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Maeda T, Obayashi O, Ishijima M, Sato T, Musha Y, Ikegami H. Finite element analysis of mechanical stress in a cementless tapered-wedge short stem in the varus position. J Orthop Surg Res 2024; 19:385. [PMID: 38951850 PMCID: PMC11218374 DOI: 10.1186/s13018-024-04856-z] [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: 04/08/2024] [Accepted: 06/15/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND In recent years, the use of tapered-wedge short stems has increased due to their ability to preserve bones and tendons. Surgical techniques occasionally result in a varus position of the stem, which is particularly pronounced in short stems. Although the varus position is not clinically problematic, there are reports of an increased incidence of stress shielding and cortical hypertrophy. Thus, we evaluated and examined the acceptable range of varus angles using finite element analysis. METHODS Patients diagnosed with osteoarthritis of the hip joint who had undergone arthroplasty were selected and classified into three types [champagne-flute (type A), intermediate (type B), and stovepipe (type C)]. Finite element analysis was performed using Mechanical Finder. The model was created using a Taperloc microplasty stem with the varus angle increased by 1° from 0° to 5° from the bone axis and classified into seven zones based on Gruen's zone classification under loading conditions in a one-leg standing position. The volume of interest was set, the mean equivalent stress for each zone was calculated. RESULTS A significant decrease in stress was observed in zone 2, and increased stress was observed in zones 3 and 4, suggesting the emergence of a distal periosteal reaction, similar to the results of previous studies. In zone 2, there was a significant decrease in stress in all groups at a varus angle ≥ 3°. In zone 3, stress increased from ≥ 3° in type B and ≥ 4° in type C. In zone 4, there was a significant increase in stress at varus angles of ≥ 2° in types A and B and at ≥ 3° in type C. CONCLUSION In zone 2, the varus angle at which stress shielding above Engh classification grade 3 may appear is expected to be ≥ 3°. Distal cortical hypertrophy may appear in zones 3 and 4; the narrower the medullary cavity shape, the smaller the allowable angle of internal recession, and the wider the medullary cavity shape, the wider the allowable range. Long-term follow-up is required in patients with varus angles > 3°.
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Affiliation(s)
- Takahiro Maeda
- Department of Orthopedic Surgery, Toho University Graduate School of Medicine, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan
- Department of Orthopedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Osamu Obayashi
- Department of Orthopedic Surgery, Juntendo Shizuoka Hospital, Nagaoka 1129, Izunokuni 410-2295, Shizuoka, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopedic and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Taichi Sato
- Department of Advanced Machinery Engineering, School of Engineering, Tokyo Denki University, 5 Senju Asahi-cho, Adachi-ku, Tokyo, 120-8551, Japan
| | - Yoshiro Musha
- Department of Orthopedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Hiroyasu Ikegami
- Department of Orthopedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
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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 PMCID: PMC11205188 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; (M.F.); (D.F.); (H.R.); (M.O.)
| | - Michael Fuchs
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
| | - David Friedrich
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
| | - 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; (M.F.); (D.F.); (H.R.); (M.O.)
| | - Moritz Oltmanns
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; (M.F.); (D.F.); (H.R.); (M.O.)
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Schader JF, Thalmann C, Maier KS, Schiener T, Stoffel K, Frigg A. Prospective evaluation of clinical and radiographic 10-year results of Fitmore short-stem total hip arthroplasty. J Orthop Surg Res 2023; 18:893. [PMID: 37993946 PMCID: PMC10666308 DOI: 10.1186/s13018-023-04359-3] [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: 08/03/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Short stems were introduced into total hip arthroplasty (THA) to preserve bone stock, to transmit more load to the proximal femur, and to enable minimal invasive approaches. This study is the first long-term study (with a follow-up of 10 years) of the survival as well as the clinical and radiographic outcomes of the Fitmore hip stem, a short curved uncemented stem. METHODS In total, 123 Fitmore hip stems were prospectively evaluated. At the final 10-year follow-up, 80 Fitmore stems (78 patients: 30 female, 48 male) were eligible for evaluation. Clinical parameters were thigh pain, EQ-5D, Harris Hip Score (HHS) and Oxford Hip Score. Radiographic parameters were cortical hypertrophy (CH), bone condensation, cortical thinning, radiolucency, reactive lines, calcar rounding, calcar resorption, subsidence and varus/valgus position. RESULTS After 10 years, there was a survival rate of 99% (1 revision because of aseptic stem loosening). HHS had improved from 59 to 94 and Oxford Hip Score from 22 to 43. CH rate after 1 year was 69% and after 10 years 74%. In the first year, radiolucency was found in 58% and in 17.5% after 10 years. Subsidence after 1 year was 1.6 ± 1.6 mm and 5.0 ± 3.1 mm after 10 years. CONCLUSIONS The Fitmore hip stem showed a survival rate of 99% as well as good clinical and radiographic outcomes in the long-term follow-up of 10 years.
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Affiliation(s)
- Jana F Schader
- Department of Orthopaedic Surgery, Cantonal Hospital Graubuenden, 7000, Chur, Switzerland.
| | - Caroline Thalmann
- Department of Orthopaedic Surgery, Cantonal Hospital Graubuenden, 7000, Chur, Switzerland
| | | | | | - Karl Stoffel
- University of Basel, 4001, Basel, Switzerland
- Department of Orthopaedic Surgery, University Hospital Basel, 4031, Basel, Switzerland
| | - Arno Frigg
- University of Basel, 4001, Basel, Switzerland
- Department of Orthopaedic Surgery, University Hospital Basel, 4031, Basel, Switzerland
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Stadler C, Schauer B, Brabec K, Schopper C, Gotterbarm T, Luger M. A neck-sparing short stem shows significantly lower blood loss in total hip arthroplasty compared to a neck-resecting short stem. Sci Rep 2023; 13:19695. [PMID: 37951980 PMCID: PMC10640618 DOI: 10.1038/s41598-023-47008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
Short stems are associated with a significantly lower blood loss (BL) compared to straight stems in total hip arthroplasty (THA). Different types of stems differ in design, fixation and level of femoral neck osteotomy. Therefore, we sought to evaluate the difference regarding the perioperative BL between two short stems with different designs in direct anterior approach (DAA). A total of 187 THA performed by a single surgeon were analysed. 107 patients received a neck-resecting (Group A) and 80 patients a neck-sparing short stem (Group B). Blood counts of the day before surgery and of two days after surgery were evaluated. Total blood volume and BL were calculated. Additionally, duration of surgery was analysed. The perioperative BL was significantly lower in Group B (451.4 ± 188.4 ml) compared to Group A (546.6 ± 232.7 ml; p = 0.002). The postoperative haematocrit (31.6 ± 3.7% vs. 30.4 ± 4.4%; p = 0.049) and haemoglobin-level (11.0 ± 1.3 g/dL vs. 10.4 ± 1.5 g/dL; p = 0.002) were significantly higher in Group B. Duration of surgery was significantly shorter in Group B (62.0 ± 11.4 min vs. 72.6 ± 21.8 min; p < 0.001). The use of a neck-sparing short stem leads to a significantly decreased BL compared to a neck-resecting short stem in DAA THA. A less extensively conducted capsular release necessary for optimal femoral exposition might lead to a lower perioperative BL and shorter durations of surgery.
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Affiliation(s)
- Christian Stadler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria.
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria.
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Katja Brabec
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Clemens Schopper
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
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Gabrion M, Rattier S, Blondin E, Michaud A, Mertl P, Gabrion A. Survival and radioclinical evaluation of the Optimys™ short stem at more than 6years' mean follow-up: A retrospective study of 108 cases. Orthop Traumatol Surg Res 2023; 109:103470. [PMID: 36336294 DOI: 10.1016/j.otsr.2022.103470] [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: 01/08/2022] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The short stems developed in recent years offer an interesting alternative to standard long stems. The Optimys™ short stem has been widely studied, but not according to the National Institute for Health and Care Excellence (NICE) criteria. We therefore conducted a retrospective study of Optimys™ at a minimum 5years' follow-up, to assess: (1) survival on NICE criteria, (2) complications, (3) functional results, and (4) subsidence, restoration of offset and bone remodeling. HYPOTHESIS Optimys™ shows survival comparable to that of other non-cemented standard and short stems, with a<0.5% per year revision rate or<2.5% at 5years on NICE criteria. MATERIAL AND METHODS A single-center retrospective study included 108 Optimys™ stems at a mean 76.5months' follow-up (range: 60-112months). Clinical [Harris, Oxford-12 and forgotten hip (French version: SHO-12) scores] and radiologic data were collected pre- and postoperatively. Analysis focused on implant survival, complications, functional results and radiological results (restoration of offset, bone remodeling, subsidence and osseointegration) and risk factors for stem migration. RESULTS At a mean 76.5months' follow-up (range: 60-112months), Optimys™ survival was 97.7% (95% CI: 0.945-1). Oxford and Harris scores improved significantly: respectively, 16.1 vs. 44.7 [Δ=28.598; 95% CI: 27.410-29.785 (p<0.001)] and 45.3 vs. 95 [Δ=49.662; 95% CI: 47.442-51.882 (p<0.001)]. Mean forgotten hip score (SHO-12) at last follow-up was 82.7±19.6 (range: 35.4-100.0). There was 1 case of aseptic revision at 11months for femoral osseointegration defect. Mean subsidence was 1.64mm (range: 0-20.63mm); no predisposing factors could be identified. Femoral offset increased by a mean 2.41±4.53mm (range: -10.10 to 14.70mm). CONCLUSION The present study reports good survival for the Optimys™ stem, which meets NICE criteria. Radiologic and clinical results were encouraging, with a low rate of subsidence, comparable to other series, but with increased femoral offset. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Matthieu Gabrion
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France.
| | - Simon Rattier
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Emile Blondin
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Audrey Michaud
- Direction de la recherche clinique et de l'innovation, site Sud - Hall 1 - 1(er) étage zone administrative, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Patrice Mertl
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, pôle santé, 3, rue des Louvels, CS 13036, 80036 Amiens, France
| | - Antoine Gabrion
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, pôle santé, 3, rue des Louvels, CS 13036, 80036 Amiens, France
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Luger M, Feldler S, Pisecky L, Allerstorfer J, Gotterbarm T, Klasan A. The 'critical trochanter angle' does not show superiority over the CCD angle in predicting varus stem alignment in cementless short-stem total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:529-537. [PMID: 35020039 PMCID: PMC9886626 DOI: 10.1007/s00402-022-04340-5] [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: 07/09/2021] [Accepted: 01/03/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Varus positioning of the femoral stem can affect the hip offset (HO). The critical trochanter angle (CTA) was introduced in 2019 as a novel geometric angle, to predict varus stem alignment in cementless straight stem THA. The aim of this study was to evaluate the applicability of the CTA as a predictor for stem alignment in THA with a cementless neck resecting short stem. PATIENTS AND METHODS In this retrospective study, 106 patients (index surgery 2014-2019) with unilateral THA and a morphologically healthy contralateral hip as a reference (Kellgren-Lawrence ≤ 1) were included. A cementless short stem with meta-diaphyseal fixation and press-fit cup was implanted in all cases. Stem alignment, CCD angle, CTA and offset reconstruction were measured on preoperative and 3 months postoperative AP radiographs of the pelvis. RESULTS Preoperative lower CTA and lower CCD angle were positively correlated (r = 0.472; p < 0.001). Higher varus stem alignment is correlated with lower CTA (r = - 0.384; p < 0.001) and lower CCD angle (r = - 0.474; p < 0.001). A CTA of 23.1° or lower showed a sensitivity of 59.1% and a specificity of 87.1% (AUC: 0.733) and a CCD angle of 132.75° or lower a sensitivity of 68.2% and a specificity of 80.6% (AUC: 0.77) for a varus stem alignment > 3°. CONCLUSION The CTA is also applicable in cementless THA with a neck resecting short stem to evaluate risk of intraoperative varus stem positioning. The CCD angle shows higher sensitivity with marginally lower specificity. Therefore, the CTA is not superior in predicting varus stem alignment in short-stem THA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthias Luger
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Sandra Feldler
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Lorenz Pisecky
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Jakob Allerstorfer
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Tobias Gotterbarm
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Antonio Klasan
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
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Luger M, Stiftinger J, Allerstorfer J, Hochgatterer R, Gotterbarm T, Pisecky L. High varus stem alignment in short-stem total hip arthroplasty: a risk for reconstruction of femoro-acetabular offset, leg length discrepancy and stem undersizing? Arch Orthop Trauma Surg 2022; 142:2935-2944. [PMID: 34554313 PMCID: PMC9474344 DOI: 10.1007/s00402-021-04176-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/09/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE Short stems are increasingly used in in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Short stems can be inserted in a more varus position compared to conventional straight stems. This poses the risk of final varus misplacement of the femoral component, which is not intended in all femoral short stems. METHODS We wanted to evaluate the effect of a high varus stem positioning in MIS THA on hip offset, leg length and femoral canal fill index. A series of 1052 consecutive THAs with a singular cementless femoral short stem and press-fit cup was retrospectively screened for inclusion. One hundred six patients with unilateral THA and a contralateral healthy hip met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior-posterior postoperative radiographs. Patients were divided into Group A (varus stem alignment ≤ 3°) and Group B (varus stem alignment > 3°). RESULTS Hip offset (HO) increased significantly in Group B by 4 mm (p = 0.013). No influence on leg length difference was detected in both groups. Preoperative CCD angle was significantly lower in Group B (p < 0.001). Canal Fill Indices (CFI) were significantly lower in Group B (CFI I: p < 0.001; CFI II p = 0.003; CF III p = 0.002). CONCLUSION High varus stem alignment > 3° leads to a statistically significant but minor increase in HO and poses the risk of stem undersizing. A preoperatively low genuine CCD angle pose a risk for varus stem positioning.
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Affiliation(s)
- Matthias Luger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria. .,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria. .,Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria.
| | - Julian Stiftinger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Jakob Allerstorfer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Rainer Hochgatterer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Lorenz Pisecky
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
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Liu H, Yin L, Li J, Liu S, Tao Q, Xu J. Minimally invasive anterolateral approach versus direct anterior approach total hip arthroplasty in the supine position: a prospective study based on early postoperative outcomes. J Orthop Surg Res 2022; 17:230. [PMID: 35413925 PMCID: PMC9003954 DOI: 10.1186/s13018-022-03126-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Minimally anterolateral approach (MAA) and direct anterior approach (DAA) have been reported as beneficial for total hip arthroplasty (THA) due to their ability to reduce postoperative pain and lead to quicker rehabilitation by preserving muscle insertions. As there is an ongoing debate on the effect of these two approaches on early postoperative outcomes, this prospective study aimed to assess the difference in early clinical, radiological, and patient-reported outcomes between the two minimally invasive approaches. METHODS A total of 98 patients, 50 in the MAA group and 48 in the DAA group, were included in the study. Patients with complete data were evaluated preoperatively and postoperatively at 2, 6, and 12 weeks. Clinical measurements, including the ability to climb stairs and walk, 6-min walk test (6MWT), the Forgotten Joint Scale (FJS-12), Japanese Orthopedic Association (JOA) Hip scores, radiological evaluation, and complications were analyzed. RESULTS There were no significant differences in clinical outcomes and implant alignments between MAA and DAA groups. In regards to patient-reported outcomes, the FJS-12 was significantly higher in the MAA group compared to group DAA at 2 and 6 weeks postoperatively. However, there was no significant difference in the FJS-12 between the two groups 12 weeks after surgery. The differences also included shorter operative times (62.4 ± 9.05 min vs. 71 ± 8.01 min), less blood loss (132.6 ± 43.31 ml vs. 159.23 ± 37.25 ml), lower Hb drop (29.56 ± 8.02 g/L vs. 36.4 ± 7.12 g/L), and fewer blood transfusions in the MAA group (4.0% vs. 18.8%). The incidence of the lateral femoral cutaneous nerve (LFCN) neuropraxia after surgery was 7 (14.6%) in the DAA group and 0 in the MAA group. One fracture was found in each group and managed conservatively. CONCLUSION MAA and DAA approach yielded excellent and similar early clinical outcomes. However, better patient-reported outcomes could be achieved by MAA THA. The MAA resulted in a safer approach associated with shorter operative times, less blood loss, lower Hb drop, fewer blood transfusions, and LFCN neuropraxia than DAA. A longer follow-up is needed to further examine differences between these procedures.
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Affiliation(s)
- Hongwen Liu
- Department of Orthopaedics, Panzhihua Central Hospital, #34 Yikang Road, Panzhihua, 617067, Sichuan Province, China
- Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, #134 East Road, Fuzhou, 350001, Fujian Province, China
| | - Li Yin
- Department of Discipline Construction Office, Panzhihua Central Hospital, #34 Yikang Road, Panzhihua, 617067, Sichuan Province, China
| | - Jiao Li
- Department of Discipline Construction Office, Panzhihua Central Hospital, #34 Yikang Road, Panzhihua, 617067, Sichuan Province, China
| | - Shaojiang Liu
- Department of Orthopaedics, Panzhihua Central Hospital, #34 Yikang Road, Panzhihua, 617067, Sichuan Province, China
| | - Qifeng Tao
- Department of Orthopaedics, Panzhihua Central Hospital, #34 Yikang Road, Panzhihua, 617067, Sichuan Province, China
| | - Jie Xu
- Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, #134 East Road, Fuzhou, 350001, Fujian Province, China.
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Fujii H, Hayama T, Abe T, Takahashi M, Amagami A, Matsushita Y, Otani T, Saito M. Do radiological findings around the Fitmore stem change over time? Bone Jt Open 2022; 3:20-28. [PMID: 35005984 PMCID: PMC9047072 DOI: 10.1302/2633-1462.31.bjo-2021-0122.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims Although the short stem concept in hip arthroplasty procedure shows acceptable clinical performance, we sometimes get unexplainable radiological findings. The aim of this retrospective study was to evaluate changes of radiological findings up to three years postoperatively, and to assess any potential contributing factors on such radiological change in a Japanese population. Methods This is a retrospective radiological study conducted in Japan. Radiological assessment was done in accordance with predetermined radiological review protocol. A total of 241 hips were included in the study and 118 hips (49.0%) revealed radiological change from immediately after surgery to one year postoperatively; these 118 hips were eligible for further analyses. Each investigator screened whether either radiolucent lines (RLLs), cortical hypertrophy (CH), or atrophy (AT) appeared or not on the one-year radiograph. Further, three-year radiographs of eligible cases were reviewed to determine changes such as, disappeared (D), improved (I), stable (S), and progression (P). Additionally, bone condensation (BC) was assessed on the three-year radiograph. Results CH was observed in 49 hips (21.1%), AT was observed in 63 hips (27.2%), and RLLs were observed in 34 hips (14.7%) at one year postoperatively. Among 34 hips with RLLs, 70.6% showed change of either D or I on the three-year radiograph. BC was observed in younger patients more frequently. Conclusion The Fitmore stem works well in a Japanese population with favourable radiological change on hips with RLLs. Longer-term follow-up is required to determine clinical relevance. Cite this article: Bone Jt Open 2022;3(1):20–28.
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Affiliation(s)
- Hideki Fujii
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuo Hayama
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiomi Abe
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Motoi Takahashi
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ayano Amagami
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yohei Matsushita
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takuya Otani
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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10
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The morphology of the proximal femur in cementless short-stem total hip arthroplasty: No negative effect on offset reconstruction, leg length difference and implant positioning. J Orthop Surg Res 2021; 16:730. [PMID: 34930358 PMCID: PMC8686665 DOI: 10.1186/s13018-021-02876-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Correct reconstruction of hip offset (HO) and leg length are important for clinical–functional outcome and patient satisfaction in total hip arthroplasty (THA). The morphology of the proximal femur can pose a risk for increased leg length difference (LLD) in cementless straight-stem THA. We therefore wanted to evaluate, if this is also applicable in THA with a cementless meta-diaphyseal short stem. Methods In a retrospective study, 106 patients (index surgery 2014–2019) with unilateral THA and a morphologically healthy hip as a reference (Kellgren–Lawrence ≤ 1) were included. The same cementless short stem with meta-diaphyseal fixation and cementless press-fit cup was implanted. The proximal femur was rated by Dorr’s classification, and subgroups were formed afterward. Measurements were carried out on preoperative and 3 months postoperative anterior–posterior radiographs of the pelvis. Kruskal–Wallis test, Fisher’s exact test and binary logistic regression were performed to evaluate the influence of the anatomical shape on postoperative leg length difference and offset reconstruction. Results The Dorr type did not show any significance influence on LLD (p = 0.532), or postoperative difference in femoral offset (p = 0.243), acetabular offset (p = 0.106) and hip offset (p = 0.698). Stem alignment (p = 0.705) and canal fill indices (CFI I: p = 0.321; CFI II: p = 0.411; CFI III: p = 0.478) were also without significant differences. Logistic regression did not show any significant increased risk for a LLD ≥ 5 mm or ≥ 10 mm as well as HO ≥ 5 mm or ≥ 10 mm. Conclusion Reconstruction of hip offset and postoperative leg length difference is not negatively influenced by Dorr type, canal flare index, cortical index and canal-to-calcar ratio in cementless short-stem THA. Implant positioning and canal fill are also not negatively affected by the anatomical shape of the proximal femur. Level of evidence: Level IV.
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11
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Freitag T, Bieger R, Kiefer H, Dornacher D, Reichel H, Ignatius A, Dürselen L. Biomechanics of a calcar loading and a shortened tapered femoral stem: Comparative in-vitro testing of primary stability and strain distribution. J Exp Orthop 2021; 8:74. [PMID: 34491456 PMCID: PMC8423873 DOI: 10.1186/s40634-021-00388-1] [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: 06/19/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The most common femoral short stems available on the market can, in principle, be divided with regard to their anchoring concepts into a calcar loading and a shortened tapered design. The purpose of this study was to compare the primary stability and stress-shielding of two short stems, which correspond to these two different anchoring concepts. Methods Using seven paired fresh frozen human cadaver femurs, primary axial and rotational stabilities under dynamic load (100–1600 N) were evaluated by miniature displacement transducers after 100,000 load cycles. Changes in cortical strains were measured before and after implantation of both stem types to detect implant-specific load transmission and possible stress-shielding effects. Results Reversible and irreversible micromotions under dynamic load displayed no significant differences between the two implants. Implantation of either stem types resulted in a reduction of cortical strains in the proximal femur, which was less pronounced for the calcar loading implant. Conclusions Both short stems displayed comparable micromotions far below the critical threshold above which osseointegration may disturbed. Neither short stem could avoid proximal stress-shielding. This effect was less pronounced for the calcar loading short stem, which corresponds to a more physiological load transmission.
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Affiliation(s)
- Tobias Freitag
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Ralf Bieger
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Hartmuth Kiefer
- Department of Trauma and Orthopaedic Surgery, Lukas Hospital, Buende, Germany
| | - Daniel Dornacher
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University Medical Centre, Helmholtzstr. 14, 89081, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University Medical Centre, Helmholtzstr. 14, 89081, Ulm, Germany
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12
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Luger M, Hipmair G, Schopper C, Schauer B, Hochgatterer R, Allerstorfer J, Gotterbarm T, Klasan A. Low rate of early periprosthetic fractures in cementless short-stem total hip arthroplasty using a minimally invasive anterolateral approach. J Orthop Traumatol 2021; 22:19. [PMID: 34019194 PMCID: PMC8140005 DOI: 10.1186/s10195-021-00583-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/14/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Minimally invasive (MIS) approaches in combination with short stems have gained popularity in recent years in total hip arthroplasty (THA). A decreased risk for periprosthetic femoral fractures (PFFs) is reported for cementless short-stem THA, but in contrast to other approaches, the risk factors for PFFs for short-stem THA using MIS anterolateral approach in supine position are not described in literature. Methods A single-center consecutive series of 1052 hips in 982 patients, performed between 2014 and 2019 with a short curved stem and a press fit using an MIS anterolateral approach in supine position, was retrospectively screened for inclusion. Fourteen patients were lost to follow-up. Therefore, 1038 THAs in 968 patients were included. Risk factors for intra- and postoperative PFFs within 90 days were analyzed. We investigated for sex, age, body mass index (BMI), diagnosis, and laterality. Results In total, 18 PFFs (1.7%) occurred. Intraoperative fracture occurred in ten cases ( 0.9%), with another eight cases (0.8%) occurring postoperatively. Increased American Society of Anesthesiologists (ASA) Score was a significant risk factor for PFF (p = 0.026), whereas sex (p = 0.155), age (p = 0.161), BMI (p = 0.996), and laterality (p = 1.000) were not. Seven PFFs (0.7%) required revision arthroplasty. Conclusion Cementless short-stem THA using the MIS anterolateral approach is a procedure with a low number of PFFs within 90 days from index surgery. Fracture rates are comparable to other MIS approaches, and comparable femoral short stems are used. Age, sex, and BMI were not identified as risk factors of PFF, while risk for PFF increased with ASA Score. Level of Evidence Level IV
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Affiliation(s)
- Matthias Luger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria. .,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
| | - Günter Hipmair
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Clemens Schopper
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Bernhard Schauer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Rainer Hochgatterer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Jakob Allerstorfer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Antonio Klasan
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
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13
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Munakata Y, Kuramitsu Y, Usui Y, Okazaki K. Comparison of radiographic changes in rectangular curved short stem with thin versus thick porous coating for cementless total hip arthroplasty: a retrospective study with a propensity score matching. J Orthop Surg Res 2021; 16:247. [PMID: 33849591 PMCID: PMC8042942 DOI: 10.1186/s13018-021-02397-3] [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: 02/12/2021] [Accepted: 04/05/2021] [Indexed: 11/12/2022] Open
Abstract
Background Radiographic changes that appear relatively quickly after fixation of cementless stem in total hip arthroplasty (THA) vary depending on the stem design and fixation style. The present study compared radiographic changes between two types of rectangular curved short stems of similar shape. Methods This retrospective study included 118 hips that underwent primary cementless THA with an anterolateral supine approach using a rectangular, curved, short stem performed by the same surgeon between June 2015 and June 2019. Among the examined hips, 39 had a thicker porous coating stem (thicker group) and 66 had a thinner porous coating and reduced tip stem (thinner group) and at least 12-month follow-up. Radiographs taken during the final course observation were assessed. Propensity score matching was performed based on demographic data and comparisons were made using pairs of 25 hips each. Statistical analysis was performed using chi-square test and p values ≤ 0.05 indicated statistical significance. Results The pattern of the radiolucent lines showed a significant difference after matching (p = 0.0044). A “proximal and distal” pattern was most common in the thicker group and a “distal only” pattern was most common in the thinner group. There was notable and significant difference in cortical hypertrophy in the thicker group after matching (p = 0.024). Conclusions Although the two short stems were similar shapes, the short-term radiographic changes were different. The thinner group showed fewer radiographic changes than the thicker group, making it a more “silent” stem.
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Affiliation(s)
- Yutaro Munakata
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yujiro Kuramitsu
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yutaka Usui
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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14
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Merle C, Innmann MM, Westhauser F, Sadoghi P, Renkawitz T. [What are the benefits of patient-specific reconstruction in total hip replacement?]. DER ORTHOPADE 2021; 50:287-295. [PMID: 33751196 DOI: 10.1007/s00132-021-04087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The success of primary total hip replacement (THR) is predominately determined by the primary stability of the implant and the restoration of the patient-specific joint biomechanics. The three-dimensional (patho-) anatomy, size, geometry, and shape of the acetabulum and proximal femur is highly variable in patients with advanced hip osteoarthritis. Accurate preoperative planning is an essential prerequisite for all replacement procedures. CURRENT SITUATION Current data demonstrates clinical advantages for patient-specific reconstruction of functional joint geometry via surrogate parameters (offset and leg length). Frequently cited "target zones" for the positioning and orientation of the cup are increasingly in the focus of scientific discussion, as individually adjusted target zones for implant positioning allow for a potential reduction of impingement risk. Patients with spinal fusions or pathologic spinopelvic alignment require that particular attention be paid to patient-specific preoperative preparation, the surgical technique, and implant selection in order to reduce the risk of postoperative instability.
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Affiliation(s)
- Christian Merle
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - Moritz M Innmann
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Fabian Westhauser
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Patrick Sadoghi
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich
| | - Tobias Renkawitz
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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15
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Ishii S, Homma Y, Baba T, Shirogane Y, Kaneko K, Ishijima M. Does increased diameter of metal femoral head associated with highly cross-linked polyethylene augment stress on the femoral stem and cortical hypertrophy? INTERNATIONAL ORTHOPAEDICS 2021; 45:1169-1177. [PMID: 33619587 DOI: 10.1007/s00264-021-04994-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Cortical hypertrophy (CH) after total hip arthroplasty (THA) is thought as a process of femoral cortical functional adaptation against the stem. However, no study has been performed to investigate the association between CH and femoral head size. The purpose of this study is to investigate the factors related to femoral CH around the cementless stem after THA. METHODS THAs in 31 patients using 36-mm metal head and as a control, age-matched 62 THAs with 32-mm metal head have been analyzed. Radiographs were reviewed at four years to determine cortical thickness change from immediate post-operative one. Pre-operative and immediate post-operative radiographs were used to calculate the femoral morphology, canal fill ratio, stem alignment, and femoral and acetabular offset. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for CH. RESULTS Patients with a 36-mm metal head had a significantly higher rate of severe CH (P = 0.001) than those with a 32-mm metal head. The multivariate logistic regression analysis with dependent variables of CH showed that the use of a 36-mm metal head had a significantly positive effect on CH. The odds ratio of a 36-mm metal head in mild CH was 2.517 (95% confidence interval, 1.032-6.143; P = 0.043), and that in severe CH was 8.273 (95% confidence interval, 2.679-25.551; P = 0.000). Age and the canal flare index were weakly and negatively influenced by mild CH. CONCLUSIONS The use of a 36-mm metal head was the dominant risk factor for CH.
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Affiliation(s)
- Seiya Ishii
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuichi Shirogane
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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16
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Meyer JS, Freitag T, Reichel H, Bieger R. Mid-term gender-specific differences in periprosthetic bone remodelling after implantation of a curved bone-preserving hip stem. Orthop Traumatol Surg Res 2020; 106:1495-1500. [PMID: 33132094 DOI: 10.1016/j.otsr.2020.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The implant-specific periprosthetic bone remodelling in the proximal femur is considered to be an important factor influencing the long-term survival of cementless hip stems. Particularly data of gender-specific differences regarding bone-preserving stems are very rare in literature and mainly limited to short-term investigations. Therefore, we investigated at mid-term one arm of a prospective randomised study to evaluate if there is an influence of gender on implant-specific stress shielding after implantation of a curved bone preserving hip stem (Fitmore) 5 years postoperatively. HYPOTHESIS We hypothesised there will be no gender-specific differences in periprosthetic bone remodelling. PATIENTS AND METHODS A total of 20 female and 37 male patients underwent total hip arthroplasty using the Fitmore stem. Clinical, radiological as well as osteodensitometric examinations were performed preoperatively, 7 days and 3, 12 and 60 months postoperatively. Clinical data collection included the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Harris Hip Score (HHS). Periprosthetic bone mineral density (BMD) was measured using Dual Energy X-ray Absorptiometry (DXA) and the periprosthetic bone was divided into 7 regions of interest (ROI) for analysis. The results at 3, 12 and 60 months were compared with the first postoperative measurement after 7 days to obtain a percentage change. RESULTS Periprosthetic BMD showed a decrease in all 7 ROIs for both groups 5 years postoperatively referred to the baseline value, except ROI 3 (0.8%, p=0.761), representing the distal lateral part of the stem, and ROI 5 (0.3%, p=0.688), representing the distal medial part of the stem in the male cohort. Significant gender differences were found in ROI 1 (-16.0% vs. -3.5%, p=0.016) and ROI 6 (-9.9% vs. -2.1%, p=0.04) in favour of the male patients. Clinical results showed no significant gender differences 5 years postoperatively with regard to WOMAC (mean 0.4 (±0.8, 0-3.3) in women vs. 0.3 (±0.8, 0-4.2) in men, p=0.76) and HHS (mean 93.0 (±9.7, 66.0-100.0) in women vs. 93.9 (±11.5, 53.0-100.0) in men, p=0.36). CONCLUSION Proximal stress shielding was observed independent of gender 5 years postoperatively. However, there was a significantly lower bone loss proximal lateral and medial below the calcar in male patients, indicating a more physiological load transfer. [ClinicalTrials.gov identifier: NCT03147131 (Study ID D.3067-244/10). Registered 10 May 2017 - retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03147131?term=Bieger&draw=2&rank=1] LEVEL OF EVIDENCE: IV; prospective study without control group.
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Affiliation(s)
- Julian Stefan Meyer
- Department of orthopaedic surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany; Department of orthopaedic surgery, Koenig-Ludwig-Haus, University of Wuerzburg, Brettreichstraße 11, 97074 Wuerzburg, Germany.
| | - Tobias Freitag
- Department of orthopaedic surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Heiko Reichel
- Department of orthopaedic surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Ralf Bieger
- Department of orthopaedic surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
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