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Glismann K, Konow T, Lampe F, Ondruschka B, Huber G, Morlock MM. Small design modifications can improve the primary stability of a fully coated tapered wedge hip stem. PLoS One 2024; 19:e0300956. [PMID: 38630711 PMCID: PMC11023602 DOI: 10.1371/journal.pone.0300956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/07/2024] [Indexed: 04/19/2024] Open
Abstract
Increasing the stem size during surgery is associated with a higher incidence of intraoperative periprosthetic fractures in cementless total hip arthroplasty with fully coated tapered wedge stems, especially in femurs of Dorr type A. If in contrast a stem is implanted and sufficient primary stability is not achieved, such preventing successful osseointegration due to increased micromotions, it may also fail, especially if the stem is undersized. Stem loosening or periprosthetic fractures due to stem subsidence can be the consequence. The adaptation of an established stem design to femurs of Dorr type A by design modifications, which increase the stem width proximally combined with a smaller stem tip and an overall shorter stem, might reduce the risk of distal locking of a proximally inadequately fixed stem and provide increased stability. The aim of this study was to investigate whether such a modified stem design provides improved primary stability without increasing the periprosthetic fracture risk compared to the established stem design. The established (Corail, DePuy Synthes, Warsaw, IN, US) and modified stem designs (Emphasys, DePuy Synthes, Warsaw, IN, US) were implanted in cadaveric femur pairs (n = 6 pairs) using the respective instruments. Broaching and implantation forces were recorded and the contact areas between the prepared cavity and the stem determined. Implanted stems were subjected to two different cyclic loading conditions according to ISO 7206-4 using a material testing machine (1 Hz, 600 cycles @ 80 to 800 N, 600 cycles @ 80 to 1600 N). Translational and rotational relative motions between stem and femur were recorded using digital image correlation. Broaching and implantation forces for the modified stem were up to 40% higher (p = 0.024), achieving a 23% larger contact area between stem and bone (R2 = 0.694, p = 0.039) resulting in a four times lower subsidence during loading (p = 0.028). The slight design modifications showed the desired effect in this in-vitro study resulting in a higher primary stability suggesting a reduced risk of loosening. The higher forces required during the preparation of the cavity with the new broaches and during implantation of the stem could bare an increased risk for intraoperative periprosthetic fractures, which did not occur in this study.
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Affiliation(s)
- Katja Glismann
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Tobias Konow
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | | | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerd Huber
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Michael M. Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
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Rainey J, Frandsen J, Mortensen A, Faizan A, Bhowmik-Stoker M, Springer B, Gililland J. Early Radiographic Fit and Fill Analysis of a New Metaphyseal-Filling Triple Taper Stem Designed Using a Large Computed Tomography Scan Database. Arthroplast Today 2023; 23:101199. [PMID: 37745965 PMCID: PMC10517270 DOI: 10.1016/j.artd.2023.101199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/25/2023] [Accepted: 07/19/2023] [Indexed: 09/26/2023] Open
Abstract
Background Numerous cementless stems are available to maximize implant stability, fit, and survivorship in total hip arthroplasty. Recently, a new metaphyseal-filling triple-taper collared stem was designed using femoral morphology data obtained from over 1300 computed tomography scans. The purpose of this study was to evaluate the radiographic fit and fill of this new stem in the coronal and sagittal dimensions. Methods In this retrospective review, postoperative radiographs of patients receiving this new stem were analyzed in accordance with previously published fit and fill analyses. All radiographs were taken 6 weeks postoperatively. Means and standard deviations were reported for all fit and fill parameters. Results Fifty-nine hips were analyzed from 55 patients undergoing total hip arthroplasty. The coronal proximal fill was 85.02 ± 8.06%, and coronal distal fill was 75.21 ± 9.71%. The sagittal proximal fill was 86.51 ± 8.77%, and sagittal distal fill was 59.17 ± 8.66%. Mean calcar collar coverage was 80.64 ± 19.6% and all patients had full seating of the collar. Six cases (10.2%) had a collar length greater than the calcar length, with a mean collar overhang of 0.7 ± 0.4 mm. Conclusions This new stem demonstrated significant proximal fill in both the coronal and sagittal planes and validates the design intent of this implant. This is the first study to evaluate sagittal fit and fill of a femoral stem. Long-term follow-up is required to understand the clinical impact these fit and fill characteristics may have on patients' long-term outcomes.
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Affiliation(s)
- Joshua Rainey
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey Frandsen
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Alexander Mortensen
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Jeremy Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Fontalis A, Kayani B, Vanhegan I, Tahmassebi J, Haddad IC, Giebaly DE, Rajput V, Hansjee S, Haddad FS. 2-Year Radiostereometric Analysis Evaluation of a Short, Proximally Coated, Triple-Taper Blade Femoral Stem Versus a Quadrangular-Taper Stem With Reinforced Proximal Body: A Randomized Controlled Trial. J Arthroplasty 2023:S0883-5403(23)00242-5. [PMID: 36931355 DOI: 10.1016/j.arth.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Cementless stem designs with proximal metaphyseal fixation aim to achieve better load distribution, reduce stress shielding, and improve primary stability. The purpose of this prospective, randomized controlled trial was to evaluate the 2-year migration and clinical outcomes of two cementless femoral stems. METHODS A total of 60 participants undergoing primary total hip arthroplasty for any cause were randomly allocated to receiving either a proximally coated, short blade stem or a quadrangular-taper stem with a reinforced proximal body. Radiostereometric Analysis (RSA) radiographs were performed post-operatively and at 6 weeks, 6 months, 1- and 2-years. The Harris Hip Score, Oxford Hip Score and the EuroQol five-dimension (EQ5D) were also collected. RESULTS At two years, the median subsidence of the short-blade stem was 0.097 millimeters (mm) [Interquartile range (IQR) -0.67 to 0.08)] versus 0.086 mm(IQR, -0.29 to 0.005, P=0.683); medial translation 0.023 mm (IQR 0.08 to 0.12) versus 0.029 mm(IQR -0.07 to 0.10, P=0.907); anterior translation 0.035 mm (IQR -0.23 to 0.33) versus 0.07 mm (IQR -0.13 to 0.08, P=0.268). At 24 months postoperatively, there were no stem revisions and Patient Reported Outcome Measures (PROMs) were comparable between groups. CONCLUSION Both cementless stems exhibited a predictable migration pattern and achieved initial stability. There was no difference in migration across the three Cartesian axes at any timepoint. Clinical outcomes and PROMs were also comparable. Biological fixation of both implants evidenced by the RSA and excellent PROMs are likely to translate to longer-term stability, which would need to be corroborated by longer-term outcome studies.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Ivor Vanhegan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Jenni Tahmassebi
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Isabella Catrina Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Dia Eldean Giebaly
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Vishal Rajput
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Shanil Hansjee
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, Gower Street, London, WC1E 6BT, UK
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Maitama MI, Lawal YZ, Dahiru IL, Alabi IA, Amaefule KE, Audu SS, Ibrahim A. Implant factors that might influence components' survival in primary total hip arthroplasty. Niger Postgrad Med J 2022; 29:1-5. [PMID: 35102943 DOI: 10.4103/npmj.npmj_726_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Primary total hip arthroplasty (THA) is an invaluable surgical procedure that has revolutionised the treatment of various end-stage hip pathologies. Aseptic loosening of either acetabular cup and/or femoral stem as well as components' dislocation are well-known post-operative complications due to so many factors: environmental, surgeon, patient related, disease related or implant design. The aim of this literature review is to look at some relevant implant designs that might influence acetabular and femoral components' survival for primary cementless THA using revision for aseptic loosening and dislocation as criteria for failure. This may also assist the surgeon in making an informed choice of using appropriate implants to match the demographic and disease-specific need of the patients undergoing the surgical procedure. This review article was performed using an online literature search on relevant publications.
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Affiliation(s)
- Mohammed Inuwa Maitama
- Department of Trauma and Orthopedic Surgery, Ahmadu Bello University Zaria, Kaduna State, Nigeria
| | - Yau Zakari Lawal
- Department of Trauma and Orthopedic Surgery, Ahmadu Bello University Zaria, Kaduna State, Nigeria
| | - Ismaila Lawal Dahiru
- Department of Trauma and Orthopedic Surgery, Ahmadu Bello University Zaria, Kaduna State, Nigeria
| | - Ibrahim Abolaji Alabi
- Department of Trauma and Orthopedic Surgery, National Orthopedic Hospital Dala, Kano State, Nigeria
| | - Kenneth Ezenwa Amaefule
- Department of Trauma and Orthopedic Surgery, Ahmadu Bello University Zaria, Kaduna State, Nigeria
| | - Simpa Siaka Audu
- Department of Trauma and Orthopedic Surgery, Ahmadu Bello University Zaria, Kaduna State, Nigeria
| | - Aniko Ibrahim
- Department of Trauma and Orthopedic Surgery, Ahmadu Bello University Zaria, Kaduna State, Nigeria
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Levadnyi I, Gubaua JE, Dicati GWO, Awrejcewicz J, Gu Y, Pereira JT, Loskutov A. Comparative Analysis of the Biomechanical Behavior of Collar and Collarless Stems: Experimental Testing and Finite Element Modelling. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00652-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Weber E, Flivik C, Sundberg M, Flivik G. Migration pattern of a short uncemented stem with or without collar: a randomised RSA-study with 2 years follow-up. Hip Int 2021; 31:500-506. [PMID: 31793347 DOI: 10.1177/1120700019888471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is an increasing interest in shorter, proximally loading, uncemented femoral stems. The aim of this study was to evaluate a new short stem type, its design based on a well-proven precursor, but with several new design features to facilitate easier insertion and possible preservation of proximal bone stock. It is available with or without a collar. METHODS The study includes 50 patients with primary osteoarthritis, mean age 59 (range 36-75) years, randomised to receive either the collar-fitted or the collarless stem. The patients underwent repeated radiostereometry (RSA) examinations (0, 0.5, 3, 12, 24 months), conventional radiography and filled out both hip-specific (HOOS) and general health (EQ-5D) questionnaires. RESULTS There was no statistically significant difference between the collared and collarless stems regarding migration and clinical outcome. Both stem types exhibit a similar pattern of initial subsidence (collared 0.63 mm vs. collarless 0.75 mm [p = 0.50]) and retroversion (collared 0.71° vs. collarless 0.97° [p = 0.36]) up to 3 months followed by stabilisation, in similarity with its precursors, suggesting good osseointegration. No stem has been revised or considered loose. CONCLUSIONS The new design features, including shortening the stem, do not compromise migration pattern or osseointegration, regardless collar or not.
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Affiliation(s)
- Erik Weber
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Carl Flivik
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Martin Sundberg
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Gunnar Flivik
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
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Alsousou J, Oragui E, Martin A, Strickland L, Newman S, Kendrick B, Taylor A, Glyn-Jones S. Primary stability of a proximally coated and tapered stem. Bone Joint J 2021; 103-B:644-649. [PMID: 33789489 DOI: 10.1302/0301-620x.103b4.bjj-2020-1648.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this prospective cohort study was to evaluate the early migration of the TriFit cementless proximally coated tapered femoral stem using radiostereometric analysis (RSA). METHODS A total of 21 patients (eight men and 13 women) undergoing primary total hip arthroplasty (THA) for osteoarthritis of the hip were recruited in this study and followed up for two years. Two patients were lost to follow-up. All patients received a TriFit stem and Trinity Cup with a vitamin E-infused highly cross-linked ultra-high molecular weight polyethylene liner. Radiographs for RSA were taken postoperatively and then at three, 12, and 24 months. Oxford Hip Score (OHS), EuroQol five-dimension questionnaire (EQ-5D), and adverse events were reported. RESULTS At two years, the mean subsidence of the head and tip for the TriFit stem was 0.38 mm (SD 0.32) and 0.52 mm (SD 0.36), respectively. The total migration of the head and tip was 0.55 mm (SD 0.32) and 0.71 mm (SD 0.38), respectively. There were no statistically significant differences between the three to 12 months' migration (p = 0.105) and 12 to 24 months' migration (p = 0.694). The OHS and EQ-5D showed significant improvements at two years. CONCLUSION The results of this study suggest that the TriFit femoral stem achieves initial stability and is likely to be stable in the mid and long term. A long-term outcome study is required to assess late mechanisms of failure and the effects of bone mineral density (BMD) related changes. Cite this article: Bone Joint J 2021;103-B(4):644-649.
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Affiliation(s)
- Joseph Alsousou
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Emeka Oragui
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alexander Martin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Louise Strickland
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Simon Newman
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ben Kendrick
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Adrian Taylor
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Siôn Glyn-Jones
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
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8
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Floerkemeier T, Budde S, Lewinski GV, Windhagen H, HurSchler C, Schwarze M. Greater early migration of a short-stem total hip arthroplasty is not associated with an increased risk of osseointegration failure: 5th-year results from a prospective RSA study with 39 patients, a follow-up study. Acta Orthop 2020; 91:266-271. [PMID: 32106733 PMCID: PMC8023937 DOI: 10.1080/17453674.2020.1732749] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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 - Short-stem hip arthroplasty has been a viable alternative to standard stems for the treatment of hip osteoarthritis for over 10 years. This study assessed whether a correlation existed between a greater initial increase in implant migration and inferior clinical outcomes at 5 years postoperatively. Results on these patients after 2 years have been published previously.Patients and methods - Radiostereometry and clinical scoring were undertaken after surgery and at 3, 6, 12, and 24 months, and 5 years postoperatively. The migration and the clinical outcomes data from the patients with initial migrations at 3 months above the 75th percentile (≥ 75% group) were compared with those with migrations at 3 months of less than the 75th percentile (< 75% group).Results - Between 3 months and 5 years after surgery, the mean resultant implant migrations were 0.40 mm (SD 0.32) in the ≥ 75% group and 0.39 mm (SD 0.25) in the < 75% group. The mean Harris Hip Scores and SF-36 physical scores at 5 years postoperatively were 100 (SD 0.4) and 44 (SD 12), respectively, for the ≥ 75% group and 99 (SD 2) and 50 (SD 10), respectively, for the < 75% group. The differences between the patient groups were not statistically significant.Interpretation - There was no correlation between a greater initial migration and inferior clinical outcomes at 5 years postoperatively. Despite a greater initial migration, there were no risks of early aseptic loosening and inferior midterm clinical outcomes associated with a short-stem implant with a primary metaphyseal anchorage.
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Affiliation(s)
| | - Stefan Budde
- Department of Orthopaedic Surgery, Hannover Medical School, Germany;; ,Correspondence:
| | | | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Germany;;
| | | | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School
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9
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Christiansen JD, Ejaz A, Nielsen PT, Laursen M. An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction. J Bone Joint Surg Am 2020; 102:128-136. [PMID: 31596796 DOI: 10.2106/jbjs.19.00104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) with a diaphyseal stem may risk bone loss. In order to save proximal bone stock in young patients with a high activity level and a long life expectancy, the interest in short stems has evolved. The purpose of this prospective observational cohort study was to evaluate the fixation of, and bone remodeling around, the Primoris femoral neck-preserving hip implant. METHODS Fifty younger patients with end-stage osteoarthritis were managed with the Primoris hip implant. We evaluated bone mineral density (BMD) using dual x-ray absorptiometry (DXA) and implant migration using radiostereometric analysis (RSA). A region-of-interest (ROI) protocol for 4 ROIs was applied to assess BMD. The association between BMD and migration was evaluated to determine the fixation of the Primoris implant and bone remodeling in the proximal part of the femur. Follow-up evaluation was performed at regular intervals from day 1 (baseline) until 24 months after surgery. RESULTS The major stem migrations were subsidence (Y axis; mean, 0.38 mm) at 6 weeks and varus tilt (rotation) (Z axis; mean, 0.93°) at 6 to 12 months. In ROI4 (the calcar area), a significant gain in bone was found with a mean difference of 4.1% (95% confidence interval [CI], 0.8% to 7.4%; p < 0.02) at 24 months postoperatively. Significant bone loss was found in ROI1 and ROI2, with a mean difference of -4.9% (95% CI, -7.4% to -2.4%; p = 0.0003) and -8.9% (95% CI, -11.5% to -6.2%; p = 0.0001), respectively. Linear regression and multivariate regression analysis showed a significant negative association between maximal total point motion and BMD (p = 0.02, R = 15%; and p < 0.05, R = 26%, respectively). CONCLUSIONS The Primoris component showed satisfactory primary stability with promising results at the 24-month follow-up. DXA scans showed limited stress-shielding with the proximal loading pattern of the Primoris. Better bone quality was associated with less implant migration. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Janus D Christiansen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ashir Ejaz
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul T Nielsen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark
| | - Mogens Laursen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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10
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Kang JS, Ko SH, Na Y, Youn YH. Clinical and Radiological Outcomes of Rectangular Tapered Cementless Stem According to Proximal Femoral Geometry in Elderly Asian Patients. Hip Pelvis 2019; 31:224-231. [PMID: 31824877 PMCID: PMC6892905 DOI: 10.5371/hp.2019.31.4.224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose A retrospective analysis of mid- to long-term clinical and radiological outcomes of Korean patients over 60 years of age who underwent hip arthroplasty using a cementless rectangular tapered stem according to Dorr proximal femur geography. Materials and Methods From January 2007 to December 2013, 107 patients (112 hips) underwent hip arthroplasty using the C2 stem. The mean age of patients was 77.4 years (range, 60–91 years) and the mean follow-up duration was 91.1 months (range, 60–116 months). All patients were evaluated clinically and radiologically with special attention to Dorr femoral bone classification, implant fixation, radiolucent line (RLL), and thigh pain. Results All implants demonstrated radiographic evidence of stable fixation by bone ingrowth without any change in position. The mean Harris hip score improved from 65.5±16.0 (preoperative) to 90.5±15.9 (final follow-up) (P<0.001). Incidence of RLLs, stress shielding, and thigh pain was highest in patients with Dorr type A (RLL, P=0.021; stress shielding, P=0.030; thigh pain, P<0.001). One stem revision was performed due to deep infection. The Kaplan–Meier survival rate of the femoral stem was 97.6%. Conclusion The overall survival rate of the C2 stems was greater than 97%; there were no significant differences in survival of the C2 stem according to the Dorr classification. The incidences of RLL of thigh pain and RLL were significantly different among Dorr classifications and (highest in patients with Dorr type A).
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Affiliation(s)
- Joon Soon Kang
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Sang Hyun Ko
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Yeop Na
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Yung Hun Youn
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
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11
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Syed F, Hussein A, Katam K, Saunders P, Young SK, Faisal M. Risk of subsidence and peri-prosthetic fractures using collared hydroxyapatite-coated stem for hip arthroplasty in the elderly. Hip Int 2018; 28:663-667. [PMID: 29726286 DOI: 10.1177/1120700017754085] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Subsidence has been noted with both cemented and uncemented stems in hip arthroplasty. On most occasions, it's minimal (i.e. less than 2 mm) and stabilises at 1 year. However, when its progressive and significant, it causes loss of length and horizontal offset, and when symptomatic warrants a revision. MATERIALS AND METHODS A retrospective radiological review of the patient database was carried out to identify all patients with age ≥ 70 years who underwent elective hip arthroplasty using uncemented HA coated collared stem and had radiographs at 1 year follow up. A total of 176 patients were identified from January 2009 to June 2010. 2 independent investigators classified the proximal femur based on Dorr type and calculated the subsidence based on Engh and Massin method of calculating the distance between the tip of greater trochanter and shoulder of the prosthesis. RESULTS 7 patients (4 Bs, 2 As, 1 C) had a subsidence of ≥ 2 mm (2-3.2 mm) at 1 year. None of them was symptomatic. 1 of them was secondary to a missed calcar crack and continued to subside for 9 mm before it stabilised on the lesser trochanter at 4 years follow up. There were Dorr 22 (12.5%) type A, 147(83.5%) type B and 7(4%) type C. The mean age was 77.4 years (70-91 years) and male: female ratio was 7:15. 3 patients had an intraoperative calcar crack requiring cabling. All were mobilised full weight-bearing postoperatively, and none had a subsidence of >2 mm at 1 year follow-up. DISCUSSION Our subgroup analysis identified that subsidence can happen when the collar is "non-functional" and the initial press fit of the stem wasn't achieved. It can also occur in an event of calcar crack, which is missed intraoperatively. In cases of calcar crack which went on to have to cable during the primary procedure, it neither changed the post-operative rehabilitation nor did it show an increased risk of subsidence. CONCLUSION A fully hydroxyapatite (HA) coated collared stem, when used in elderly age group for elective THR, has only 2% risk of intraoperative periprosthetic fracture. There's a 4% risk of radiologically significant subsidence (i.e. ≥2 mm), however, it has not proven to be clinically significant in our study. Dorr canal type had no bearing on either risk of periprosthetic fracture or subsidence. Collared stems did not have a statistically significant difference in risk of subsidence and peri-prosthetic fracture in comparison to un-collared stem, although there was a non-significant trend in favour of collar use.
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Affiliation(s)
- Farhan Syed
- Trauma and Orthopaedics, Warwick Hospital, UK
| | - Amr Hussein
- Trauma and Orthopaedics, Warwick Hospital, UK
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12
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Ferguson RJ, Broomfield JA, Malak TT, Palmer AJR, Whitwell D, Kendrick B, Taylor A, Glyn-Jones S. Primary stability of a short bone-conserving femoral stem. Bone Joint J 2018; 100-B:1148-1156. [DOI: 10.1302/0301-620x.100b9.bjj-2017-1403.r1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aims The aim of this study was to determine the stability of a new short femoral stem compared with a conventional femoral stem in patients undergoing cementless total hip arthroplasty (THA), in a prospective randomized controlled trial using radiostereometric analysis (RSA). Patients and Methods A total of 53 patients were randomized to receive cementless THA with either a short femoral stem (MiniHip, 26 patients, mean age: 52 years, nine male) or a conventional length femoral stem (MetaFix, 23 patients, mean age: 53 years, 11 male). All patients received the same cementless acetabular component. Two-year follow-up was available on 38 patients. Stability was assessed through migration and dynamically inducible micromotion. Radiographs for RSA were taken postoperatively and at three, six, 12, 18, and 24 months. Results At two years, there was significantly less subsidence (inferior migration) of the short femoral stem (head, 0.26 mm, 95% confidence interval (CI) 0.08 to 0.43, sd 0.38; tip, 0.11 mm, 95% CI -0.08 to 0.31, sd 0.42) compared with the conventional stem (head, 0.62 mm, 95% CI 0.34 to 0.90, sd 0.56, p = 0.02; tip, 0.43 mm, 95% CI 0.21 to 0.65, sd 0.44, p = 0.03). There was no significant difference in dynamically inducible micromotion, rate of complications or functional outcome. Conclusion This study demonstrates that the short femoral stem has a stable and predictable migration. However, longer-term survival analysis still needs to be determined. Cite this article: Bone Joint J 2018;100-B:1148–56.
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Affiliation(s)
- R. J. Ferguson
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - J. A. Broomfield
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - T. T. Malak
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - A. J. R. Palmer
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - D. Whitwell
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - B. Kendrick
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - A. Taylor
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - S. Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
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Schwarze M, Budde S, von Lewinski G, Windhagen H, Keller MC, Seehaus F, Hurschler C, Floerkemeier T. No effect of conventional vs. minimally invasive surgical approach on clinical outcome and migration of a short stem total hip prosthesis at 2-year follow-up: A randomized controlled study. Clin Biomech (Bristol, Avon) 2018; 51:105-112. [PMID: 29287171 DOI: 10.1016/j.clinbiomech.2017.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/30/2017] [Accepted: 12/08/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
| | - Stefan Budde
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Gabriela von Lewinski
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Marie Christina Keller
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Frank Seehaus
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Thilo Floerkemeier
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
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14
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Bonin N, Gedouin JE, Pibarot V, Bejui-Hughues J, Bothorel H, Saffarini M, Batailler C. Proximal femoral anatomy and collared stems in hip arthroplasty: is a single collar size sufficient? J Exp Orthop 2017; 4:32. [PMID: 28975538 PMCID: PMC5626675 DOI: 10.1186/s40634-017-0107-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background Even if the benefits of collars are unclear, they remain widely used, in several femoral stem designs. This study aimed to determine whether collar size should be proportional to hip dimensions and morphology. The hypothesis was that the collar should be larger for greater stem sizes and for varus femoral necks. Methods Computed Tomography scans of 204 healthy hips were digitally analysed and manually templated to determine principle dimensions, appropriate stem size and model, as well as cortical distance at the femoral calcar (ideal collar size). Results Univariable analysis revealed that cortical distance was moderately correlated with mediolateral offset (r = 0.572; p < 0.0001) and stem model (r = 0.520; p < 0.0001). Cortical distance was weakly correlated with head diameter (r = 0.399; p < 0.0001), stem size (r = 0.200; p = 0.017), and patient gender (r = 0.361; p < 0.0001). Multivariable analysis confirmed that stem model (p < 0.0001) and head diameter (p = 0.0162) are directly correlated to cortical distance. Conclusion We found that cortical distance along the femoral calcar is directly correlated with the model of the stem implanted (‘standard’ or ‘varus’) and with the head diameter. This cortical distance indicates optimal collar size, which would grant maximum calcar coverage without prosthetic overhang. Collar size should be proportional to the size of the operated hip, and should be larger for ‘varus’ stem models than for ‘standard’ stem models.
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Affiliation(s)
- Nicolas Bonin
- Lyon Ortho Clinic, 29B Avenue des sources, Lyon, France
| | | | - Vincent Pibarot
- Service de chirurgie orthopédique et traumatologique, Hôpital Edouard Herriot, Lyon, France
| | | | - Hugo Bothorel
- ReSurg SA, Chemin de la Vuarpillière 35, 1260, Nyon, Switzerland
| | - Mo Saffarini
- ReSurg SA, Chemin de la Vuarpillière 35, 1260, Nyon, Switzerland.
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15
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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: 55] [Impact Index Per Article: 6.9] [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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16
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Adewuyi TE, MacLennan G, Cook JA. Non-compliance with randomised allocation and missing outcome data in randomised controlled trials evaluating surgical interventions: a systematic review. BMC Res Notes 2015; 8:403. [PMID: 26336099 PMCID: PMC4558937 DOI: 10.1186/s13104-015-1364-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 07/31/2015] [Indexed: 12/22/2022] Open
Abstract
Background Randomised controlled trials are widely acknowledged as the gold standard in medical research although their validity can be undermined by non-compliance with the randomly allocated treatment and missing data. Due to the nature of the intervention, surgical trials face particular threat to compliance and data collection. For example, ineligibility for the intervention may only become apparent once the operation has commenced. It is unclear how such cases are reported and handled. Objective The objective was to assess non-compliance and missing data in reports of trials of surgical interventions. Methods Searches for reports of trials involving at least one surgical procedure and published in 2010 were carried out in the Medical Literature Analysis and Retrieval System Online (MEDLINE®). Data on missing data, non-compliance and methods of handling missing data were extracted from full texts. Descriptive data analyses were carried out on the data. Results Forty-five (55 %) studies reported non-compliance with treatment allocation and 52 (63 %) reported primary outcome missing data. The median levels of non-compliance and missing data were 2 % [IQR (0, 5), range (0–29)] and 6 % [IQR (0, 15), range (0–57)], respectively. Fifty-two (63 %) studies analysed as randomised, 17 (21 %) analysed per protocol and 3 (4 %) analysed as treated. Complete case analysis was the most common method used to deal with missing data, 35/52 (67 %). Conclusions The reporting of non-compliance to allocation and the handling of missing data were typically suboptimal. There is still room for improvement on the use of the CONSORT statement particularly in accounting for study participants. Transparency in reporting would facilitate evidence synthesis. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1364-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Temitope E Adewuyi
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK.
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK.
| | - Jonathan A Cook
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK.
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McCalden RW, Korczak A, Somerville L, Yuan X, Naudie DD. A randomised trial comparing a short and a standard-length metaphyseal engaging cementless femoral stem using radiostereometric analysis. Bone Joint J 2015; 97-B:595-602. [DOI: 10.1302/0301-620x.97b5.34994] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This was a randomised controlled trial studying the safety of a new short metaphyseal fixation (SMF) stem. We hypothesised that it would have similar early clinical results and micromovement to those of a standard-length tapered Synergy metaphyseal fixation stem. Using radiostereometric analysis (RSA) we compared the two stems in 43 patients. A short metaphyseal fixation stem was used in 22 patients and a Synergy stem in 21 patients. No difference was found in the clinical outcomes pre- or post-operatively between groups. RSA showed no significant differences two years post-operatively in mean micromovement between the two stems (except for varus/valgus tilt at p = 0.05) (subsidence 0.94 mm (sd 1.71) vs 0.32 mm (sd 0.45), p = 0.66; rotation 0.96° (sd 1.49) vs 1.41° (sd 2.95), p = 0.88; and total migration 1.09 mm (sd 1.74) vs 0.73 mm (sd 0.72), p = 0.51). A few stems (four SMF and three Synergy) had initial migration > 1.0 mm but stabilised by three to six months, with the exception of one SMF stem which required revision three years post-operatively. For most stems, total micromovement was very low at two years (subsidence < 0.5 mm, rotation < 1.0°, total migration < 0.5 mm), which was consistent with osseous ingrowth. The small sample makes it difficult to confirm the universal applicability of or elucidate the potential contraindications to the use of this particular new design of stem. Cite this article: Bone Joint J 2015; 97-B:595–602.
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Affiliation(s)
- R. W. McCalden
- University Hospital, 339
Windermere Road, London, Ontario
N6A 5A5, Canada
| | - A. Korczak
- University Hospital, 339
Windermere Road, London, Ontario
N6A 5A5, Canada
| | - L. Somerville
- University Hospital, 339
Windermere Road, London, Ontario
N6A 5A5, Canada
| | - X. Yuan
- Western University, 1151
Richmond Street, London, Ontario
N6A 3K7, Canada
| | - D. D. Naudie
- University Hospital, 339
Windermere Road, London, Ontario
N6A 5A5, Canada
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18
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Inter-subject variability effects on the primary stability of a short cementless femoral stem. J Biomech 2015; 48:1032-42. [DOI: 10.1016/j.jbiomech.2015.01.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/20/2014] [Accepted: 01/26/2015] [Indexed: 01/13/2023]
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19
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The predictive value of radiostereometric analysis for stem survival in total hip arthroplasty. A systematic review. Hip Int 2015; 24:215-22. [PMID: 24474413 DOI: 10.5301/hipint.5000102] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND The high precision of radiostereometric analysis (RSA) has enabled us to predict long-term implant survival with a small sample of patients followed for a relatively short period of time. The purpose of our systematic review was to validate the predictive value of two-year RSA results on long-term survival of different types of primary total hip arthroplasty stems. METHODS We systematically reviewed literature to determine the maximum total point motion (MTPM), distal migration and rotation of stem designs and correlated these values to survival rates for aseptic loosening of these specific stems in arthroplasty registries. RESULTS We included 32 studies describing migration of 15 different stem designs. The mean MTPM for straight polished cemented stems was 1.35 mm, for other cemented stems 0.83 mm and for other uncemented stems 1.50 mm. No data were available for the uncemented collared stem. Mean distal migration for straight polished cemented stems was 1.24 mm, for other cemented stems 0.26 mm, the uncemented collared stem 0.40 mm and for other uncemented stems 0.66 mm. Internal rotation was presented for 13 stems and all stems rotated into retroversion. All stems showed 10-year survival rates of >97% corrected for aseptic loosening. DISCUSSION Reporting RSA results in a universal way including interpretation of outliers could improve the predictive value of RSA, allowing this technique to be an important tool during the phased introduction of new implant designs. However, a quality assessment of the data by an experienced reviewer is essential.
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20
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Weber E, Sundberg M, Flivik G. Design modifications of the uncemented Furlong hip stem result in minor early subsidence but do not affect further stability: a randomized controlled RSA study with 5-year follow-up. Acta Orthop 2014; 85:556-61. [PMID: 25175668 PMCID: PMC4259023 DOI: 10.3109/17453674.2014.958810] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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 Even small design modifications of uncemented hip stems may alter the postoperative 3-D migration pattern. The Furlong Active is an uncemented femoral stem which, in terms of design, is based on its precursor-the well-proven Furlong HAC-but has undergone several design changes. The collar has been removed on the Active stem along with the lateral fin; it is shorter and has more rounded edges in the proximal part. We compared the migration patterns of the uncemented Furlong HAC stem and the modified Furlong Active stem in a randomized, controlled trial over 5 years using radiostereometry (RSA). PATIENTS AND METHODS 50 patients with primary osteoarthritis were randomized to receive either the HAC stem or the Active stem. The patients underwent repeated RSA examinations (postoperatively, at 3 months, and after 1, 2, and 5 years) and conventional radiography, and they also filled out hip-specific questionnaires. RESULTS During the first 3 months, the collarless Active stem subsided to a greater extent than the collar-fitted HAC stem (0.99 mm vs. 0.31 mm, p=0.05). There were, however, no other differences in movement measured by RSA or in clinical outcome between the 2 stems. After 3 months, both stem types had stabilized and almost no further migration was seen. INTERPRETATION The Active stem showed no signs of unfavorable migration. Our results suggest that the osseointegration is not compromised by the new design features.
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Affiliation(s)
- Erik Weber
- Department of Orthopedics, Lund University and Skåne University Hospital, Lund, Sweden.
| | - Martin Sundberg
- Department of Orthopedics, Lund University and Skåne University Hospital, Lund, Sweden.
| | - Gunnar Flivik
- Department of Orthopedics, Lund University and Skåne University Hospital, Lund, Sweden.
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Madanat R, Mäkinen TJ, Aro HT, Bragdon C, Malchau H. Adherence of hip and knee arthroplasty studies to RSA standardization guidelines. A systematic review. Acta Orthop 2014; 85:447-55. [PMID: 24954489 PMCID: PMC4164860 DOI: 10.3109/17453674.2014.934187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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 Guidelines for standardization of radiostereometry (RSA) of implants were published in 2005 to facilitate comparison of outcomes between various research groups. In this systematic review, we determined how well studies have adhered to these guidelines. METHODS We carried out a literature search to identify all articles published between January 2000 and December 2011 that used RSA in the evaluation of hip or knee prosthesis migration. 2 investigators independently evaluated each of the studies for adherence to the 13 individual guideline items. Since some of the 13 points included more than 1 criterion, studies were assessed on whether each point was fully met, partially met, or not met. RESULTS 153 studies that met our inclusion criteria were identified. 61 of these were published before the guidelines were introduced (2000-2005) and 92 after the guidelines were introduced (2006-2011). The methodological quality of RSA studies clearly improved from 2000 to 2011. None of the studies fully met all 13 guidelines. Nearly half (43) of the studies published after the guidelines demonstrated a high methodological quality and adhered at least partially to 10 of the 13 guidelines, whereas less than one-fifth (11) of the studies published before the guidelines had the same methodological quality. Commonly unaddressed guideline items were related to imaging methodology, determination of precision from double examinations, and also mean error of rigid-body fitting and condition number cutoff levels. INTERPRETATION The guidelines have improved methodological reporting in RSA studies, but adherence to these guidelines is still relatively low. There is a need to update and clarify the guidelines for clinical hip and knee arthroplasty RSA studies.
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Affiliation(s)
- Rami Madanat
- Helsinki University Central Hospital, Helsinki,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Hannu T Aro
- Turku University Hospital and University of Turku, Turku, Finland
| | - Charles Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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22
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Issa K, Pivec R, Wuestemann T, Tatevossian T, Nevelos J, Mont MA. Radiographic fit and fill analysis of a new second-generation proximally coated cementless stem compared to its predicate design. J Arthroplasty 2014; 29:192-8. [PMID: 23706811 DOI: 10.1016/j.arth.2013.04.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/04/2013] [Accepted: 04/12/2013] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to compare in vivo fit and fill analysis of a new second-generation proximally coated cementless stem compared to its predicate design. This prospective trial of 100 total hip arthroplasties compared specific radiographic "Fit and Fill" parameters between the two designs. Fit type was assessed by comparing the type of canal fill. Post-operative fill parameters such as mean stem-to-canal ratios and mean minimum and maximum gaps between the stems to the cortical bone in different sections and areas were compared. A significantly higher proportion of the second-generation stems had Type I fit (82% vs. 54%), had better stem to canal fill ratio in the middle (90.6% vs. 85.3%) and distal sections (88.1% vs. 78.6%) compared to the older design. The new second-generation stem design had a significantly better canal fit and distal canal fill in the medial and lateral portions.
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Affiliation(s)
- Kimona Issa
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
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23
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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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What is the optimal time point to assess patient-reported recovery after hip and knee replacement? A systematic review and analysis of routinely reported outcome data from the English patient-reported outcome measures programme. Health Qual Life Outcomes 2013; 11:128. [PMID: 23895227 PMCID: PMC3733605 DOI: 10.1186/1477-7525-11-128] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 07/27/2013] [Indexed: 11/10/2022] Open
Abstract
Background It is unclear if there is a clinically important improvement in the six to 12-month recovery period after hip and knee replacement. This is an obvious gap in the evidence required by patients undergoing these procedures. It is also an issue for the English PROMs (Patient-Reported Outcome Measures) Programme which uses 6-month outcome data to compare the results of hospitals that perform hip and knee replacements. Methods A systematic review of studies reporting the Oxford Hip Score (OHS) or Oxford Knee Score (OKS) at 12 months after surgery was performed. This was compared with six-month outcome data collected for 60, 160 patients within the English PROMs programme. A minimally important difference of one standard error of the measurement, equivalent to 2.7 for the OHS and 2.1 for the OKS, was adopted. Results and discussion Six studies reported OHS data for 10 different groups containing 8,308 patients in total. In eight groups the change scores reported were at least 2.7 points higher than the six-month change observed in the PROMs programme (20.2 points). Nine studies reported OKS data for 13 different groups containing 4,369 patients in total. In eight groups the change scores reported were at least 2.1 points higher than the six-month change observed in the PROMs programme (15.0 points). Conclusions There is some evidence from this systematic review that clinically important improvement in the Oxford hip and knee scores occurs in the six to 12 month recovery period. This trend is more apparent for hip than knee replacement. Therefore we recommend that the English Department of Health study the impact on hospital comparisons of using 12- rather than six-month outcome data.
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Cordero-Ampuero J, Peñalver P, Antón R, Galán M, Cordero E. Radiographic Subsidence in Asymptomatic Patients After THR Using the Furlong Active HAP Stem. HSS J 2013; 9:161-5. [PMID: 24426863 PMCID: PMC3757488 DOI: 10.1007/s11420-013-9342-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 05/12/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The short, tapered, collarless Furlong Active stem has been recently associated in the published literature with significant subsidence using Roentgen stereophotogrammetric analysis. QUESTIONS/PURPOSES The purpose of this study was to analyze the short-term radiographic subsidence in Furlong Active HAP stems and correlate the results with the age, gender, bone morphology, and bone quality of the proximal femur, stem diameter, and medullary canal filling. METHODS Sixty-five consecutive patients (70 hips) receiving the Furlong Active HAP stems were enrolled in this prospective series. The average follow-up was 2.99 ± 1.38 years. All patients were evaluated clinically using the Harris Hip Score (HHS) and radiographically for femoral stem subsidence. In addition, proximal femoral osteopenia, proximal femur morphology, and medullary canal filling were also evaluated. RESULTS The average subsidence was 2.4 mm (from 0 to 13 mm) at the end of the follow-up period. The average HHS score at the end of follow-up was 90 (range, 81-98). There was one intraoperative fracture. CONCLUSIONS Of the Furlong Active stems 61% subsided with initial weight bearing. Subsidence is higher in males, but no correlation has been found with age, stem diameter, morphology, osteopenia, or canal filling.
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Affiliation(s)
- José Cordero-Ampuero
- />Hospital Universitario La Princesa, c/ Diego de León 62, 28006 Madrid, Spain , />Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
| | - Pablo Peñalver
- />Hospital Universitario La Princesa, c/ Diego de León 62, 28006 Madrid, Spain , />Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
| | - Rodrigo Antón
- />Hospital Universitario La Princesa, c/ Diego de León 62, 28006 Madrid, Spain , />Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
| | - María Galán
- />Hospital Universitario La Princesa, c/ Diego de León 62, 28006 Madrid, Spain , />Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
| | - Enrique Cordero
- />Hospital Universitario La Princesa, c/ Diego de León 62, 28006 Madrid, Spain , />Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
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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: 49] [Impact Index Per Article: 4.1] [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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