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Weiner TR, Woelfle CA, Xu W, Yim DG, Shah RP, Cooper HJ. Does Lack of Initial Collar-Calcar Contact Influence Performance of Collared Cementless Femoral Stems? Arthroplast Today 2024; 27:101432. [PMID: 38882465 PMCID: PMC11180310 DOI: 10.1016/j.artd.2024.101432] [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: 11/19/2023] [Revised: 04/02/2024] [Accepted: 05/01/2024] [Indexed: 06/18/2024] Open
Abstract
Background Initial stability of cementless stems is important to minimize the risk of subsidence, pain, and periprosthetic fracture after total hip arthroplasty (THA). Collared stems improve initial component stability when contacting the femoral calcar. Direct contact is not always achieved, and collared stem performance has not been studied in this context. We hypothesized that collared stems achieving direct contact would demonstrate reduced subsidence. Methods A single-surgeon retrospective study of 482 consecutive primary THAs implanted between February 2020 and May 2023 using collared cementless stems was performed. The 2 cohorts included stems with initial collar-calcar contact vs stems without. Subsidence was evaluated by comparing intraoperative fluoroscopy to postoperative 8-week radiographs. Binary logistic regression identified independent risk factors for subsidence. Chi-square tests were used for categorical variables and t-tests for continuous variables. Results Of stems, 63.9% achieved initial collar-calcar contact, while 36.1% did not. The rate (1.3% vs 19.0%; P < .001) and magnitude (0.02 mm, range 0-3 mm vs 0.35 mm, range 0-3 mm; P < .001) of subsidence were significantly higher among stems without initial contact. Stems without initial collar-calcar contact (P < .001) and male gender (P = .007) were independent risk factors for subsidence. Two patients with initial contact had nondisplaced calcar cracks and <3 mm of subsidence at 4 weeks, which healed with protected weight-bearing. Stem survivorship was 100% in both groups, with all achieving osteointegration and none needing revision. Conclusions Excellent performance of collared cementless stems was observed at 8 weeks after primary THA. Initial collar-calcar contact lowered the risk and magnitude of minor subsidence but did not affect survivorship or fracture risk. Level of Evidence Level III.
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Affiliation(s)
- Travis R Weiner
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Catelyn A Woelfle
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Winnie Xu
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Duke G Yim
- Department of Orthopedic Surgery, Kaiser Permanente, Lone Tree, CO, USA
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
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Ashkenazi I, Benady A, Ben Zaken S, Factor S, Abadi M, Shichman I, Morgan S, Gold A, Snir N, Warschawski Y. Radiological Comparison of Canal Fill between Collared and Non-Collared Femoral Stems: A Two-Year Follow-Up after Total Hip Arthroplasty. J Imaging 2024; 10:99. [PMID: 38786553 PMCID: PMC11121886 DOI: 10.3390/jimaging10050099] [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: 04/03/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Collared femoral stems in total hip arthroplasty (THA) offer reduced subsidence and periprosthetic fractures but raise concerns about fit accuracy and stem sizing. This study compares collared and non-collared stems to assess the stem-canal fill ratio (CFR) and fixation indicators, aiming to guide implant selection and enhance THA outcomes. This retrospective single-center study examined primary THA patients who received Corail cementless stems between August 2015 and October 2020, with a minimum of two years of radiological follow-up. The study compared preoperative bone quality assessments, including the Dorr classification, the canal flare index (CFI), the morphological cortical index (MCI), and the canal bone ratio (CBR), as well as postoperative radiographic evaluations, such as the CFR and component fixation, between patients who received a collared or a non-collared femoral stem. The study analyzed 202 THAs, with 103 in the collared cohort and 99 in the non-collared cohort. Patients' demographics showed differences in age (p = 0.02) and ASA classification (p = 0.01) but similar preoperative bone quality between groups, as suggested by the Dorr classification (p = 0.15), CFI (p = 0.12), MCI (p = 0.26), and CBR (p = 0.50). At the two-year follow-up, femoral stem CFRs (p = 0.59 and p = 0.27) were comparable between collared and non-collared cohorts. Subsidence rates were almost doubled for non-collared patients (19.2 vs. 11.7%, p = 0.17), however, not to a level of clinical significance. The findings of this study show that both collared and non-collared Corail stems produce comparable outcomes in terms of the CFR and radiographic indicators for stem fixation. These findings reduce concerns about stem under-sizing and micro-motion in collared stems. While this study provides insights into the collar design debate in THA, further research remains necessary.
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Affiliation(s)
| | | | | | - Shai Factor
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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Lemme NJ, McDonald CL, Hamilton WG, Crisco JJ, Cohen EM. Uncemented Collared Femoral Stems in Total Hip Arthroplasty. Orthopedics 2022; 45:e122-e126. [PMID: 35112959 DOI: 10.3928/01477447-20220128-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The procedure of total hip arthroplasty (THA) is rapidly evolving. Patients undergoing THA are younger and more active, and they demand an earlier return to their daily activities. All of these factors increase both the early forces on uncemented femoral stems and the risk for complications. Consequently, surgeons must choose implants that provide immediate primary stability. This has led to renewed interest in the use of uncemented collared stems, which have benefits including increased primary stability, decreased risk of subsidence and periprosthetic fracture, and improved load transfer to the proximal femur. [Orthopedics. 2022;45(3):e122-e126.].
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Darwich A, Pankert K, Ottersbach A, Betsch M, Gravius S, Bdeir M. 5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis. J Clin Med 2022; 11:346. [PMID: 35054040 PMCID: PMC8780166 DOI: 10.3390/jcm11020346] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to investigate the radiological and clinical outcome of the direct anterior approach (DAA) in total hip arthroplasty (THA) using a collared cementless femoral short-stem. This retrospective study included 124 patients with 135 THAs operated from 2014 to 2016 using a collared cementless triple tapered hydroxyapatite-coated femoral short-stem (AMIStem H Collared®, Medacta International, Castel San Pietro, Switzerland) implanted with a DAA. Follow-up was performed at three months, 12 months, and five years. Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence. The mean age was 67.7 ± 11.3 years and the mean body mass index (BMI) was 27.4 ± 4.4 kg/m2. The stem survival rate at five years was 99.1% with one revision due to recurrent dislocations. Mean HOOS score improved from 40.9 ± 18.3 preoperatively to 81.5 ± 19.7 at three months, 89.3 ± 10.9 at 12 months, and 89.0 ± 14.0 at five years (all with p < 0.001). No significant correlations were found between age, femoral bone morphology, BMI and HOOS, and the appearance of relevant radiolucencies.
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Affiliation(s)
- Ali Darwich
- Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (M.B.); (S.G.); (M.B.)
| | - Kim Pankert
- Department of Knee Surgery, Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switzerland;
| | - Andreas Ottersbach
- Department of Orthopaedics, Hospital Centre Oberwallis, Ueberlandstrasse 14, 3900 Brig, Switzerland;
| | - Marcel Betsch
- Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (M.B.); (S.G.); (M.B.)
| | - Sascha Gravius
- Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (M.B.); (S.G.); (M.B.)
| | - Mohamad Bdeir
- Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (M.B.); (S.G.); (M.B.)
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Levadnyi I, Gubaua JE, Dicati GWO, Awrejcewicz J, Gu Y, Pereira JT, Loskutov A. Comparative Analysis of the Biomechanical Behavior of Collar and Collarless Stems: Experimental Testing and Finite Element Modelling. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00652-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Faria LGD, Minto BW, Shimano AC, Macedo AP, Diogo LMI, Dreibi RM, Nobile M, Santos Junior WS, Kawamoto FYK, Franco GG, Dias LGGG. Biomechanical evaluation of a new femoral stem design for total hip replacement in a canine model. Acta Cir Bras 2021; 36:e360506. [PMID: 34161433 PMCID: PMC8221799 DOI: 10.1590/acb360506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/14/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the biomechanical properties of a novel total hip replacement femoral stem. METHODS Eight pairs of femurs from dog cadavers were used. The femurs were separated into different groups. A novel femoral stem with a convex proximal portion (Stem B) was biomechanically evaluated and compared to awell-known veterinary collared stem (Stem A). Femoral stems were inserted into the contralateral femurs from the same dog, forming 16 constructs. A flexo-compression load was applied on the axial axis of each sample. Maximum strength, deflection, stiffness, and energy absorption were analysed. RESULTS Group B constructs showed significantly higher values (p ? 0.05) for the variables, except stiffness. The mean maximum strength was 1,347 ± 357 N for Group A and 1,805 ± 123 N for Group B (p ? 0.0069). The mean deflection was5.54 ± 2.63 mm for Group A and 10.03 ± 3.99 mm for Group B (p ? 0.0056). For the energy variable, the force was 6,203 ± 3,488 N/mm for Group A and 12,885 ± 5,056 N/mm for Group B (p ? 0.0054). Stem B had greater maximum strength, deflection, and energy. CONCLUSIONS The new stem was effective in neutralizing the impact of axial flexion-compression stresses during biomechanical tests in cadaveric models.
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Affiliation(s)
| | | | | | | | | | | | - Matheus Nobile
- Universidade Estadual Paulista “Julio de Mesquita Filho”, Brazil
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Qiu J, Ke X, Chen S, Zhao L, Wu F, Yang G, Zhang L. Risk factors for iliopsoas impingement after total hip arthroplasty using a collared femoral prosthesis. J Orthop Surg Res 2020; 15:267. [PMID: 32677980 PMCID: PMC7364523 DOI: 10.1186/s13018-020-01787-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background The relationship between collar design of a femoral component and iliopsoas impingement (IPI) after total hip arthroplasty (THA) is still underrecognized. The purpose of our study was to determine the possible risk factors for IPI related to the femoral component, when using a collared femoral prosthesis. Methods A total of 196 consecutive THA patients (206 hips) using a collared femoral prosthesis were reviewed retrospectively after exclusion of the factors related to acetabular component and femoral head. The patients were divided into +IPI and −IPI group according to the presence of IPI. Radiological evaluations were performed including femoral morphology, stem positioning, and collar protrusion length (CPL). Multivariate regression analysis was performed to assess the risk factors for IPI. Results At a minimum follow-up of 1 year, IPI was observed in 15 hips (7.3%). Dorr type C proximal femur was found in nine hips (60%) in the +IPI group and in 28 hips in the −IPI group (14.7%, p < 0.001). The mean stem anteversion in the +IPI group was significantly greater than that in the −IPI group (19.1° vs. 15.2°, p < 0.001), as well as the mean CPL (2.6 mm vs. − 0.5 mm, p < 0.001). The increased stem anteversion (OR = 1.745, p = 0.001) and CPL (OR = 13.889, p = 0.001) were potential risk factors for IPI. Conclusions The incidence of IPI after THA is higher than expected when using a collared femoral prosthesis. Among the factors related to collared femoral prosthesis, excessively increased stem anteversion and prominent collar protrusion are independent predictors for IPI. In addition, high risk of IPI should be carefully considered in Dorr type C bone, despite that femoral morphology is not a predictive factor. Level of evidence Level IV, clinical cohort study
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Affiliation(s)
- Jiandi Qiu
- Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325200, Zhejiang Province, China
| | - Xiurong Ke
- Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325200, Zhejiang Province, China
| | - Shanxi Chen
- Department of Radiology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325200, Zhejiang Province, China
| | - Liben Zhao
- Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325200, Zhejiang Province, China
| | - Fanghui Wu
- Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325200, Zhejiang Province, China
| | - Guojing Yang
- Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325200, Zhejiang Province, China
| | - Lei Zhang
- Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325200, Zhejiang Province, China. .,Department of Sports Medicine, The Third Affiliated Hospital of Wenzhou Medical University, No.108, Wansong Road, Ruian, Wenzhou, 325200, Zhejiang, China.
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