institute for Health and Care Excellence (NICE) guidelines. Patients ⩽65 years with osteoarthritis and Dorr A/B femoral morphology may be ideal candidates for THA with this stem. Femoral remodelling is common and not associated with adverse outcome.
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Affiliation(s)
- Jonathan Bourget-Murray
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Brook Biniam
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Raman S Bhullar
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Kim
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Wade Gofton
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - George Grammatopoulos
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Yabusaki Y, Asai K, Hisakado H, Takano N. Effect of short stem alignment on initial fixation, stress transfer, and failure risk. Technol Health Care 2024; 32:117-130. [PMID: 37302047 DOI: 10.3233/thc-220591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Short stems are advantageous for revision as they preserve autogenous bone. At present, the method of short-stem installation is determined based on the surgeon's experience. OBJECTIVE To provide the guideline for installing a short stem, we aimed to investigate the alignment effect on the initial fixation of the stem, stress transfer, and the risk of failure numerically. METHODS Models in which the caput-collum-diaphyseal (CCD) angle and flexion angle were hypothetically changed based on the two clinical cases of hip osteoarthritis were analyzed using the non-linear finite element method. RESULTS The medial settlement of the stem increased in the varus model and decreased in the valgus model. With varus alignment, the stresses acting on the femur were high in the distal to the femoral neck. In contrast, the stresses in the proximal to the femoral neck tend to be higher with valgus alignment, although the difference in the femur stress between varus and valgus alignment was slight. CONCLUSION Both initial fixation and stress transmission are lower when the device was placed in the valgus model than in the actual surgical case. In order to obtain initial fixation and suppress stress shielding, it is essential to extend the contact area between the medial portion of the stem and the femur along the bone axis, and to ensure adequate contact between the lateral portion of the stem tip and the femur.
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Affiliation(s)
- Yumie Yabusaki
- Department of Mechanical Engineering, Kanazawa Institute of Technology, Hakusan, Japan
| | - Kenji Asai
- Department of Mechanical Engineering, Kanazawa Institute of Technology, Hakusan, Japan
| | | | - Noriyuki Takano
- Integrated Technology Research Center of Medical Science and Engineering, Kanazawa Institute of Technology, Hakusan, Japan
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De Santis V, Bonfiglio N, Basilico M, Tanzi Germani G, Matrangolo MR, Carosini A, Malerba G, Maccauro G. Clinical and radiographic outcomes after total hip arthroplasty with the NANOS neck preserving hip stem: a 10 to 16-year follow-up study. BMC Musculoskelet Disord 2022; 22:1061. [PMID: 35012499 PMCID: PMC8750837 DOI: 10.1186/s12891-021-04953-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Short-stem Hip Arthroplasty (SHA) are increasingly implanted in recent years thanks to their potential advantage in preserving metaphyseal bone-stock. Among them, the NANOS® short-stem implant demonstrated satisfactory results to short and mid-term. The purpose of this retrospective study was to evaluate the clinical and radiographic outcome of the Nanos® short stem at a minimum follow-up of 10 years. METHODS Sixty-seven patients aged 53 ± 20 years were enlisted in the study, for a total of 72 hips. Primary outcomes were survivorship of the implant and clinical outcome measured using the Hip disability and Osteoarthritis Outcome scores (HOOS) and the Short Form Survey (SF12) questionnaire. The secondary outcome was a radiological evaluation calculating the inclination and the anteversion angle of the acetabular cup for each implant and investigating osteolysis, heterotopic ossifications and stem position. RESULTS We observed a 95.5% stem survivorship. The complication rate was 7.6% and three implants underwent revision because of an aseptic loosening, an infection and a periprosthetic fracture due to trauma. Among 58 patients (63 hips) evaluated in an outpatient visit 10-16 years after surgery, improvement in clinically relevant scores comparing with baseline was observed: HOOS score increased after surgery in all its subcategories (from 32.25 ± 14.07% up to 91.91 ± 9.13%) as well as SF12 which increased by more than 18 percentage points. On clinical assessment, the range of motion (ROM) was restored at follow-up, 1 patient (1.7%) showed a squeaking hip and 2 (3.4%) reported leg-length discrepancy. Neutral stem positioning was achieved in 58 hips and heterotopic ossifications occurred in 10 hips (16%). CONCLUSIONS The current study reports good clinical and radiological outcomes following NANOS® short-stem hip implant at minimum 10 years-follow-up. Since the high rate of stem survivorship, the low complication rate demonstrated and the overall patient satisfaction, our results suggest NANOS® neck-preserving prostheses should be considered as a valid alternative to standard implants.
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Affiliation(s)
- Vincenzo De Santis
- Department of Orthopaedics, Mater Olbia Hospital, Olbia, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nadia Bonfiglio
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Mattia Basilico
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | | | - Maria Rosaria Matrangolo
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Angelo Carosini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Giuseppe Malerba
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy.
| | - Giulio Maccauro
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
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Won SH, Park JW, Lee YK, Ha YC, Koo KH. No Clinically Important Differences in Thigh Pain or Bone Loss Between Short Stems and Conventional-length Stems in THA: A Randomized Clinical Trial. Clin Orthop Relat Res 2021; 479:767-777. [PMID: 33009239 PMCID: PMC8083837 DOI: 10.1097/corr.0000000000001505] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/26/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Short-length stems were developed to reduce bone loss of the proximal femur and potentially decrease the incidence of thigh pain after cementless THA. However, it remains unknown whether short stems indeed reduce bone loss or the frequency of thigh pain. QUESTIONS/PURPOSES Is there a difference between short- and standard-length stems in terms of: (1) the frequency or severity of thigh pain, (2) modified Harris hip scores, (3) implant loosening, or (4) bone mineral density as measured by dual-energy x-ray absorptiometry? METHODS Between March 2013 and January 2014, three surgeons performed 205 primary THAs. To be eligible, patients needed to be at least 20 years of age, have not undergone previous history of hip surgery, and have no metabolic bone disease. A total of 100 patients were randomized to receive THA either with a short stem (n = 56) or with a standard-length stem (n = 44). Both stems were proximally coated, tapered, cementless stems. Compared with standard stems, short stems typically were 30- to 35-mm shorter. A total of 73% (41 of 56) and 77% (34 of 44) of those groups, respectively, were accounted for at a minimum of 5 years and were analyzed. The presence of thigh pain during activity was evaluated using a 10-point VAS, and the modified Harris hip score was calculated by research assistants who were blinded to the treatment groups. Plain radiographs were taken at 6 weeks, 6 months, and 12 months postoperatively, and every 1 year thereafter; loosening was defined as subsidence > 3 mm or a position change > 3° on serial radiographs. Radiological assessment was performed by two researchers who did not participate in the surgery and follow-up evaluations. Bone mineral density of the proximal femur was measured using dual-energy x-ray absorptiometry at 4 days, 1 year, 2 years, and 5 years postoperatively. The primary endpoint of our study was the incidence of thigh pain during 5-year follow-up. Our study was powered at 80% to detect a 10% difference in the proportion of patients reporting thigh pain at the level of 0.05. RESULTS With the numbers available, we found no difference between the groups in the proportion of patients with thigh pain; 16% (9 of 56) of patients in the short-stem group and 14% (6 of 44) of patients in the standard-stem group experienced thigh pain during the follow-up period (p = 0.79). In all patients, the pain was mild or moderate (VAS score of 4 or 6 points). Among the 15 available patients who reported thigh pain, there was no difference between the implant groups in mean severity of thigh pain (4.3 ± 0.8 versus 4.2 ± 0.7; p = 0.78). There were no between-group differences in the short versus standard-length stem groups in terms of mean modified Harris hip score by 5 years after surgery (89 ± 13 versus 95 ± 7 points; p = 0.06). No implant was loose and no hip underwent revision in either group. Patients in the short-stem group showed a slightly smaller decrease in bone mineral density in Gruen Zones 2, 3, and 5 than those in the standard-stem group did; the magnitude of the difference seems unlikely to be clinically important. CONCLUSION We found no clinically important differences (and few differences overall) between short and standard-length THA stems 5 years after surgery in a randomized trial. Consequently, we recommend that clinicians use standard-length stems in general practice because standard-length stems have a much longer published track record in other studies, and short stems can expose patients to the uncertainty associated with novelty, without any apparent offsetting benefit. LEVEL OF EVIDENCE Level I, therapeutic study.
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MESH Headings
- Absorptiometry, Photon
- Adult
- Arthralgia/diagnosis
- Arthralgia/etiology
- Arthralgia/physiopathology
- Arthralgia/prevention & control
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/instrumentation
- Biomechanical Phenomena
- Bone Density
- Female
- Hip Joint/diagnostic imaging
- Hip Joint/physiopathology
- Hip Joint/surgery
- Hip Prosthesis
- Humans
- Male
- Middle Aged
- Osteoporosis/diagnostic imaging
- Osteoporosis/etiology
- Osteoporosis/physiopathology
- Osteoporosis/prevention & control
- Pain Measurement
- Pain Threshold
- Pain, Postoperative/diagnosis
- Pain, Postoperative/etiology
- Pain, Postoperative/physiopathology
- Pain, Postoperative/prevention & control
- Prosthesis Design
- Range of Motion, Articular
- Recovery of Function
- Republic of Korea
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Seok-Hyung Won
- S.-H. Won, Y.-K. Lee, K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- J.-W. Park, Y.-C. Ha, Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
- K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Wee Park
- S.-H. Won, Y.-K. Lee, K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- J.-W. Park, Y.-C. Ha, Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
- K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Young-Kyun Lee
- S.-H. Won, Y.-K. Lee, K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- J.-W. Park, Y.-C. Ha, Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
- K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Yong-Chan Ha
- S.-H. Won, Y.-K. Lee, K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- J.-W. Park, Y.-C. Ha, Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
- K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- S.-H. Won, Y.-K. Lee, K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- J.-W. Park, Y.-C. Ha, Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
- K.-H. Koo, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Yan CH. Commentary: Clinical results of a short stem with flat tapered wedge design in primary total hip arthroplasty for hip dysplasia in Asians. J Orthop Surg (Hong Kong) 2021; 28:2309499020970407. [PMID: 33345739 DOI: 10.1177/2309499020970407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Chun Hoi Yan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
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Mid-term results of 119 Taperloc Microplasty™ femoral stems after a mean 61 months (50-82) of follow-up. Orthop Traumatol Surg Res 2020; 106:1501-1506. [PMID: 33268300 DOI: 10.1016/j.otsr.2020.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Short stems are not all the same and do not meet the same objectives in terms of shape, fixation and biomechanics. The Taperloc Microplasty™ is a shortened stem. In France, no articles have been published on this subject and very few articles are available in the international literature. We therefore decided to analyse results for this stem after a mean follow-up of 61 months, asking the following questions: (1) Is the survival of the Taperloc Microplasty™ at least equivalent to the best conventional cementless prostheses on the market, i.e. with a 10-year revision rate of less than 5% according to NICE criteria? (2) Have the expected benefits of short stems been confirmed? HYPOTHESIS The Taperloc Microplasty™ prosthesis meets the NICE criteria with a revision rate of less than 5% at 10 years. MATERIALS AND METHODS This is a retrospective single-surgeon study of 119 prostheses implanted between April 2013 and December 2015. The inclusion criteria were hip arthrosis or avascular necrosis of the femoral head in patients under the age of 70 regardless of height or weight, excluding Dorr type C femurs. The series consisted of 108 patients (11 bilateral total hip arthroplasties (THA)) with a mean age of 58.8±10 years [17-70]; 81 were men and 38 were women. RESULTS The results were assessed in 110 hips (103 patients since 9 hips (7 patients) were lost to follow-up) at a mean follow-up of 61±8 months [50-82]. At follow-up the Postel-Merle d'Aubigné (PMA) score was 17.8±0.8 [12-18] and the Oxford score 13.1±3.5 [12-41] (p<0.05 versus pre operative). On X-rays, we identified 9 pedestal signs (7.5%) below the distal end of the stem, 6 calcar atrophies (5%), but no cortical hypertrophy greater than 2 mm, no stem subsidence greater than 5mm, and no radiolucent line indicating the absence of integration. The survivorship at 61 months was 100% (95% CI: 0.905; 1.095), taking femoral revision as the end-point and 98.2% (95% CI: 0.887; 1.077) considering revision for any reason. CONCLUSION The Taperloc Microplasty™ stem is equivalent to the best conventional cementless prostheses on the market in selected surgical indications after a mean follow-up of 61 months. The follow-up is still not sufficient to confirm all the benefits expected from this type of implant. LEVEL OF EVIDENCE IV, retrospective cohort study.
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10
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Harper KD, Incavo SJ, Clyburn TA. Short-Stem Prostheses in Total Hip Arthroplasty: An Unexpected Short-Term Complication: A Report of 2 Cases. JBJS Case Connect 2020; 10:e0159. [PMID: 32224668 DOI: 10.2106/jbjs.cc.19.00159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present here 2 cases of postoperative stress fractures in the setting of a short-stem implant. Both patients had well-aligned implants with good bone quality and presented with delayed onset and atraumatic thigh pain. They were diagnosed with periprosthetic fractures around stable implants. CONCLUSIONS We now reserve the use of these stems for patients who have femoral morphology and are unable to accept standard stems. Patients who complain of new-onset thigh pain in the setting of short-stem total hip arthroplasty should have a femoral stress fracture included in the differential diagnosis and be worked up appropriately.
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Affiliation(s)
- Katharine D Harper
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Stephen J Incavo
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Terry A Clyburn
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
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