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Bidea I, Foruria X, Calvo I, Moreta J, Zabala J, González R. Mid-term clinical radiological results of the constrained condylar knee prosthesis in total knee revision. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-03977-9. [PMID: 38758388 DOI: 10.1007/s00590-024-03977-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The aim of the present study is to analyze the clinical-radiological outcomes of patients undergoing knee prosthesis revision surgery using constrained condylar prosthesis (LCCK; Zimmer-Biomet). MATERIAL AND METHODS Retrospective study of 89 patients operated on between the years 2008 and 2020 with a minimum of 2 years of follow-up. Clinical outcomes were evaluated using the WOMAC Index score and KOOS scales. Radiological results (radiolucent lines, osteolysis, and cortical hypertrophy) were evaluated by two independent observers. Implant survival was analyzed using the Kaplan-Meier method. RESULTS At the end of follow-up, a mean WOMAC Index score of 78.67 and KOOS score of 68.8 were obtained. Radiolucent lines (both non-progressive and progressive) were detected in 83.3% of the patients in the sample. Areas of osteolysis > 5 mm around the components were present in 6.75%. Cortical hypertrophy was seen around the femoral stem in 20.3% of cases, around the tibial stem in 20.3% and around both components in 6.76%. No statistically significant relationship was found between the presence of radiolucent lines, osteolysis or cortical hypertrophy with functional results. Implant survival was 88.1% at 13 years. CONCLUSION The present study shows high survival of LCCK prosthesis in revision surgery. The progressive radiolucencies, were associated with worst clinical outcome.
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Affiliation(s)
- Iñigo Bidea
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Galdakao-Usansolo, 48960, Galdakao, Biscay, Spain.
| | - Xabier Foruria
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Galdakao-Usansolo, 48960, Galdakao, Biscay, Spain
- Lower Limb Reconstruction Group, Biocruces Bizkaia Health Research Institute, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Isidoro Calvo
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Galdakao-Usansolo, 48960, Galdakao, Biscay, Spain
| | - Jesús Moreta
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Galdakao-Usansolo, 48960, Galdakao, Biscay, Spain
- Department of Orthopaedic Surgery and Traumatology, Hospital San Juan de Dios Santurtzi, 48980, Santurtzi, Biscay, Spain
- Lower Limb Reconstruction Group, Biocruces Bizkaia Health Research Institute, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Jon Zabala
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Galdakao-Usansolo, 48960, Galdakao, Biscay, Spain
- Lower Limb Reconstruction Group, Biocruces Bizkaia Health Research Institute, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Rodrigo González
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Galdakao-Usansolo, 48960, Galdakao, Biscay, Spain
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Jørgensen PB, Jakobsen SS, Vainorius D, Homilius M, Hansen TB, Stilling M. Less early subsidence of cemented Exeter short stems compared with cemented Exeter standard stems in Dorr type A femurs. Bone Jt Open 2023; 4:507-515. [PMID: 37407021 DOI: 10.1302/2633-1462.47.bjo-2023-0008.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Aims The Exeter short stem was designed for patients with Dorr type A femora and short-term results are promising. The aim of this study was to evaluate the minimum five-year stem migration pattern of Exeter short stems in comparison with Exeter standard stems. Methods In this case-control study, 25 patients (22 female) at mean age of 78 years (70 to 89) received cemented Exeter short stem (case group). Cases were selected based on Dorr type A femora and matched first by Dorr type A and then age to a control cohort of 21 patients (11 female) at mean age of 74 years (70 to 89) who received with cemented Exeter standard stems (control group). Preoperatively, all patients had primary hip osteoarthritis and no osteoporosis as confirmed by dual X-ray absorptiometry scanning. Patients were followed with radiostereometry for evaluation of stem migration (primary endpoint), evaluation of cement quality, and Oxford Hip Score. Measurements were taken preoperatively, and at three, 12, and 24 months and a minimum five-year follow-up. Results At three months, subsidence of the short stem -0.87 mm (95% confidence interval (CI) -1.07 to -0.67) was lower compared to the standard stem -1.59 mm (95% CI -1.82 to -1.36; p < 0.001). Both stems continued a similar pattern of subsidence until five-year follow-up. At five-year follow-up, the short stem had subsided mean -1.67 mm (95% CI -1.98 to -1.36) compared to mean -2.67 mm (95% CI -3.03 to -2.32) for the standard stem (p < 0.001). Subsidence was not influenced by preoperative bone quality (osteopenia vs normal) or cement mantle thickness. Conclusion The standard Exeter stem had more early subsidence compared with the short Exeter stem in patients with Dorr type A femora, but thereafter a similar migration pattern of subsidence until minimum five years follow-up. Both the standard and the short Exeter stems subside. The standard stem subsides more compared to the short stem in Dorr type A femurs. Subsidence of the Exeter stems was not affected by cement mantle thickness.
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Affiliation(s)
- Peter B Jørgensen
- AutoRSA Reseach Group Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stig S Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dovydas Vainorius
- Department of Orthopaedics, Gødstrup Regional Hospital, Herning, Denmark
| | - Morten Homilius
- Department of Orthopaedics, Gødstrup Regional Hospital, Herning, Denmark
| | - Torben B Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopaedics, Gødstrup Regional Hospital, Herning, Denmark
| | - Maiken Stilling
- AutoRSA Reseach Group Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Vind TD, Jørgensen PB, Vainorius D, Jakobsen SS, Søballe K, Stilling M. Migration pattern of cemented Exeter short stem in Dorr type A femurs. A prospective radiostereometry study with 2-year follow-up. Arch Orthop Trauma Surg 2023; 143:1071-1080. [PMID: 35113240 DOI: 10.1007/s00402-021-04307-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Exeter short stem (ESS) is 25 mm shorter than the standard length v40 Exeter stem (Stryker) and intended for a narrow femoral diaphysis. The purpose of the study was to evaluate the migration pattern of the cemented ESS. MATERIAL AND METHOD In a prospective single-center cohort study, 23 patients (21 female) mean age 78 (range 70-89) with hip osteoarthritis and Dorr Type A femurs were included. Preoperative DXA was used to group patients into normal (> - 1) and low (< - 1) T-score. Components were the collarless polished double-tapered Exeter short stem type N°1 L125. Patients were followed for 2 years with model-based RSA (stem migration), regular hip radiographs (stem position and cementation quality), Oxford Hip Score (OHS) and VAS pain. RESULTS At 2-year follow-up, the stems subsided 1.48 mm (CI 95% 1.69; 1.26) and retroverted 0.45° (CI 95% 0.01; 0.88). From 12 to 24 months, stem subsidence was 0.18 mm (CI 95% 0.1; 0.25) (p = 0.001) and retroversion was - 0.04° (CI 95% - 0.27; 0.18) (p = 0.70). T-score and stem subsidence correlated (rho = 0.48; p = 0.025) and patients with normal T-score (n = 7) had 0.42 mm (CI 95% - 0.01; 0.85) less subsidence as compared to patients with low T-score (n = 15) (p = 0.054). Stems in varus position (n = 9) subsided 1.7 mm (CI 95% 1.35; 2.05) compared to 1.33 mm (CI 95% 1.05; 1.60) for stems in neutral position (n = 13) (p = 0.07). Postoperative cementation quality did not influence 2-year stem migration. OHS improved to 40.7 (CI 95% 36.8; 44.7) and VAS pain at rest and activity decreased to 5 mm and 10 mm, respectively (p < 0.001). CONCLUSION The 2-year migration pattern of the cemented ESS was similar to reports for the cemented standard length Exeter stem. Low preoperative T-score and varus stem-position showed a tendency for higher stem migration and should be studied as risk factors for failure in larger studies of cemented polished stems.
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Affiliation(s)
- Tobias Dahl Vind
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark.
- Aarhus University, Aarhus, Denmark.
| | - Peter Bo Jørgensen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark
| | - Dovydas Vainorius
- Hospital Unit West, University Clinic for Hand, Hip and Knee Surgery, Lægårdvej 12, 7500, Holstebro, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark
| | - Kjeld Søballe
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark
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Mustaki L, Goetti P, Gallusser N, Morattel B, Rüdiger HA, Cherix S. Unrecognized Chondrosarcoma as a Cause of Total Hip Arthroplasty Failure. Arthroplast Today 2021; 7:84-90. [PMID: 33521202 PMCID: PMC7818612 DOI: 10.1016/j.artd.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022] Open
Abstract
Background Total hip arthroplasty (THA) is one of the most successful procedures in orthopedic surgery. The most frequent THA indications are osteoarthritis and avascular necrosis, whereas symptomatic aseptic loosening is the most common indication to revision surgery. Chondrosarcoma (CS) is the most frequent bone sarcoma in adults, and proximal femur is the most prevalent location. Wide resection is the treatment of choice.We report 3 cases of unrecognized high-grade CS in the setting of primary or revision THA and reviewed the literature on this rare clinical presentation. Methods A systematic literature review on CS in the setting of THA, published between 1980 and 2020, was performed on PubMed, Embase, Medline, Ovid SP, and Web of Science, using the guidelines set in the Preferred Reporting Items for Systematic Reviews and Mata-analyses (PRISMA). Results Case series: Three patients were referred to our sarcoma center after failure of THA due to unrecognized high-grade CS. All 3 had rapid fatal outcome. Literature review: Fifty-nine articles were identified, of which 8 were included in the study. They confirmed that primary or revision THA failure due to unrecognized CS is extremely rare, with only few cases reported in the literature. Conclusions Before proceeding to primary or revision arthroplasty, diagnosis must be ascertained. Atypical presentation of a common pathology, such as osteoarthritis, avascular necrosis, or aseptic loosening of an endoprosthesis, should raise suspicion for another cause to symptoms, and additional workup be performed. As our cases demonstrated, unrecognized or inadequately managed bone sarcoma may lead to poor or even fatal outcome.
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Affiliation(s)
- Laurent Mustaki
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick Goetti
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Gallusser
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Boris Morattel
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hannes A Rüdiger
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Orthopeadics, Schulthess Clinic, Zürich, Switzerland
| | - Stéphane Cherix
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Hasler J, Flury A, Dimitriou D, Holweg I, Helmy N, Finsterwald M. Mid-term subsidence and periprosthetic radiolucency of the AMIStem: a 5-year EBRA-FCA analysis. J Orthop Surg Res 2021; 16:19. [PMID: 33413463 PMCID: PMC7792117 DOI: 10.1186/s13018-020-02104-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/19/2020] [Indexed: 01/22/2023] Open
Abstract
Background There has been an evolution in cementless total hip arthroplasty (THA) with newer short stem designs aimed to preserve metaphyseal bone stock and facilitate implantation through minimally invasive approaches. While early subsidence has been correlated to aseptic loosening in conventional stems, there is a paucity of data regarding short stems. The current study aims to report on stem subsidence and mid-term clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, specifically designed for the direct anterior approach (DAA). Methods Ninety-four consecutive patients (100 hips) with a minimum follow-up of 5 years following cementless THA were included in this single-center retrospective study. Subsidence was evaluated using the “Ein-Bild-Roentgen-Analyse” (EBRA). Periprosthetic radiolucency allocated to the zones of Charnley and Gruen was assessed. Additionally, demographic and implant-related factors potentially associated with increased subsidence and clinical outcomes were evaluated. Results At the last follow-up, the average stem subsidence was 1.98 ± 1.20 mm, with 48% of the implants demonstrating subsidence of > 2 mm. Periprosthetic radiolucency of > 2 mm was found in 26% of the implants in zone 1 and in 9% in zone 7, respectively. Neither the amount of subsidence nor proximal periprosthetic radiolucency was associated with aseptic loosening or worse clinical outcomes. Conclusions Comparable to other proximally fixed short stem designs, the highest subsidence was observed within the first 3 months following implantation. No demographic or implant-related factors were found to have a statistically significant influence on stem subsidence. Periprosthetic radiolucency and subsidence of the AMISstem is not correlated with worse clinical outcomes at 5-year follow-up.
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Affiliation(s)
- Julian Hasler
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland.
| | - Andreas Flury
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Dimitris Dimitriou
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Iris Holweg
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Naeder Helmy
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Michael Finsterwald
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
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Steens W, Souffrant R, Kluess D, Mittelmeier W, Bader R, Katzer A. Primary stability of total hip stems: does surgical technique matter? Arch Orthop Trauma Surg 2019; 139:569-575. [PMID: 30671624 DOI: 10.1007/s00402-019-03124-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND With this preliminary study we hypothesized a modified implantation technique may lead to higher primary stability than the conventional one. METHODS In the conventional technique we used a sharp spoon to open the femoral cavity. Subsequently the opening was extended by increasing sizes of a sensing device to approve the final size. Finally, a bone compactor of the corresponding size was inserted in the cavity preparing it for implantation while compressing the surrounding cancellous bone. After initial opening of the femoral canal with a sharp spoon, the modified implantation technique was characterized by direct use of increasing sizes of bone compactors. A standardized procedure was implemented for micromotion analysis using LVDT's. Each specimen was positioned in a servo-hydraulic testing machine following a standardized test regime. A total of 1500 load cycles with a maximum hip reaction force of 1000 N were applied on each sample in three series of 500 cycles. The force was applied as a cyclic sinusoidal with a frequency of 1 Hz and a load ratio of R = 0.1. RESULTS No significant differences of micromotion between implant and surrounding bone stock could be detected regarding conventional vs. modified implantation technique. However, independent of the surgical technique used, significant differences were observed for the operated side, i.e. backhand driving of right-handed surgeon resulted in higher interfacial micromotions at the left side. CONCLUSION The results did not support our hypothesis. However, the correlation found between operated side and surgeon's backhand driving as a potential risk for reduced primary stability should encourage further investigations.
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Affiliation(s)
- Wolfram Steens
- Department of Orthopaedics, University Medicine, Doberaner Strasse 142, 18057, Rostock, Germany. .,, Roentgenstrasse 10, 45661, Recklinghausen, Germany.
| | - Robert Souffrant
- Department of Orthopaedics, University Medicine, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Daniel Kluess
- Department of Orthopaedics, University Medicine, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, University Medicine, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, University Medicine, Doberaner Strasse 142, 18057, Rostock, Germany
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Lee YK, Kim TY, Ha YC, Koo KH. To withhold or to implement bisphosphonate after cementless hip arthroplasty: a dilemma in elderly hip fracture patients. J Orthop Surg Res 2019; 14:66. [PMID: 30808386 PMCID: PMC6390618 DOI: 10.1186/s13018-019-1104-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 02/18/2019] [Indexed: 01/23/2023] Open
Abstract
Background Prior studies reported ambivalent effects of bisphosphonates on the fixation of cementless stem in hip arthroplasty patients. To set up the postoperative guide of bisphosphonate use after cementless hip arthroplasty, we investigated whether zoledronate has beneficial or negative effects in the stem migration and walking ability after cementless hemi-arthroplasty in elderly patients, who were operated due to femoral neck fracture. Methods We compared 59 patients (zoledronate group), who received zoledronate after cementless hemi-arthroplasty, and 66 patients (control group), who did not receive that agent. We evaluated stem subsidence, cortical porosis around the stem, and walking ability with the use of Koval’s categories at 2-year follow-up. Results No patient had more than 2 mm of stem subsidence in both groups. One patient in the control group had cortical porosis around the stem, but none in the zoledronate group. There were no significant differences in the postoperative Koval scores (p = 0.769) and in the proportion of walking recovery to pre-fracture status (p = 0.695) between the two groups. Conclusion We did not find neither beneficial nor negative effect of this agent in terms of stem fixation and walking ability. Zoledronate can be used after cementless hemi-arthroplasty to manage the osteoporosis in elderly patients.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 13620, South Korea
| | - Tae-Young Kim
- Konkuk University Medical Center, Department of Orthopaedic Surgery, School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea.
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 06973, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 13620, South Korea
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Impact Force, Polar Gap and Modal Parameters Predict Acetabular Cup Fixation: A Study on a Composite Bone. Ann Biomed Eng 2018; 46:590-604. [DOI: 10.1007/s10439-018-1980-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/06/2018] [Indexed: 10/18/2022]
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Godoy-Monzon D, Buttaro M, Comba F, Zanotti G, Piccaluga F, Neira-Borrajo I. Outcomes using wedge stem with full hydroxiapatite coverage with a minimum of 5 years’ follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Godoy-Monzon D, Buttaro M, Comba F, Zanotti G, Piccaluga F, Neira-Borrajo I. Outcomes using wedge stem with full hydroxiapatite coverage with a minimum of 5 years' follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:390-396. [PMID: 28917605 DOI: 10.1016/j.recot.2017.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 04/28/2017] [Accepted: 06/27/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Total Hip Arthroplsty (THA) using uncemented stems is a popular practice in the last decades. The implant survivorship is crtitical and a less than 10% revision at 10 years is been propesed for commercialization and use. OBJECTIVE To analyse the clinicoradiological results of an uncemented hydroxiapatite covered wedge stem with a 5 years minimum follow up. MATERIAL AND METHODS Prospective study, patients aged from 21-75years were included. All patients received an Element stem (Exactech) and uncemented cup with crosslink poly and 32 mm metal head, and posterior approach with piriformis retention was used. Scheduled clinical and radiographic evaluation at 3 weeks, 3-6 month, year and subsequent years using Harris Hip Score and Merle d'Aubigné Postel. Intraoperative and during follow up complications were recorded. RESULTS One hundred and fourteen total hip replacements in 104 patients: 54 females and 50 males (52%/48%). Follow-up of 5.7 years (range, 5-6.2years). Average age 56.8years (range, 42-75years). Clinical evaluation the Merle d'Aubigné score improved 6.8 points and from the initianl Harris Hip Score 47.3 to 93.1 points at last follow up. Radiographic evaluation shows osteointegration in all stems. And in 6 cases (5.3% at 3 months subsidence was detected, average 1.4 mm (range 0-2.6 mm) with no clinical manifestation, 3 cases of subsidence were associated to intraoperative fractures (1 greater trochanter and 2 in the calcar area, all resolved with wire cerclaje). Subjective evaluation: 86 cases (82.6%) excellent, 9 patients (8.6%) good, 6 cases (5.9%) satisfactory and 3 cases (2.9%) poor. All poor results linked to the intraoperative complications. No patient lost during follow up period. No femoral pain dislocation or aseptic or loosening detected. All implants were in situ at last follow up. CONCLUSIONS The radiological results confirm the benefits of this type of stem with good osteointegration. The clinical and subjective results are promising. With good surgical technical and without complications the risk of aseptic loosening should be absent or minimal.
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Affiliation(s)
- D Godoy-Monzon
- Centro de Cadera Sir John Charnley, Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M Buttaro
- Centro de Cadera Sir John Charnley, Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F Comba
- Centro de Cadera Sir John Charnley, Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G Zanotti
- Centro de Cadera Sir John Charnley, Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F Piccaluga
- Centro de Cadera Sir John Charnley, Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Schilcher J, Ivarsson I, Perlbach R, Palm L. No Difference in Periprosthetic Bone Loss and Fixation Between a Standard-Length Stem and a Shorter Version in Cementless Total Hip Arthroplasty. A Randomized Controlled Trial. J Arthroplasty 2017; 32:1220-1226. [PMID: 27993496 DOI: 10.1016/j.arth.2016.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/27/2016] [Accepted: 11/09/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cementless femoral stems in total hip arthroplasty provide dependable clinical and radiographic results in the treatment of osteoarthritis. Stem length might affect the preservation of proximal bone stock and stability. We hypothesized that a shorter stem decreases proximal bone loss without affecting implant stability. METHODS We randomly assigned 60 patients aged between 50 and 70 years to either a standard cementless femoral stem or a 35-mm shorter version. Patients were followed with dual-energy X-ray absorptiometry, radiostereometric analysis, Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, and clinical follow-up at 3, 6, 12, and 24 months. The trial is registered on ClinicalTrials.gov/. RESULTS After 24 months, short stems had on average 3.8% (95% confidence interval, 1.2%-8.9%) more bone loss in zone 1 compared to standard stems (P = .14). In zone 7, the bone loss was on average 6.5% (95% confidence interval, 6.6%-19.7%) higher compared to standard stems (P = .33). After 24 months, standard stems had migrated 0.93 mm (range, 0.25-4.66 mm) and short stems 0.93 mm (range, 0.17-2.96 mm; Student t-test after log transformation, P = .3). Patient-reported outcome measures were similar in both groups. One patient in the standard stem group was diagnosed with infection, one with a posterior dislocation, and one with a deep venous thrombosis. No stems were revised. CONCLUSION There were no statistically significant differences in periprosthetic bone loss or fixation between the stems at 24 months.
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Affiliation(s)
- Jörg Schilcher
- Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Ingemar Ivarsson
- Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Rico Perlbach
- Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Lars Palm
- Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden
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12
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Castellini I, Andreani L, Parchi PD, Bonicoli E, Piolanti N, Risoli F, Lisanti M. Hydroxyapatite in total hip arthroplasty. Our experience with a plasma spray porous titanium alloy/hydroxyapatite double-coated cementless stem. ACTA ACUST UNITED AC 2017; 13:221-227. [PMID: 28228786 DOI: 10.11138/ccmbm/2016.13.3.221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE Total hip arthroplasty could fail due to many factors and one of the most common is the aseptic loosening. In order to achieve an effective osseointegration and reduce risk of lossening, the use of cemented implant, contact porous bearing surface and organic coating were developed. Aim of this study was to evaluate clinical and radiological mid-term outcomes of a porous titanium alloy/hydroxyapatite double coating manufactured cementless femoral stem applied with "plasma spray" technique and to demonstrate the possibility to use this stem in different types of femoral canals. METHODS Between January 2008 and December 2012, 240 consecutive primary total hip arthroplasties (THAs) were performed using a porous titanium alloy/hydroxyapatite double coating manufactured cementless femoral stem. 182 patients were examined: 136 were females (74.7%) and 46 males (25.2%); average age was 72 years old (ranging from 26 to 92 years old). For each patient, Harris Hip Scores (HHS) and Womac Scores were collected. All X-ray images were analyzed in order to demonstrate stem survival rate and subsidence. RESULTS Harris Hip Score was good or excellent in 85% of the cases (average 90%) and mean WOMAC score was 97.5 (ranging from 73.4 to 100). No cases of early/late infection or periprosthetic fracture were noticed, with an excellent implant survival rate (100%) in a mean period of 40 months (ranging from 24 and 84 months). 5 cases presented acute implant dislocation, 2 due to wrong cup positioning in a dysplastic acetabulum and 3 after ground level fall. Dorr classification of femoral geometry was uses and the results were: 51 type A bone, 53 type B bone and 78 type C bone. Stem subsidence over 2 mm was considered as a risk factor of future implant loosening and was evidenced in 3 female patients with type C of Dorr classification. No radiolucencies signs around the proximally coated portion of stem or proximal reabsorption were visible during the radiographic follow-up. CONCLUSIONS Concerning the use of porous titanium alloy/hydroxyapatite double coating, this study reported an excellent implant survival rate in a mid-term period with a rate of 1,64% of subsidence in patients with type C of femoral canal but with an optimal HHS and Womac Score results. Regarding this stem, primary stability is guaranteed by trapezoid shape of proximal region and tapering in frontal plane through press-fit technique. Radiological absence of pedestal has been accepted as sign of no excessive stress transmission to distal cortex due to its tapered diaphyseal region. Thanks to the reported data, Authors can consider this double coating a valid choice with an excellent medium-term survival and encouraging subsidence results. Further studies are needed to ensure these results can be replicated.
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Affiliation(s)
- Iacopo Castellini
- Orthopaedics and Traumatology 1st Department, University of Pisa, Pisa, Italy
| | - Lorenzo Andreani
- Orthopaedics and Traumatology 1st Department, University of Pisa, Pisa, Italy
| | | | - Enrico Bonicoli
- Orthopaedics and Traumatology 1st Department, University of Pisa, Pisa, Italy
| | - Nicola Piolanti
- Orthopaedics and Traumatology 1st Department, University of Pisa, Pisa, Italy
| | - Francesca Risoli
- Orthopaedics and Traumatology 1st Department, University of Pisa, Pisa, Italy
| | - Michele Lisanti
- Orthopaedics and Traumatology 1st Department, University of Pisa, Pisa, Italy
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Carli AV, Warth LC, de Mesy Bentley KL, Nestor BJ. Short to Midterm Follow-Up of the Tritanium Primary Acetabular Component: A Cause for Concern. J Arthroplasty 2017; 32:463-469. [PMID: 27642044 DOI: 10.1016/j.arth.2016.07.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/13/2016] [Accepted: 07/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several acetabular components utilizing novel ultraporous metal substrates have been introduced over the past decade. Collectively by design, they have a lower modulus of elasticity to reduce stress shielding, a higher coefficient of friction to enhance interference fit, and ultraporous surfaces to enhance osseointegration. However, little literature exists regarding their clinical performance. METHODS This study compared the clinical and radiographic results of 109 hips in 95 patients using a Tritanium primary cup (Stryker, Mahwah, NJ) to an age, body mass index, and gender-matched cohort of 100 patients that received a contemporary cup (Stryker Trident PSL HA). RESULTS At an average 4.24 + 1.49 years, implant survivorship of the Tritanium primary cup was 98.2%, with 2 cups revised for failure of osseointegration. One-year radiographs revealed radiolucent and radiosclerotic lines in 2 or more DeLee zones in 30.3% of cups and 3 zone involvement in 8.2%. These proportions increased (40.0% and 17.1%, respectively) at minimum 5-year follow-up. A comparison of 1 year and last follow-up radiographs revealed progression in 13.8%. Tritanium primary components with radiolucency in 2 or more zones exhibited significantly lower HHS at 2 years compared to all Trident peripheral self-locking (PSL) components (P < .0001) and Tritanium primary components with 1 zone or no radiolucency (P = .026). Scanning electron microscopy of a retrieved cup revealed local inflammatory reaction and no evidence of osseointegration. CONCLUSION Despite adequate implant survivorship, over one third of Tritanium primary cups had 2 or more zone radiolucency at minimum 5-year follow-up with associated lower Harris hip scores.
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Affiliation(s)
- Alberto V Carli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Lucian C Warth
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Karen L de Mesy Bentley
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
| | - Bryan J Nestor
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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14
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Meinardi JE, Valstar ER, Van Der Voort P, Kaptein BL, Fiocco M, Nelissen RGHH. Palacos compared to Palamed bone cement in total hip replacement: a randomized controlled trial. Acta Orthop 2016; 87:473-8. [PMID: 27329869 PMCID: PMC5016905 DOI: 10.1080/17453674.2016.1199146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Stability and survival of cemented total hip prostheses is dependent on a multitude of factors, including the type of cement that is used. Bone cements vary in viscosity, from low to medium and high. There have been few clinical RSA studies comparing the performance of low- and high-viscosity bone cements. We compared the migration behavior of the Stanmore hip stem cemented using novel low-viscosity Palamed bone cement with that of the same stem cemented with conventional high-viscosity Palacos bone cement. Patients and methods - We performed a randomized controlled study involving 39 patients (40 hips) undergoing primary total hip replacement for primary or secondary osteoarthritis. 22 patients (22 hips) were randomized to Palacos and 17 patients (18 hips) were randomized to Palamed. Migration was determined by RSA. Results - None of these 40 hips had been revised at the 10-year follow-up mark. To our knowledge, the patients who died before they reached the 10-year endpoint still had the implant in situ. No statistically significant or clinically significant differences were found between the 2 groups for mean translations, rotations, and maximum total-point motion (MTPM). Interpretation - We found similar migration of the Stanmore stem in the high-viscosity Palacos cement group and the low-viscosity Palamed cement group. We therefore expect that the risk of aseptic loosening with the new Palamed cement would be comparable to that with the conventional Palacos cement. The choice of which type of bone cement to use is therefore up to the surgeon's preference.
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Affiliation(s)
- Joris E Meinardi
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden;,Correspondence:
| | - Edward R Valstar
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden;,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft
| | - Paul Van Der Voort
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden
| | - Marta Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center (LUMC), Leiden;,Mathematical Institute, Leiden University, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden
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15
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Panichkul P, Parks NL, Ho H, Hopper RH, Hamilton WG. New Approach and Stem Increased Femoral Revision Rate in Total Hip Arthroplasty. Orthopedics 2016; 39:e86-92. [PMID: 26726989 DOI: 10.3928/01477447-20151222-06] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 06/08/2015] [Indexed: 02/03/2023]
Abstract
This study compared the femoral stem revision and loosening rates in primary total hip arthroplasty between 2 different approaches and stem designs. Recent reports comparing the direct anterior approach with either the posterior or lateral approach showed that patients undergoing the direct anterior approach have less pain and an accelerated functional recovery in the early postoperative period. After converting to an anterior approach, the authors observed an increased rate of femoral stem revision. From 2003 to 2009, a posterior or lateral approach was used to insert 514 stems of 2 designs. These cases included the use of an extensively coated cobalt-chrome stem (n=232) or a straight, dual-tapered, proximally porous-coated titanium stem (n=282). In the following years, from 2009 to 2012, 594 short, proximally coated, titanium tapered-wedge stems were inserted through a direct anterior approach. The revision rates of femoral stems inserted through a posterior approach or a lateral approach were compared with those inserted via a direct anterior approach. No stem revisions occurred in the posterior approach group or the lateral approach group, and 5 stems were revised in the anterior approach group for periprosthetic fracture or aseptic loosening (0.8%). Significantly more stem revisions occurred after the use of the new stem design and a direct anterior approach (P=.04).
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16
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Parry MC, Vioreanu MH, Garbuz DS, Masri BA, Duncan CP. The Wagner Cone Stem for the Management of the Challenging Femur in Primary Hip Arthroplasty. J Arthroplasty 2016; 31:1767-72. [PMID: 27017202 DOI: 10.1016/j.arth.2016.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/14/2016] [Accepted: 02/02/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Splined conical stems offer design features that facilitate their use in the misshapen, dysplastic proximal femur. METHODS This study assessed the survivorship of a conical prosthesis when applied to secondary coxarthrosis because of a range of pathologies. Fifty-one prostheses were implanted in 50 patients with a mean age of 50 (range, 15-80) and a median follow-up of 34 months (range, 24-73 months). Indications for the stem included developmental (36), neuromuscular (7), post-traumatic or surgical (7), and inflammatory conditions (1). Survivorship, functional outcome (WOMAC [Western Ontaria and McMaster University Osteoarthrits Index], Oxford Hip Score, and UCLA [University of California Los Angeles]), health status (short form-12 [SF-12]), satisfaction, and osseointegration were determined. RESULTS Survivorship for aseptic loosening was 100% at 2 years and 98.04% for septic revision. Eight patients required reoperation, 4 for instability, and 1 each for infection, impingement, adverse reaction to metal debris, and pelvic insufficiency fracture. The mean WOMAC score was 85 (standard deviation [SD], 18), the mean Oxford Hip Score 84 (SD, 18), the mean physical SF-12 score was 48.3 (SD, 8.6), and the mean mental SF-12 was 53.7 (SD, 9.2), the mean satisfaction score was 91.5 (SD, 3.9), and the mean UCLA was 6 (SD, 1.6). All femoral components demonstrated osseointegration. CONCLUSION The cone femoral prosthesis demonstrates excellent early survival and osseointegration when applied to the challenging femur. Because of these encouraging results, we recommend this prosthesis be considered for the small, abnormal femur in primary hip arthroplasty.
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Affiliation(s)
- Michael C Parry
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mihai H Vioreanu
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald S Garbuz
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Clive P Duncan
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Gabarre S, Herrera A, Ibarz E, Mateo J, Gil-Albarova J, Gracia L. Comparative Analysis of the Biomechanical Behaviour of Two Cementless Short Stems for Hip Replacement: Linea Anatomic and Minihip. PLoS One 2016; 11:e0158411. [PMID: 27391328 PMCID: PMC4938462 DOI: 10.1371/journal.pone.0158411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/15/2016] [Indexed: 12/18/2022] Open
Abstract
A comparative study between two stems (Linea Anatomic and Minihip) has been performed in order to analyse the differences in their biomechanical behaviour, concerning stem micromotions and load transmission between stem and bone. From the corresponding finite element models, a parametric study was carried out to quantify ranges of micromotions taking into account: friction coefficient in the stem-bone interface, press-fit and two types of gait cycle. Micromotions were evaluated for each stem at six different levels along repeated gait cycles. An initial and marked stem subsidence at the beginning of the simulation was observed, followed by an asymptotic decrease due to friction forces. Once migration occurs, a repeated reversible cyclic micromotion is developed and stabilized as gait cycle times are simulated. The general motion pattern exhibited higher amplitude of micromotion for Minihip compared to Linea stem. The load transmission mechanism was analyzed, identifying the main internal forces. The results show higher local forces for Minihip stem up to 80% greater than for Linea stem. The differences of design between Minihip and Linea conditioned different distributions of load, influencing the posterior stress-shielding. Consequently, short stems require high bone stock and quality should, being indicated for young patients with high bone quality.
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Affiliation(s)
- Sergio Gabarre
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragón Institute for Engineering Research, Zaragoza, Spain
| | - Antonio Herrera
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
- * E-mail:
| | - Elena Ibarz
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragón Institute for Engineering Research, Zaragoza, Spain
| | - Jesús Mateo
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Jorge Gil-Albarova
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis Gracia
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragón Institute for Engineering Research, Zaragoza, Spain
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18
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Streit MR, Haeussler D, Bruckner T, Proctor T, Innmann MM, Merle C, Gotterbarm T, Weiss S. Early Migration Predicts Aseptic Loosening of Cementless Femoral Stems: A Long-term Study. Clin Orthop Relat Res 2016; 474:1697-706. [PMID: 27130649 PMCID: PMC4887381 DOI: 10.1007/s11999-016-4857-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 04/19/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Excessive early migration of cemented stems and cups after THA has been associated with poor long-term survival and allows predictable evaluation of implant performance. However, there are few data regarding the relationship between early migration and aseptic loosening of cementless femoral components, and whether early migration might predict late failure has not been evaluated, to our knowledge. Einzel-Bild-Röntgen-Analyse-femoral component analysis (EBRA-FCA) is a validated technique to accurately measure axial femoral stem migration without the need for tantalum markers, can be performed retrospectively, and may be a suitable tool to identify poor performing implants before their widespread use. QUESTIONS/PURPOSES We asked: (1) Is axial migration within the first 24 months as assessed by EBRA-FCA greater among cementless stems that develop aseptic loosening than those that remain well fixed through the second decade; (2) what is the diagnostic performance of implant migration at 24 months postoperatively to predict later aseptic loosening of these components; and (3) how does long-term stem survivorship compare between groups with high and low early migration? METHODS We evaluated early axial stem migration in 158 cementless THAs using EBRA-FCA. The EBRA-FCA measurements were performed during the first week postoperatively (baseline measurement) and at regular followups of 3, 6, and 12 months postoperatively and annually thereafter. The mean duration of followup was 21 years (range, 18-24 years). The stems studied represented 45% (158 of 354) of the cementless THAs performed during that time, and cementless THAs represented 34% (354 of 1038) of the THA practice during that period. No patient enrolled in this study was lost to followup. Multivariate survivorship analysis using Cox's regression model was performed with an endpoint of aseptic loosening of the femoral component. Loosening was defined according to the criteria described by Engh et al. and assessed by two independent observers. Patients with a diagnosis of prosthetic joint infection were excluded. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance of axial stem migration 1, 2, 3, and 4 years postoperatively as a predictor of aseptic loosening. Survivorship of hips with high (≥ 2.7 mm) and low (< 2.7 mm) migration was compared using a competing-events analysis. RESULTS Femoral components that had aseptic loosening develop showed greater mean distal migration at 24 months postoperatively than did components that remained well fixed throughout the surveillance period (4.2 mm ± 3.1 mm vs 0.8 mm ± 0.9 mm; mean difference, 3.4 mm, 95% CI, 2.5-4.4; p ≤ 0.001). Distal migration at 24 months postoperatively was a strong risk factor for aseptic loosening (hazard ratio, 1.98; 95% CI, 1.51-2.57; p < 0.001). The associated overall diagnostic performance of 2-year distal migration for predicting aseptic loosening was good (area under the ROC curve, 0.86; 95% CI, 0.72-1.00; p < 0.001). Sensitivity of early migration measurement was high for the prediction of aseptic loosening during the first decade after surgery but decreased markedly thereafter. Stems with large amounts of early migration (≥ 2.7 mm) had lower 18-year survivorship than did stems with little early migration (29% [95% CI, 0%-62%] versus 95% [95% CI, 90%-100%] p < 0.001). CONCLUSIONS Early migration, as measured by EBRA-FCA at 2 years postoperatively, has good diagnostic capabilities for detection of uncemented femoral components at risk for aseptic loosening during the first and early second decades after surgery. However, there was no relationship between early migration patterns and aseptic loosening during the late second and third decades. EBRA-FCA can be used as a research tool to evaluate new cementless stems or in clinical practice to evaluate migration patterns in patients with painful femoral components. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Marcus R. Streit
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Daniel Haeussler
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Tanja Proctor
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Moritz M. Innmann
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Christian Merle
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Tobias Gotterbarm
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Stefan Weiss
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany ,Department of Joint Replacement Surgery, ARCUS Kliniken Pforzheim, Pforzheim, Germany
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Malak TT, Broomfield JAJ, Palmer AJR, Hopewell S, Carr A, Brown C, Prieto-Alhambra D, Glyn-Jones S. Surrogate markers of long-term outcome in primary total hip arthroplasty: A systematic review. Bone Joint Res 2016; 5:206-14. [PMID: 27267795 PMCID: PMC4921042 DOI: 10.1302/2046-3758.56.2000568] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/23/2016] [Indexed: 12/24/2022] Open
Abstract
Objectives High failure rates of metal-on-metal hip arthroplasty implants have highlighted the need for more careful introduction and monitoring of new implants and for the evaluation of the safety of medical devices. The National Joint Registry and other regulatory services are unable to detect failing implants at an early enough stage. We aimed to identify validated surrogate markers of long-term outcome in patients undergoing primary total hip arthroplasty (THA). Methods We conducted a systematic review of studies evaluating surrogate markers for predicting long-term outcome in primary THA. Long-term outcome was defined as revision rate of an implant at ten years according to National Institute of Health and Care Excellence guidelines. We conducted a search of Medline and Embase (OVID) databases. Separate search strategies were devised for the Cochrane database and Google Scholar. Each search was performed to include articles from the date of their inception to June 8, 2015. Results Our search strategy identified 1082 studies of which 115 studies were included for full article review. Following review, 17 articles were found that investigated surrogate markers of long-term outcome. These included one systematic review, one randomised control trial (RCT), one case control study and 13 case series. Validated surrogate markers included Radiostereometric Analysis (RSA) and Einzel-Bild-Röntgen-Analyse (EBRA), each measuring implant migration and wear. We identified five RSA studies (one systematic review and four case series) and four EBRA studies (one RCT and three case series). Patient Reported Outcome Measures (PROMs) at six months have been investigated but have not been validated against long-term outcomes. Conclusions This systematic review identified two validated surrogate markers of long-term primary THA outcome: RSA and EBRA, each measuring implant migration and wear. We recommend the consideration of RSA in the pre-market testing of new implants. EBRA can be used to investigate acetabular wear but not femoral migration. Further studies are needed to validate the use of PROMs for post-market surveillance. Cite this article: T. T. Malak, J. A. J. Broomfield, A. J. R. Palmer, S. Hopewell, A. Carr, C. Brown, D. Prieto-Alhambra, S. Glyn-Jones. Surrogate markers of long-term outcome in primary total hip arthroplasty: A systematic review. Bone Joint Res 2016;5:206–214. DOI: 10.1302/2046-3758.56.2000568.
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Affiliation(s)
- T T Malak
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Lane, Oxford OX3 7LD, UK
| | - J A J Broomfield
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Lane, Oxford OX3 7LD, UK
| | - A J R Palmer
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Lane, Oxford OX3 7LD, UK
| | - S Hopewell
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Lane, Oxford OX3 7LD, UK
| | - A Carr
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Lane, Oxford OX3 7LD, UK
| | - C Brown
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Lane, Oxford OX3 7LD, UK
| | - D Prieto-Alhambra
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Lane, Oxford OX3 7LD, UK
| | - S Glyn-Jones
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Lane, Oxford OX3 7LD, UK
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20
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Nebergall AK, Rolfson O, Rubash HE, Malchau H, Troelsen A, Greene ME. Stable Fixation of a Cementless, Proximally Coated, Double Wedged, Double Tapered Femoral Stem in Total Hip Arthroplasty: A 5-Year Radiostereometric Analysis. J Arthroplasty 2016; 31:1267-1274. [PMID: 26725135 DOI: 10.1016/j.arth.2015.11.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The objective of this 5-year prospective study of 51 hips was to assess migration of a cementless tapered femoral stem using radiostereometric analysis (RSA), plain radiographs (radiolucencies), and patient-reported outcome measures (PROMs). METHODS Forty-seven patients (51 hips) agreed to participate in this prospective RSA study. All patients received a Taperloc stem. Tantalum beads were inserted into the femoral bone surrounding the stem to measure migration using RSA. RSA films, plain radiograph, and PROM follow-up were obtained immediately after surgery, 6 months, 1, 2, 3, and 5 years after surgery. RESULTS The median (interquartile range) subsidence was 0.03 mm (-0.23 to 0.06) at 5 years, with no significant differences over time. Four outlier stems had >1.5 mm of subsidence by 1 year. No stem showed radiolucencies in more than 3 zones during the 5 years. All PROMs remained favorable at 5 years, suggesting an excellent outcome. There were no stems revised for mechanical loosening; 1 stem was revised for an infection. CONCLUSION After initial settling, the cementless tapered femoral stems in our series were stable. The 4 outlier stems with >1.5 mm of subsidence by 1 year remain stable at 5 years. RSA was the most sensitive method of detection for stems at greater risk for potential future failure. This report adds contributions to the positive results associated with this type of fixation. The results at 5 years showed excellent midterm survivorship in this cohort with a cementless tapered femoral component.
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Affiliation(s)
- Audrey K Nebergall
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Ola Rolfson
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Harry E Rubash
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Henrik Malchau
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Anders Troelsen
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopedics, Copenhagen University Hvidovre Hospital, Hvidovre, Denmark
| | - Meridith E Greene
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
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Rawal B, Yadav A, Pare V. Life Estimation of Knee Joint Prosthesis by Combined Effect of Fatigue and Wear. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.protcy.2016.03.072] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fokter SK, Sarler T, Strahovnik A, Repše-Fokter A. Results of total hip arthroplasty using a bionic hip stem. INTERNATIONAL ORTHOPAEDICS 2014; 39:1065-71. [PMID: 25488512 DOI: 10.1007/s00264-014-2623-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 11/26/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The trabecular-orientated bionic hip stem was designed to mimic the natural force transmission through the femur in total hip arthroplasty, resulting in supposedly longer prosthesis survivability. The aim of this study was to compare the second-generation bionic hip stem to a standard uncemented hip stem. METHODS A group of 18 patients (21 hips) who underwent total hip arthroplasty with a bionic stem (bionic group) was compared with a historic group of 12 patients (12 hips) treated with standard anatomic hip stem (control group). During the first year after the procedure, the densitometric measurements of the bone around the prosthesis were taken. Radiographic and clinical assessments were additionally performed preoperatively and at the three month, six month, one year and three year follow-ups in the bionic group. RESULTS In the bionic group, one patient was revised for aseptic loosening and 16 patients (19 hips) were available to the final follow-up. A significant decrease of bone mineral density was found in Gruen zones 3, 4 and 5 in the bionic group, and in zone 7 in both groups. The bionic group had a significantly higher bone mineral density in Gruen zone 1 at the one year follow-up. At the final follow-up, all prostheses were radiologically stable in both groups. CONCLUSIONS Provided that a good implant position is achieved, comparable short-term results can be obtained using a bionic stem. Still, a decrease of bone mineral density in Gruen zone 7 occurred in both groups. Further studies are required to determine survivability of the bionic stem.
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Affiliation(s)
- Samo K Fokter
- Department of Orthopaedics, University Clinical Centre, Ljubljanska 5, 2000, Maribor, Slovenia,
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23
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Ahmad Hatem M, Ferreira da Luz B, Nishimoto Nishi R, Gilberto Cimbalista de Alencar P. Avaliação dos resultados de componente femoral cônico de fixação proximal não cimentado em fêmur tipo C de Dorr. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ahmad Hatem M, Ferreira da Luz B, Nishimoto Nishi R, Gilberto Cimbalista de Alencar P. Evaluation of the results from proximal fixation of uncemented conical femoral components in Dorr type C femurs. Rev Bras Ortop 2014; 49:260-6. [PMID: 26229810 PMCID: PMC4511651 DOI: 10.1016/j.rboe.2014.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 10/15/2013] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the results from proximal fixation of uncemented conical femoral components in patients with a type C proximal femur and compare them with the results obtained from type A and B femurs. METHODS This was a retrospective study on 87 patients with 90 uncemented total hip arthroplasty procedures. Three patients (three hips) were excluded because their follow-up lasted for less than two years. The follow-up ranged from 2 to 4.3 years and the mean was 2.8 years. The Bicontact femoral implant model was used. The preoperative radiographs were evaluated, the femurs were classified as Dorr types A, B or C and the cortical indices were measured. The patients were evaluated clinically by means of the Harris Hip Score (HHS), before the surgery and at the last follow-up. The sequences of postoperative radiographs were compared regarding stability, complications and any signs of osseointegration of the femoral prosthesis. RESULTS Among the 87 hips with follow-up greater than two years, 32 femurs were type A (37%), 37 type B (42%) and 18 type C (21%). Before the operation, the mean HHS was 39.4 for types A and B and 38.8 for type C. At the last follow-up, the mean HHS was 89.8 for types A and B and 86 for type C. None of the 87 femoral components had been revised by the time of the last follow-up; all of them were considered stable. In 86 cases, the radiographs showed signs of osseointegration. CONCLUSION There were no significant differences in the clinical results or in the fixation (and osseointegration) of conical uncemented femoral prostheses with proximal porosity, among femurs with different types of femoral morphology according to the Dorr classification. This conclusion may vary if another implant model were to be used.
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Affiliation(s)
- Munif Ahmad Hatem
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR, Brazil
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25
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Prospective five-year subsidence analysis of a cementless fully hydroxyapatite-coated femoral hip arthroplasty component. Hip Int 2014; 24:91-7. [PMID: 24474406 PMCID: PMC6159840 DOI: 10.5301/hipint.5000082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2013] [Indexed: 02/04/2023]
Abstract
Early subsidence >1.5 mm is considered to be a predictive factor for later aseptic loosening of the femoral component following total hip arthroplasty (THA). The aim of this study was to assess five-year subsidence rates of the cementless hydroxyapatite-coated twinSys stem (Mathys Ltd., Bettlach, Switzerland).This prospective single-surgeon series examined consecutive patients receiving a twinSys stem at Maria Middelares Hospital, Belgium. Patients aged >85 years or unable to come to follow-up were excluded. Subsidence was assessed using Ein Bild Roentgen Analyse--Femoral Component Analysis (EBRA-FCA). Additional clinical and radiographic assessments were performed. Follow-ups were prospectively scheduled at two, five, 12, 24, and 60 months.In total, 218 THA (211 patients) were included. At five years, mean subsidence was 0.66 mm (95% CI: 0.43-0.90). Of the 211 patients, 95.2% had an excellent or good Harris Hip Score. There were few radiological changes. Kaplan-Meier analysis indicated five-year stem survival to be 98.4% (95% CI: 97.6-100%).Subsidence levels of the twinSys femoral stem throughout the five years of follow-up were substantially lower than the 1.5 mm level predictive of aseptic loosening. This was reflected in the high five-year survival rate.
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Haugan K, Husby OS, Klaksvik J, Foss OA. The migration pattern of the Charnley femoral stem: a five-year follow-up RSA study in a well-functioning patient group. J Orthop Traumatol 2012; 13:137-43. [PMID: 22576838 PMCID: PMC3427697 DOI: 10.1007/s10195-012-0187-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 03/10/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Implant stability is considered vital to long-time implant survival in total hip arthroplasty (THA), since loose implants are reported to be a major cause of hip revision. There is an association between early implant micromotion and increased risk of revision. More implant-specific data are needed to establish acceptable levels of early implant movement. MATERIALS AND METHODS Thirty-five patients (36 hips) undergoing Charnley THA were followed with repeated clinical, radiographic, and radiostereometric analysis (RSA) over 5 years. Twenty-three patients attended 5 years postoperatively. RESULTS The patient group was well functioning based on the radiological and clinical evaluations. The stems constantly moved up to 5 years postoperatively, with subsidence, retroversion, and varus tilt, based on the RSA. CONCLUSION Continuous movement of the Charnley stem was observed up to 5 years postoperatively in a well-functioning patient group. The migration data presented herein could be useful when defining acceptable migration limits for certain types of cemented femoral stems.
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Affiliation(s)
- Kristin Haugan
- Orthopaedic Research Centre, Trondheim University Hospital, 7006, Trondheim, Norway.
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Bohm E, Petrak M, Gascoyne T, Turgeon T. The effect of adding tobramycin to Simplex P cement on femoral stem micromotion as measured by radiostereometric analysis: a 2-year randomized controlled trial. Acta Orthop 2012; 83:115-20. [PMID: 22248163 PMCID: PMC3339523 DOI: 10.3109/17453674.2011.652885] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Previous in vitro research on addition of antibiotics to bone cement has found no statistically significant deterioration in mechanical properties. However, no clinical studies have compared the performance of tobramycin-laden bone cement with that of standard bone cement (Simplex P). PATIENTS AND METHODS 23 patients (25 hips) were randomized to receive an Exeter (Stryker Orthopaedics) femoral stem cemented with either Simplex P (standard) or Simplex T (tobramycin-laden) cement. There were 2 years of follow-up, with scheduled radiostereometric (RSA) examinations. RESULTS All stems migrated distally and showed some degree of retroversion. No clinically significant differences in stem subsidence or retroversion were found between the Simplex T and Simplex P cement groups after 2 years. Overall subsidence was less than in previous studies, probably due to a postponed initial post-surgical examination. Rates of subsidence in both cement groups were consistent with those from previous studies of Exeter stems. INTERPRETATION Subsidence of the femoral stem after 2 years was similar in the Simplex T (tobramycin-laden) and Simplex P (standard) groups.
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Affiliation(s)
| | - Martin Petrak
- Concordia Joint Replacement Group, Concordia Hip and Knee Institute
| | - Trevor Gascoyne
- Concordia Joint Replacement Group, Concordia Hip and Knee Institute
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White CA, Carsen S, Rasuli K, Feibel RJ, Kim PR, Beaulé PE. High incidence of migration with poor initial fixation of the Accolade stem. Clin Orthop Relat Res 2012; 470:410-7. [PMID: 22045070 PMCID: PMC3254738 DOI: 10.1007/s11999-011-2160-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous cementless femoral stem design variations are in clinical use. Because initial implant instability and micromotion are associated with aseptic loosening of the femoral component, migration analysis provides an early assessment of implant survivorship. QUESTIONS/PURPOSES We determined the (1) migration pattern of the Accolade cementless femoral stem; (2) clinical factors predisposing to stem migration; (3) self-reported patient outcomes; and (4) our current rate of aseptic stem loosening. METHODS We retrospectively analyzed 81 femoral stems for aseptic migration using Ein-Bild-Roentgen-Analyse-femoral component analysis. Postoperatively, patients completed the WOMAC and SF-12 questionnaires. We assessed radiographic factors potentially associated with subsidence: indices of bone shape and quality, canal fill of the implant, and radiographic signs of loosening. Minimum followup was 24 months (mean, 29 months; range, 24-48 months). RESULTS The average subsidence at 24 months was 1.3 mm (range, 0-1.5 mm). In the first 2 years, 36% of stems subsided more than 1.5 mm. Large stem size was associated with subsidence. Radiolucent lines (> 1.5 mm in three zones) were present in 10% of stems and associated with lower questionnaire scores. The 5-year survivorship for aseptic loosening of the 367 stems was 97% with revision as end point and 95% for radiographic failure. CONCLUSIONS The high incidence of migration and stems with radiographic failure raises concerns about patient clinical function and long-term survivorship of this stem design. This migration pattern may be due to poor initial stability with a subsequent lack of osseointegration. Our results differ from radiographic findings and clinical durability of other similar cementless stem designs. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Craig A. White
- Adult Reconstruction, The Ottawa Hospital, 501 Smyth Road, Room W1646, Ottawa, ON K1H 8L6 Canada
| | - Sasha Carsen
- Adult Reconstruction, The Ottawa Hospital, 501 Smyth Road, Room W1646, Ottawa, ON K1H 8L6 Canada
| | - Kevin Rasuli
- Adult Reconstruction, The Ottawa Hospital, 501 Smyth Road, Room W1646, Ottawa, ON K1H 8L6 Canada
| | - Robert J. Feibel
- Adult Reconstruction, The Ottawa Hospital, 501 Smyth Road, Room W1646, Ottawa, ON K1H 8L6 Canada
| | - Paul R. Kim
- Adult Reconstruction, The Ottawa Hospital, 501 Smyth Road, Room W1646, Ottawa, ON K1H 8L6 Canada
| | - Paul E. Beaulé
- Adult Reconstruction, The Ottawa Hospital, 501 Smyth Road, Room W1646, Ottawa, ON K1H 8L6 Canada
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Kadar T, Hallan G, Aamodt A, Indrekvam K, Badawy M, Havelin LI, Stokke T, Haugan K, Espehaug B, Furnes O. A randomized study on migration of the Spectron EF and the Charnley flanged 40 cemented femoral components using radiostereometric analysis at 2 years. Acta Orthop 2011; 82:538-44. [PMID: 21895504 PMCID: PMC3242949 DOI: 10.3109/17453674.2011.618914] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE We performed a randomized study to determine the migration patterns of the Spectron EF femoral stem and to compare them with those of the Charnley stem, which is regarded by many as the gold standard for comparison of implants due to its extensive documentation. PATIENTS AND METHODS 150 patients with a mean age of 70 years were randomized, single-blinded, to receive either a cemented Charnley flanged 40 monoblock, stainless steel, vaquasheen surface femoral stem with a 22.2-mm head (n = 30) or a cemented Spectron EF modular, matte, straight, collared, cobalt-chrome femoral stem with a 28-mm femoral head and a roughened proximal third of the stem (n = 120). The patients were followed with repeated radiostereometric analysis for 2 years to assess migration. RESULTS At 2 years, stem retroversion was 2.3° and 0.7° (p < 0.001) and posterior translation was 0.44 mm and 0.17 mm (p = 0.002) for the Charnley group (n = 26) and the Spectron EF group (n = 74), respectively. Subsidence was 0.26 mm for the Charnley and 0.20 mm for the Spectron EF (p = 0.5). INTERPRETATION The Spectron EF femoral stem was more stable than the Charnley flanged 40 stem in our study when evaluated at 2 years. In a report from the Norwegian arthroplasty register, the Spectron EF stem had a higher revision rate due to aseptic loosening beyond 5 years than the Charnley. Initial stability is not invariably related to good long-term results. Our results emphasize the importance of prospective long-term follow-up of prosthetic implants in clinical trials and national registries and a stepwise introduction of implants.
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Affiliation(s)
| | - Geir Hallan
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | | | | | - Mona Badawy
- Hagevik Hospital, Haukeland University Hospital, Hagavik
| | | | - Terje Stokke
- Department of Radiology, Haukeland University Hospital, Bergen
| | - Kristin Haugan
- Department of Orthopaedic Surgery, Trondheim University Hospital, Trondheim
| | - Birgitte Espehaug
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
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Baad-Hansen T, Kold S, Olsen N, Christensen F, Søballe K. Excessive distal migration of fiber-mesh coated femoral stems. Acta Orthop 2011; 82:308-14. [PMID: 21504304 PMCID: PMC3235308 DOI: 10.3109/17453674.2011.574562] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The surface texture, localization, and magnitude of the surface material applied to the femoral stem can facilitate bone ingrowth and influence the survival of total hip arthroplasties. Clinical and radiographic studies have shown superior bone ingrowth in proximally porous-coated stems with a diaphyseal grit-blasted surface in comparison to a smooth diaphyseal surface. Surface textures-especially porous surface material-have been suggested to have a sealing effect against migration of polyethylene debris along the implant-bone interface and to reduce the inflammatory response, leading to a prolonged implant survival. PATIENTS AND METHODS Between 2004 and 2006, we conducted a randomized, controlled trial (RCT) involving 50 patients with non-inflammatory arthritis. They received either a distally tapered, extended coated stem or a straight, proximally coated stem. During surgery, tantalum markers were inserted into the greater and lesser trochanter. Implant migration was evaluated at 3, 12, and 24 months postoperatively by radiostereometric analysis. The primary endpoint was stem migration 2 years after surgery. RESULTS All femoral components in both groups showed pronounced distal translation, with the highest rate of translation occurring between 0 and 3 months. After 2 years, the mean distal translation was 2.67 (95% CI: -3.93 to -1.42) mm for the tapered, extended coated stem and 1.80 (-2.45 to -1.15) mm for the straight, proximally coated stem. Half of the tapered, extended coated stems and two-thirds of the straight, proximally coated stems had migrated more than 1 mm. No difference between the 2 stems could be seen with regard to translation or rotation at any time point. After 2 years, 2 hips have been reoperated due to mechanical loosening of the stem. INTERPRETATION An excessive amount of migration of both stem types was seen 2 years postoperatively. It is of vital importance to follow this patient cohort since radiostereometric analysis is known to be predictive of late implant failure, especially in this study where pronounced early migration was observed. We recommend longer follow-up of both stem types.
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Affiliation(s)
| | - Søren Kold
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
| | - Niels Olsen
- Department of Orthopaedic Surgery, Kolding Region Hospital, Kolding, Denmark
| | - Finn Christensen
- Department of Orthopaedic Surgery, Kolding Region Hospital, Kolding, Denmark
| | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
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Total hip replacement with an uncemented Wagner cone stem for patients with congenital hip dysplasia. INTERNATIONAL ORTHOPAEDICS 2011; 35:1767-70. [PMID: 21318569 DOI: 10.1007/s00264-011-1218-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 01/18/2011] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this study was to review retrospectively the cases operated upon in our department in recent years with a Wagner stem and a small socket in cases of Crowe I or II dysplastic hips. METHODS We conducted a retrospective clinical radiological review of 30 hips diagnosed with hip dysplasia Crowe I or II treated in our centre between 2002 and 2008. All of them were treated with a Wagner cone stem and a small Trilogy acetabulum (Zimmer ®). RESULTS There were 15 men and 11 women with 13 left and 17 right femurs. Mean follow-up was 43.44 months (range 14-87). Eight patients were Crowe I type and 22 were Crowe II type. Merlé d'Aubigne score pre-operatively was 12.23 and at the last follow-up was 15.54. Mean leg length inequality was 1.79 and after surgery it was 0.69 cm. Complications included three infection and three dislocations (two of them in the same patient). CONCLUSIONS The use of a Wagner stem is a good option to correct the different deformities in the proximal femur in these cases. A small socket allows a correct relocation of the acetabulum in a dysplastic socket with good bone coverage.
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Hammerberg EM, Wan Z, Dastane M, Dorr LD. Wear and range of motion of different femoral head sizes. J Arthroplasty 2010; 25:839-43. [PMID: 19775859 DOI: 10.1016/j.arth.2009.07.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 07/07/2009] [Indexed: 02/01/2023] Open
Abstract
Femoral head sizes greater than 32 mm are more prevalent with current total hip arthroplasty. We hypothesized that linear wear rates of Durasul highly cross-linked polyethylene would not differ with different head sizes. We also compared the range of motion of the hip. Ninety-four consecutive arthroplasties in 84 patients were studied for a mean 3.6 +/- 0.7 years. There was no statistical difference in linear wear rates and annual or total penetration rates when 28-mm and 32-mm heads were compared to 38-mm and 44-mm heads. Volumetric wear was 12.4 mm(3)/y higher with bigger heads. Range of motion did not differ. Larger femoral head sizes show no evidence of an accelerated wear pattern when used with Durasul.
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Affiliation(s)
- Eric Mark Hammerberg
- The Arthritis Institute at Good Samaritan Hospital, Los Angeles, California 90017, USA
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D'Angelo F, Murena L, Vulcano E, Zatti G, Cherubino P. Seven to twelve year results with Versys ET cementless stem. A retrospective study of 225 cases. Hip Int 2010; 20:81-6. [PMID: 20235069 DOI: 10.1177/112070001002000112] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2009] [Indexed: 02/04/2023]
Abstract
A retrospective review was conducted to evaluate the mid-term results (8.5 years follow-up) of the Versys ET stem (Zimmer, Warsaw, Indiana, USA). From 1995 to 2000, 225 total hip arthroplasties (THA) were performed using this device. All patients were evaluated clinically by the Harris Hip Score, and radiographically. The Hip Score increased from 54 preoperatively to 97 points postoperatively. The stem displayed a varus alignment between 5 degrees and 10 degrees in 17 cases without any clinical consequences (HHS 96.8). We recorded one case of septic loosening and one case of aseptic loosening. The stability of the stem was radiographically evaluated according to Engh's criteria, confirming bone ongrowth in all other cases.
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Affiliation(s)
- Fabio D'Angelo
- Department of Orthopaedics and Traumatology "M. Boni", Università dell'Insubria, Varese, Italy.
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Park Y, Albert C, Yoon YS, Fernlund G, Frei H, Oxland TR. The effect of abductor muscle and anterior-posterior hip contact load simulation on the in-vitro primary stability of a cementless hip stem. J Orthop Surg Res 2010; 5:40. [PMID: 20576151 PMCID: PMC2907319 DOI: 10.1186/1749-799x-5-40] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 06/24/2010] [Indexed: 11/11/2022] Open
Abstract
Background In-vitro mechanical tests are commonly performed to assess pre-clinically the effect of implant design on the stability of hip endoprostheses. There is no standard protocol for these tests, and the forces applied vary between studies. This study examines the effect of the abductor force with and without application of the anterior-posterior hip contact force in the in-vitro assessment of cementless hip implant stability. Methods Cementless stems (VerSys Fiber Metal) were implanted in twelve composite femurs which were divided into two groups: group 1 (N = 6) was loaded with the hip contact force only, whereas group 2 (N = 6) was additionally subjected to an abductor force. Both groups were subjected to the same cranial-caudal hip contact force component, 2.3 times body weight (BW) and each specimen was subjected to three levels of anterior-posterior hip contact load: 0, -0.1 to 0.3 BW (walking), and -0.1 to 0.6 BW (stair climbing). The implant migration and micromotion relative to the femur was measured using a custom-built system comprised of 6 LVDT sensors. Results Substantially higher implant motion was observed when the anterior-posterior force was 0.6BW compared to the lower anterior-posterior load levels, particularly distally and in retroversion. The abductor load had little effect on implant motion when simulating walking, but resulted in significantly less motion than the hip contact force alone when simulating stair climbing. Conclusions The anterior-posterior component of the hip contact load has a significant effect on the axial motion of the stem relative to the bone. Inclusion of the abductor force had a stabilizing effect on the implant motion when simulating stair climbing.
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Affiliation(s)
- Youngbae Park
- Department of Mechanical Engineering, Korean Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
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Jedenmalm A, Affatato S, Taddei P, Leardini W, Gedde UW, Fagnano C, Viceconti M. Effect of head surface roughness and sterilization on wear of UHMWPE acetabular cups. J Biomed Mater Res A 2009; 90:1032-42. [PMID: 18671264 DOI: 10.1002/jbm.a.32161] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The impact of femoral head surface roughness on wear of gamma-irradiation sterilized (3 MRad in nitrogen, crosslinked) and nonsterilized (not crosslinked) UHMWPE acetabular cups has been evaluated. Gravimetric wear testing was performed in a hip joint simulator for 2 x 10(6) cycles. CoCrMo heads were used with different surface roughness (R(a) = 15 nm and R(a) = 400 nm). The surface roughness after wear test was unchanged for the roughened heads, whereas the initially smooth heads showed a few scratches. The roughened heads increased the wear of the acetabular cups 2-fold. The gamma-irradiated cups tested against rough heads underwent the highest wear. The absorption of water was highest for the gamma-irradiated cups (0.0204% compared to 0.0031% after 85 days). Raman spectroscopy showed small but significant crystallinity changes in the wear zone, where the gamma-irradiated cups with the most extensive abrasion increased in crystallinity, whereas the nonsterilized cups underwent a crystallinity decrease.
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Affiliation(s)
- A Jedenmalm
- Royal Institute of Technology (KTH), School of Chemical Science and Engineering, Fiber and Polymer Technology, SE-100 44 Stockholm, Sweden
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Zhang HY, Brown L, Barrans S, Blunt L, Jiang XQ. Investigation of relative micromotion at the stem—cement interface in total hip replacement. Proc Inst Mech Eng H 2009; 223:955-64. [DOI: 10.1243/09544119jeim594] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cemented total hip replacement has become a standard surgical technique to treat patients with osteoarthritis and osteonecrosis. The stem—cement interface experiences fretting wear in vivo due to low-amplitude oscillatory micromotion under physiological loading, and this wear is currently becoming important as a potential mechanism for the overall wear of cemented total hip replacements. However, the relative micromotion at the stem—cement interface has not been widely reported. In the present study, a new micromotion sensor is developed that is based on the deformation of a strain gauge, and this sensor is used to probe the migration of a polished Exeter stem within a Simplex P cement mantle through an in vitro wear simulation. It is demonstrated that the stem migration value generally increases with an increase in the number of loading cycles, with a gradual decrease of migration rate. Additionally, fretting wear is successfully replicated on the stem surface, and the micropores in the cement surface are considered to contribute to initiation and propagation of the fretting damage on the stem. This is confirmed by the observation that no evidence of fretting wear is detected on the stem where the surface is in contact with the pore-free areas on the cement. This study allows a deep insight into the micromotion at the stem—cement interface, and provides evidence highlighting the significance of the micropores in the cement surface in the generation of fretting wear on a polished femoral stem.
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Affiliation(s)
- H-Y Zhang
- Centre for Precision Technologies, School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | - L Brown
- Centre for Precision Technologies, School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | - S Barrans
- Centre for Precision Technologies, School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | - L Blunt
- Centre for Precision Technologies, School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | - X-Q Jiang
- Centre for Precision Technologies, School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
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39
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Gortchacow M, Saxena S, Wettstein M, Pioletti D, Terrier A. Measuring micromotion around a loaded hip stem using μCT imaging. Comput Methods Biomech Biomed Engin 2009. [DOI: 10.1080/10255840903080893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Digas G. New polymer materials in total hip arthroplasty. ACTA ORTHOPAEDICA. SUPPLEMENTUM 2009. [DOI: 10.1080/17453674078540521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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41
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Tägil M, Jeppsson C, Wang JS, Aspenberg P. No augmentation of morselized and impacted bone graft by OP-1 in a weight-bearing model. ACTA ACUST UNITED AC 2009; 74:742-8. [PMID: 14763709 DOI: 10.1080/00016470310018306] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Impacted morselized bone allograft is thought to be remodeled to a great extent. We have previously shown that load-bearing increases the remodeling of impacted morselized bone allografts in a rabbit knee prosthesis model. Bone Morphogenic Proteins (BMPs) also stimulate bone formation and bone allograft remodeling. In this study, our aim was to determine whether it was possible to increase further the remodeling of impacted morselized bone allografts by combining load-bearing with a BMP. EXPERIMENT A solution of Osteogenic Protein-1 (OP-1, also called BMP-7) was added to freeze-dried bone allograft chips before impaction grafting in our rabbit knee prosthesis model. 23 skeletally mature rabbits received an uncemented tibial knee prosthetic component inserted into a bed of impacted morselized bone allograft. 12 rabbits were given OP-1-treated allograft (50 microg OP-1 per gram allograft), and 11 rabbits vehicle-treated allograft. Each rabbit received mean 0.53 g graft. The rabbits were killed after 3 or 6 weeks and the grafted region was examined by histomorphometric assessment of the volume fraction of newly formed bone and remaining graft. RESULTS AND INTERPRETATION We found that OP-1 did not increase the bone density (graft plus new bone) to any substantial extent. However, we can not exclude that this might be due to a carrier problem, since the OP-1 was added as a solution directly to the dry graft.
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Affiliation(s)
- Magnus Tägil
- Department of Orthopedics, Lund University Hospital, Lund, Sweden.
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42
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Abstract
With increasing numbers of research groups carrying out radiostereometric analysis (RSA), it is important to reach a consensus on how the main aspects of the technique should be carried out and how the results should be presented in an appropriate and consistent way. In this collection of guidelines, we identify a number of methodological and reporting issues including: measurement error and precision, migration and migration direction data, and the use of RSA as a screening technique. Alternatives are proposed, and a statistical analysis is presented, from which a sample size of 50 is recommended for screening of newly introduced prostheses.
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Affiliation(s)
| | - Robin J Prescott
- 2Medical Statistics Unit,Public Health Sciences, University of Edinburgh Medical SchoolEdinburghUK
| | - Martyn L Porter
- 1Centre for Hip Surgery, Wrightington HospitalAppley BridgeUK
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Aseptic stem loosening in primary THA: migration analysis of cemented and cementless fixation. INTERNATIONAL ORTHOPAEDICS 2008; 33:1501-5. [PMID: 19066889 DOI: 10.1007/s00264-008-0701-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Revised: 10/28/2008] [Accepted: 10/28/2008] [Indexed: 10/21/2022]
Abstract
Early migration has reportedly been predictive for later implant failure. Using four different migration patterns, this study aimed to analyse migration behaviour of the two types of implant fixation--cemented and cementless--throughout the process of loosening. Migrational behaviour of 69 revised stems (49 cemented, 20 uncemented) was analysed retrospectively with EBRA-FCA (Einzel-Bild-Röntgen-Analyse, Femoral Component Analysis). Uncemented stems failed after early and late onset migration alike, while late migration was the predominant pattern in cemented stems. Mean prosthetic failure after early migration occurred 5.8 (+/-4.4) years postoperatively due to insufficient primary stability. Initially stable stems with late onset migration were revised after 12.4 (+/-4.5) years. Measurement of early migration was found to be a valuable tool to screen short-term and mid-term failure. In the long run the method's sensitivity decreased. Late onset migration, however, preceded long-term failure by a mean of three years.
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44
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Gabbar OA, Rajan RA, Londhe S, Hyde ID. Ten- to twelve-year follow-up of the furlong hydroxyapatite-coated femoral stem and threaded acetabular cup in patients younger than 65 years. J Arthroplasty 2008; 23:413-7. [PMID: 18358381 DOI: 10.1016/j.arth.2007.01.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2005] [Revised: 01/04/2007] [Accepted: 01/28/2007] [Indexed: 02/01/2023] Open
Abstract
We reviewed 82 patients who had 92 primary Furlong uncemented hydroxyapatite (HA)-coated total hip replacements inserted between 1988 and 1992. All patients had the Furlong HA-coated stem and screw in acetabular cup with a 28-mm alumina oxide ceramic modular head. The mean age at the time of primary total hip arthroplasty was 54 years (range, 31-67 years). At 10 years, we reviewed 64 patients (72 total hip arthroplasties). Eight had died (10 total hip arthroplasties), 3 could not attend for follow-up, 2 were lost to follow-up, and 5 were revised (2 for infection and 3 for acetabular loosening and recurrent dislocation). We conclude that the Furlong HA-coated total hip replacement is a good prosthesis for patients younger than 65 years, with a cumulative survival rate of 94.29% at 10 to 12 years using revision as the end point.
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Affiliation(s)
- Omar Abdul Gabbar
- Department of Orthopaedics, Lincoln County Hospital, Lincoln, Lincolnshire, UK
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45
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Kang MN, Huddleston JI, Hwang K, Imrie S, Goodman SB. Early outcome of a modular femoral component in revision total hip arthroplasty. J Arthroplasty 2008; 23:220-5. [PMID: 18280416 DOI: 10.1016/j.arth.2007.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Accepted: 03/07/2007] [Indexed: 02/01/2023] Open
Abstract
Forty-six hips in 42 patients underwent revision surgery with a modular femoral component (ZMR; Zimmer, Warsaw, Ind). Thirty-nine hips with 2 to 5 years' follow-up were evaluated radiographically and clinically by the Harris hip score and WOMAC pain/stiffness/function scores. The Harris hip score improved from 47.4 to 72.3 (P<.001), with significant improvements in the WOMAC pain/stiffness/function scores. The mean subsidence was 4.4 mm, with 5 hips demonstrating significant subsidence of more than 5 mm. Four hips required reoperation, 1 due to failure of the femoral component. No early complications were encountered regarding the modular junction. Modular, cementless, extensively porous, coated femoral components have demonstrated early clinical and radiographic success. Distal intramedullary fit helps ensure initial stability; proximal modularity further maximizes fit while optimizing hip offset and length.
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Affiliation(s)
- Michael N Kang
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305, USA
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46
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Toms A, Marshall T, Cahir J, Darrah C, Nolan J, Donell S, Barker T, Tucker J. MRI of early symptomatic metal-on-metal total hip arthroplasty: a retrospective review of radiological findings in 20 hips. Clin Radiol 2008; 63:49-58. [DOI: 10.1016/j.crad.2007.07.012] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 05/17/2007] [Accepted: 07/22/2007] [Indexed: 11/26/2022]
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Gheduzzi S, Miles AW. A review of pre-clinical testing of femoral stem subsidence and comparison with clinical data. Proc Inst Mech Eng H 2007; 221:39-46. [PMID: 17315767 DOI: 10.1243/09544119jeim129] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Immediate postoperative stability of femoral stems is one of the key factors for the long-term success of total hip replacement. The need to develop a reliable technique to assess in vitro implant stability under physiological loading conditions is widely recognized. A critical review of the in vitro techniques developed for the assessment of implant stability is presented. In vitro predictions of subsidence are compared to in vivo clinical data available from Roentgen stereophotogrammetric analysis (RSA) studies. Limited correlation between in vitro predictions of stability and clinical measurements of subsidence obtained through RSA data was found even though similar migration patterns could be distinguished.
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Affiliation(s)
- S Gheduzzi
- Department of Orthopaedic Surgery, University of Bristol, Bristol, UK
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Ince A, Lermann J, Göbel S, Wollmerstedt N, Hendrich C. No increased stem subsidence after arthroplasty in young patients with femoral head osteonecrosis: 41 patients followed for 1-9 years. Acta Orthop 2006; 77:866-70. [PMID: 17260193 DOI: 10.1080/17453670610013141] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Poor bone stock in patients with osteonecrosis of the femoral head may be a reason for poor outcome after hip replacement. One way of studying bone quality is to measure implant migration. We thus investigated the clinical and radiographic results of cementless THR in younger patients with femoral head osteonecrosis. PATIENTS AND METHODS We studied hips in 41 patients (mean age 48 (25-63) years) with a cementless hip arthroplasty after late stage osteonecrosis. Clinical evaluation was by the Harris hip score, the WOMAC score and the SF-36 score. Stem subsidence was measured with the Ein Bild Roentgen Analyse femoral component analysis (EBRA-FCA) at 3, 12, 24, 60, and 72 months after operation. The average duration of follow-up was 7(1-9) years, with less than 2 years for 2 patients. RESULTS There was no revision of any hip. No radiographic or clinical stem loosening was seen. After 60 months, the cementless stems showed a median subsidence of -0.7 mm (95% CI: -0.9 to -0.2). No femoral osteolysis occurred. Femoral radiolucent lines, all < 1 mm, were seen in 10 hips. At the latest follow-up the Harris hip score was 83 (23-100) points. INTERPRETATION Our findings for porous-coated stems in patients with femoral osteonecrosis indicate no greater risk of stem subsidence and rate of osteolysis after an average of 7 years follow-up. Thus, we continue to use uncemented stems in younger patients with femoral osteonecrosis. However, continued follow-up will be necessary to evaluate the long-term outcome.
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Affiliation(s)
- Akif Ince
- Department of Orthopaedic Surgery, University Hospital Würzburg, Würzburg, Germany.
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Clauss M, Reitzel T, Pritsch M, Schlegel UJ, Bitsch RG, Ewerbeck V, Mau H, Breusch SJ. [The cemented MS-30 stem. A multi-surgeon series of 333 consecutive cases]. DER ORTHOPADE 2006; 35:776-83. [PMID: 16628398 DOI: 10.1007/s00132-006-0956-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION So far there is only one peer-reviewed long-term publication from the inventors' clinic for the MS-30 stem. MATERIAL AND METHODS In a retrospective study we followed the first 333 consecutive MS-30 stems. All patients with 5- to 11-year follow-up were clinically and radiographically evaluated. At the time of implantation the criteria of modern cementing techniques were not implemented. Clinical evaluation was done using the scores of Harris and Merle d'Aubigné and Postel. Radiographic evaluation included quality of the cement mantle (true lateral radiographs taken under fluoroscopy), stem subsidence, loosening signs, and the risk for pending failure. RESULTS At follow-up 12 hips had undergone femoral revision: 3 for aseptic loosening, 6 for infection, 1 for periprosthetic fracture, and 2 for recurrent dislocation. The overall survival for all reasons at 10 years was 96.1%; survival with aseptic loosening as an end point was 99.0%. The median Harris Hip Score at follow-up was 80 (26-100) points. Radiological evaluation revealed a thin cement mantle (<2 mm) in approximately 2/3, predominantly on the lateral views (Gruen zones 8/9). One-third of all reviewed prostheses were considered at risk for pending failure, which strongly correlated with the initial quality of the cement mantle. CONCLUSION Midterm results with the MS-30 stem are encouraging and an even better long-term outcome can be expected with a better cement technique.
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Affiliation(s)
- M Clauss
- Stiftung Orthopädische Universitätsklinik, Schlierbacher Landstrasse 200a, 69118, Heidelberg.
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Saito J, Aslam N, Tokunaga K, Schemitsch EH, Waddell JP. Bone remodeling is different in metaphyseal and diaphyseal-fit uncemented hip stems. Clin Orthop Relat Res 2006; 451:128-33. [PMID: 16770282 DOI: 10.1097/01.blo.0000224045.63754.a3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Femoral component stability in uncemented total hip arthroplasties depends on periprosthetic bone remodeling. Stem design is an important factor influencing bone remodeling, however the design that promotes the most bone remodeling is unclear. We examined metaphyseal and diaphyseal-fit stems to determine the effect of stem design on bone remodeling and stability. Twenty-three patients who had total hip arthroplasties (28 hips) with metaphyseal-fit stems were matched with 27 patients (32 hips) who had uncemented total hip arthroplasties with diaphyseal-fit stems. We assessed preoperative radiographs for canal fill, canal shape, and bone quality. We then assessed postoperative radiographs for periprosthetic bone remodeling including spot welds, cortical hypertrophy, and pedestal formation. Patients were examined clinically using a modified Harris hip score. Patients with metaphyseal stems had increased cortical hypertrophy 1 year postoperatively. However, there was no functional difference 2 years postoperatively. Both stem designs resulted in bone remodeling by 2 years postoperatively with similar clinical results.
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Affiliation(s)
- Jun Saito
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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