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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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Rele S, O'Bryan E, Holder C, Lewis PL, Di Bella C. Collared Cementless Femoral Components Reduce the Revision Rates in Primary Total Hip Arthroplasty Using the Direct Anterior Approach: An Australian Orthopaedic Association National Joint Replacement Registry Study. J Arthroplasty 2024:S0883-5403(24)00442-X. [PMID: 38735543 DOI: 10.1016/j.arth.2024.05.009] [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: 12/15/2023] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND An increased risk of periprosthetic fracture and aseptic loosening is reported when the direct anterior approach (DAA) is used for total hip arthroplasty (THA), especially with cementless implants. We assessed the rate of revision comparing collared and collarless femoral stems when using the DAA for THA. METHODS We used data from the Australian Orthopaedic Association National Joint Replacement Registry for primary THA for osteoarthritis inserted with the DAA between January 2015 and December 2022. There were 48,567 THAs that used the DAA (26,690 collarless cementless, 10,161 collared cementless, and 11,716 cemented). Cumulative percent revision was calculated for all-cause revision, revision for periprosthetic femoral fractures, and aseptic femoral stem loosening. Cox proportional hazard ratios [HRs] were used to compare the revision of collared and collarless cementless stems. We also compared collared cementless stems and cemented stems. RESULTS A higher rate of all-cause revision within 3 months of surgery was observed with collarless compared to collared cementless implants (HR: 1.99 [95% confidence interval (CI), 1.56 to 2.54]; P < .001). Similarly, collarless cementless implants were associated with a greater rate of revision for fracture in the first 6 months (HR: 2.90 [95% CI, 1.89 to 4.45]; P < .001) and after 6 months (HR 10.04 [95% CI 1.38 to 73.21]; P = .02), as well as an increased rate of revision for aseptic loosening after 2 years (HR: 5.76 [95% CI, 1.81 to 18.28], P = .003). Collared cementless and cemented stems performed similarly. CONCLUSION Collared stems were associated with a reduced rate of all-cause revision for cementless THA performed via the DAA. The reduction in risk may be due to protection from periprosthetic femoral fracture and aseptic loosening.
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Affiliation(s)
- Siddharth Rele
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Edward O'Bryan
- Orthopaedic Department, Alfred Health, Melbourne, Victoria, Australia
| | - Carl Holder
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia; University of Adelaide Medical School, Adelaide, South Australia, Australia
| | - Claudia Di Bella
- Department of Surgery, The University of Melbourne, Eastern Hill Campus, Fitzroy, Victoria, Australia; Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Victorian Bone and Joint Specialists, Fitzroy, Victoria, Australia
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Böttinger MJ, Labudek S, Schoene D, Jansen CP, Stefanakis ME, Litz E, Bauer JM, Becker C, Gordt-Oesterwind K. "TiC-TUG": technology in clinical practice using the instrumented timed up and go test-a scoping review. Aging Clin Exp Res 2024; 36:100. [PMID: 38676844 PMCID: PMC11055724 DOI: 10.1007/s40520-024-02733-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/05/2024] [Indexed: 04/29/2024]
Abstract
Digitized assessments have a considerable potential to guide clinicial decision making and monitor progress and disease trajectories. The Timed Up and Go test (TUG) has been long established for assessment in geriatric medicine and instrumented versions (iTUG) have been developed and validated. This scoping review includes studies that applied the iTUG and aims to identify use cases to show where and how iTUG assessment could guide interventions and clinical management. The literature search was limited to peer-reviewed studies that performed pre- and post-intervention measurements with a 3-meter TUG instrumented with body-worn technology in samples of at least 20 subjects aged 60+ years. Of 3018 identified articles 20 were included. Four clinical use cases were identified: stratification for subsequent therapy, monitoring of disease or treatment-associated changes and evaluation of interventions in patients with idiopathic normal pressure hydrocephalus (1), and patients with Parkinson's disease (2); monitoring after joint replacement surgery (3), and evaluation after different exercise and rehabilitation interventions (4). The included studies show diversity in terms of iTUG technology and procedures. The identified use cases highlight clinical relevance and high potential for the clinical application of the iTUG. A consensual approach as well as comprehensive reporting would help to further exploit the potential of the iTUG to support clinical management. Future studies should investigate the benefits of segmental iTUG analysis, responsiveness and participants' perspectives on clinically meaningful changes in iTUG.
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Affiliation(s)
- Melissa J Böttinger
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany.
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany.
| | - Sarah Labudek
- Clinic for Psychiatry and Psychotherapy, Helios Hospital Schwerin, Schwerin, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Daniel Schoene
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Carl-Philipp Jansen
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Marios-Evangelos Stefanakis
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Elena Litz
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Jürgen M Bauer
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Clemens Becker
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Katharina Gordt-Oesterwind
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
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Nerys-Figueroa J, Parsa A, Curley A, Charif S, Domb BG, Schinsky MF. Slightly reduced early subsidence with similar outcomes and complications rate in collared stems - A systematic review of randomized clinical trials. J Orthop 2024; 50:170-176. [PMID: 38328796 PMCID: PMC10845209 DOI: 10.1016/j.jor.2024.01.013] [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: 11/27/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Background There is a growing trend towards using femoral stems with a medial calcar collar during total hip arthroplasty (THA). Purpose Systematically review the literature comparing a femoral collared stem and femoral collarless stem on subsidence, patient-reported outcomes (PROs), and revision rate. Study design Systematic Review, Level of Evidence 1. Methods A literature search of Pubmed and Medline was according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials that evaluated collared and collarless stems, subsidence and PROs for adult patients undergoing total hip arthroplasty (THA) were included. Additional data collection included patient demographics, stem-calcar contact, canal-fill ratio (CFR), stem orientation, surgical approach, Dorr Type, complications, and revisions. Results Five studies met inclusion criteria. 674 patients (704 hips) were included. Mean patient ages ranged 58.5-72.4 years old, and mean BMI ranged 26.6-29.8 kg/m2. Mean reported follow-up of the included clinical trials ranged 1-9.6 years. Two studies reported mean early subsidence at two weeks postoperatively, which was 0.36, 0.99 mm for collared stems and 0.52, 3.22 mm for collarless stems, proving to be statistically significant (P = 0.023), (P = 0.05). All studies demonstrated improved PROs at most recent follow-up. Revision rates ranged from 4 to 11.3 %, but these were not statistically significant. Conclusions Implantation of collared stems compared to collarless may reduce early post-operative subsidence, while no substantial effect on aseptic loosening, thigh pain, proximal femoral fracture, and revision is seen. When measuring patient-reported outcomes, the collared femoral stem was not superior to the collarless femoral stem as both resulted in similar improvement preoperatively to postoperative state.
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Affiliation(s)
| | - Ali Parsa
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Andrew Curley
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Sam Charif
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
- American Hip Institute, Chicago, IL, 60018, USA
| | - Mark F. Schinsky
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
- American Hip Institute, Chicago, IL, 60018, USA
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Giovanoulis V, Kenanidis E, Aïm F, Gamie Z, Marmor S, Potoupnis M, Lustig S, Tsiridis E. Collared versus collarless hydroxyapatite-coated stems for primary cementless total hip arthroplasty; a systematic review of comparative studies. Is there any difference in survival, functional, and radiographic outcomes? SICOT J 2024; 10:8. [PMID: 38358293 PMCID: PMC10868518 DOI: 10.1051/sicotj/2024003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION This systematic review aims to critically assess the literature comparative studies investigating collared and collarless Corail stem in primary total hip arthroplasty (THA) to find differences in revision rates, radiographic and clinical outcomes, and postoperative complications between these two types of the same stem. METHODS Eligible studies were found by searching PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews from conception till May 2023. The PRISMA guidelines were followed. The investigation encompassed randomized controlled trials, case series, comparative, cohort, and observational studies that assessed at least one comparative outcome or complication between collared and collarless Corail stems. RESULTS Twelve comparative studies with 90,626 patients undergoing primary THA were included. There were 40,441 collared and 58,543 collarless stems. The follow-up ranged from 12 to 360 months. Our study demonstrated no significant difference in stem revision relative risk (RR = 0.68; 95% confidence interval (CI), 0.23, 2.02; p = 0.49), number of radiolucent lines (RR = 0.3; 95% CI, 0.06, 2.28; p = 0.29) and overall complication risk (RR = 0.62; 95% CI, 0.22, 1.76; p = 0.37) between collared and collarless stems. The collared stems demonstrated significantly lesser subsidence (mean difference: 1.01 mm; 95% CI, -1.77, -0.25; p = 0.009) and risk of periprosthetic fractures (RR = 0.52; 95% CI, 0.29, 0.92; p = 0.03). CONCLUSION The comparative studies between collared and collarless stem groups showed similar survival and overall complication rates and functional outcomes. The similar revision rates between groups make the impact of higher subsidence for collarless stems uncertain. The lower risk of periprosthetic fractures in the collared stems group must be clarified further but could be related to increased rotational stability.
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Affiliation(s)
- Vasileios Giovanoulis
- Orthopedic Surgery Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon 125 Rue d’Avron 75020 Paris France
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon 103 Grande Rue de La Croix Rousse 69004 Lyon France
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| | - Florence Aïm
- Orthopedic Surgery Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon 125 Rue d’Avron 75020 Paris France
| | - Zakareya Gamie
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| | - Simon Marmor
- Orthopedic Surgery Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon 125 Rue d’Avron 75020 Paris France
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon 103 Grande Rue de La Croix Rousse 69004 Lyon France
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
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Girardot G, Guy S, Bonin N. No significant differences in 60-day postoperative complication rates between conventional and shortened stems. J Exp Orthop 2023; 10:149. [PMID: 38153605 PMCID: PMC10754806 DOI: 10.1186/s40634-023-00696-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/14/2023] [Indexed: 12/29/2023] Open
Abstract
PURPOSE To compare 60-day complication rates, radiographic outcomes, and clinical outcomes following primary THA with conventional versus shortened stems, in a large cohort study. METHODS The authors reviewed a consecutive series of 800 primary THAs, of which 781 met the inclusion/exclusion criteria: 395 received a conventional stem and 386 received a shortened stem. Intraoperative and postoperative complications were noted. Radiographic and clinical assessments were performed preoperatively and 60 days after surgery. RESULTS Compared to conventional stems, shortened stems had significantly less intraoperative complications (2.8% vs 0.3%, p = 0.006), but no significant differences in complications that did not require reoperation (1.0% vs 1.3%, p = 0.620), complications that required reoperation without stem revision (2.0% vs 1.0%, p = 0.384), and complications that required stem revision (0.5% vs 0.5%, p = 1.000). Four hips (two from each group) required stem revision and were thus excluded from 60-day assessment. There were no significant differences between groups in subsidence ≥ 3 mm (1.0% vs 0.5%, p = 0.686), alignment (90.3%vs 86.7%, p = 0.192), net change in offset (within 3 mm, 32.3% vs 30.5%, p = 0.097), and limb length discrepancy (3.0 ± 2.6 mm vs 2.9 ± 2.4 mm, p = 0.695). Compared to conventional stems, shortened stems had significantly better preoperative mHHS (56.5 ± 18.5 vs 64.5 ± 13.5, p < 0.001), and significantly lower net improvement in mHHS (29.9 ± 17.1 vs 24.4 ± 15.0, p < 0.001), but no significant differences in postoperative mHHS (87.3 ± 11.9 vs 89.4 ± 9.6, p = 0.109). CONCLUSIONS There were no significant differences between conventional and shortened stems in terms of postoperative complication rates, radiographic outcomes, and postoperative mHHS. However, patients implanted with shortened stems had less intraoperative complications, but lower net improvement in mHHS. LEVEL OF EVIDENCE Level IV, Retrospective comparative cohort study.
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Affiliation(s)
- Guillaume Girardot
- Lyon Ortho Clinic, Clinique de La Sauvegarde, Ramsay Santé, 29B Avenue Des Sources, Lyon, France
| | - Sylvain Guy
- Lyon Ortho Clinic, Clinique de La Sauvegarde, Ramsay Santé, 29B Avenue Des Sources, Lyon, France
| | - Nicolas Bonin
- Lyon Ortho Clinic, Clinique de La Sauvegarde, Ramsay Santé, 29B Avenue Des Sources, Lyon, France.
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Turgeon TR, Righolt CH, Burnell CD, Gascoyne TC, Hedden DR, Bohm ER. Comparison of two hydroxyapatite-coated femoral components: a randomized clinical trial using radiostereometric analysis. Bone Joint J 2023; 105-B:1045-1051. [PMID: 37782569 DOI: 10.1302/0301-620x.105b10.bjj-2023-0427.r1] [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: 10/04/2023]
Abstract
Aims The primary aim of this trial was to compare the subsidence of two similar hydroxyapatite-coated titanium femoral components from different manufacturers. Secondary aims were to compare rotational migration (anteversion/retroversion and varus/valgus tilt) and patient-reported outcome measures between both femoral components. Methods Patients were randomized to receive one of the two femoral components (Avenir or Corail) during their primary total hip arthroplasty between August 2018 and September 2020. Radiostereometric analysis examinations at six, 12, and 24 months were used to assess the migration of each implanted femoral component compared to a baseline assessment. Patient-reported outcome measures were also recorded for these same timepoints. Overall, 50 patients were enrolled (62% male (n = 31), with a mean age of 65.7 years (SD 7.3), and mean BMI of 30.2 kg/m2 (SD 5.2)). Results The two-year subsidence was similar for Avenir (-0.018 mm (95% confidence interval (CI) -0.053 to 0.018) and Corail (0.000 mm (95% CI -0.027 to 0.026; p = 0.428). Both anteversion/retroversion (Avenir 0.139° (95% CI -0.204 to 0.481°); Corail -0.196° (95% CI -0.445 to 0.053°; p = 0.110) and varus/valgus tilt (Avenir -0.024° (95% CI -0.077 to 0.028); Corail -0.049° (95% CI -0.098 to 0.000°; p = 0.473) were not statistically significantly different. After two years, patients reported similar improvements in EuroQol five-dimension five-level health questionnaire (Avenir 0.22 (SD 0.2); Corail 0.22 (SD 0.18); p = 0.965) and other outcomes scores. Patient satisfaction on a five-point Likert scale was also similar between both groups after two years (Avenir 1.38 (SD 0.88); Corail 1.33 (SD 0.57); p = 0.846). Conclusion The performance of both femoral components was similar in terms of stability and patient outcomes.
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Affiliation(s)
- Thomas R Turgeon
- Concordia Joint Replacement Group, Winnipeg, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Christiaan H Righolt
- Concordia Joint Replacement Group, Winnipeg, Canada
- Orthopaedic Innovation Centre, Winnipeg, Canada
| | - Colin D Burnell
- Concordia Joint Replacement Group, Winnipeg, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Canada
| | | | - David R Hedden
- Concordia Joint Replacement Group, Winnipeg, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Eric R Bohm
- Concordia Joint Replacement Group, Winnipeg, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Canada
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Munir S, Suzuki L, Dixon M. Migration Characteristics of a Proximally Coated Collarless Femoral Stem: A Prospective 2-Year Radiostereometric Analysis Study. Arthroplast Today 2023; 22:101157. [PMID: 37521743 PMCID: PMC10374859 DOI: 10.1016/j.artd.2023.101157] [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: 12/01/2022] [Revised: 03/10/2023] [Accepted: 05/14/2023] [Indexed: 08/01/2023] Open
Abstract
Background Collared femoral stems have been considered to reduce the risk of early subsidence over collarless stems. However, with advances in material technology, new surface treatments have been introduced into cementless stem design to enhance primary fixation and long-term stability. This study aims to analyze the early migration behaviors of a proximally coated collarless femoral stem and cementless acetabular component and compare the outcomes with commercially available cementless stems and acetabular cups. Methods A total of 24 patients (25 hips) undergoing total hip arthroplasty were recruited and followed up for 2 years. All patients received a Masterloc femoral stem (Medacta International SA, Castel San Pietro, Switzerland) and an Mpact acetabular component (Medacta International SA, Castel San Pietro, Switzerland) with tantalum beads embedded during the operation. Radiographs for radiostereometric analysis were taken immediately postsurgery, 6-months, 1-year, and 2-years postoperatively. Results The median condition number for this study was 59. The median stem subsidence was -0.08 mm (-2.47 to 0.40) at 2 years. The median cup subsidence was -0.03 mm (-0.38 to 0.57) at 2 years. The migration of the Masterloc stem was less than that of other cementless collarless, as well as collared stems, as reported in literature. Conclusions This study has demonstrated the high stability and fixation provided with the use of a collarless cementless stem. The subsidence seen in both this cementless femoral stem and acetabular cup at 2 years postoperative was below the range reported in literature for cementless collarless and collared stems.
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Affiliation(s)
- Selin Munir
- Medical Affairs Department, Medacta Australia, Lane Cove, New South Wales, Australia
| | - Leina Suzuki
- Medical Affairs Department, Medacta Australia, Lane Cove, New South Wales, Australia
| | - Michael Dixon
- Orthopaedic Department, The Sutherland Hospital, Caringbah, New South Wales, Australia
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Pomeroy E, McGoldrick NP, Moody PW, Vasarhelyi EM, McCalden RW, Lanting BA. Cement Mantle Quality and Stem Alignment in Cemented Collarless Polished Tapered Stems Implanted via the Direct Anterior and Direct Lateral Approaches: A Single Institution Experience. J Arthroplasty 2022; 37:2208-2213. [PMID: 35580767 DOI: 10.1016/j.arth.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study was to compare the stem alignment and the quality of cement mantle of collarless polished tapered cemented stems inserted through the direct anterior approach (DAA) and the direct lateral approach (DLA). METHODS A comparative retrospective study of 232 hybrid total hip arthroplasties using a cemented collarless polished tapered stem through either the DAA (n = 147) or DLA (n = 85) was performed. Radiographic evaluation included stem alignment, cement mantle quality, and cement mantle thickness. RESULTS On anteroposterior radiographs, stems implanted through the DLA were more likely to be in neutral alignment, than those implanted through the DAA (83.5%[n = 71] versus 71.4% [n = 105]; P = <.001). No difference between approaches was noted for stem alignment on lateral radiographs or cement mantle quality. Multivariate analysis revealed factors associated with suboptimal cement mantle and included Dorr type B or C femur as well as male gender. A mean cement mantle thickness ≥2mm was achieved in all Gruen zones for both approaches. CONCLUSION In our series, the DAA was associated with a higher incidence of coronal plane stem malalignment compared to the DLA when using cemented tapered polished femoral components for total hip arthroplasty. No difference in lateral stem alignment or cement mantle quality was found.
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Affiliation(s)
- Eoghan Pomeroy
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | | | - Patrick W Moody
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | | | - Richard W McCalden
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Brent A Lanting
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
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Wirries N, Örgel M, Schwarze M, Budde S, Windhagen H, Skutek M. Cementless total hip arthroplasty with anatomic-shaped implants. Does the minimal invasive anterolateral technique influence the stem position or subsidence in contrast to the standard lateral approach? Arch Orthop Trauma Surg 2022; 142:2389-2395. [PMID: 34390388 DOI: 10.1007/s00402-021-04122-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Using cementless stems in total hip arthroplasty (THA) has revealed variable results. The risk for early aseptic loosening has been associated to certain surgical approaches and implant designs. This study determines misalignment of collared/collarless stems and the rate of subsidence using the anterolateral approach (ALA) compared to implantations via the direct lateral approach (DLA). MATERIALS AND METHODS One hundred consecutive patients underwent primary unilateral THA using the minimal invasive ALA in the lateral decubitus position and were compared to another cohort of 100 patients, treated trough the DLA. Clinical results were noted preoperatively and after 1 year using the WOMAC score. The radiographic evaluation included the stem alignment and subsidence. RESULTS Overall, all patients improved in WOMAC from 48.9 points (± 11.4; 21.0-82.0) to 3.1 (± 3.2; 0.0-22.0) (p < 0.001). For DLA and ALA, the stem was placed on average 2.5° in varus to the femoral axis. The mean alignment was about 0.5° more valgus for collarless stems. The mean subsidence in the DLA group was about 0.3 mm higher compared to the ALA group. With collarless implants, the subsidence was about 1.0 mm higher compared to collared implants (p < 0.05), especially in patients with Dorr type B femurs. CONCLUSIONS Changing from the DLA to the minimal invasive ALA did not significantly affect the implant position. Misalignment and a potential risk for early aseptic loosening could not be seen. The use of a collared cementless stem seems safe and is likely to prevent a relevant subsidence, even more so in Dorr type B femurs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Nils Wirries
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany. .,Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany.
| | - Marcus Örgel
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Stefan Budde
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
| | - Michael Skutek
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
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Scott CEH, Clement ND, Davis ET, Haddad FS. Modern total hip arthroplasty: peak of perfection or room for improvement? Bone Joint J 2022; 104-B:189-192. [PMID: 35094584 DOI: 10.1302/0301-620x.104b2.bjj-2022-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Chloe E H Scott
- Royal Infirmary of Edinburgh, Edinburgh, UK.,The Bone & Joint Journal , London, UK.,Bone & Joint Research , London, UK.,University of Edinburgh, Edinburgh, UK
| | | | | | - Fares S Haddad
- The Bone & Joint Journal , London, UK.,University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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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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