Use of the Corail stem for revision total hip arthroplasty: evaluation of clinical outcomes and cost

Cementless Primary Stems in Revision Hip Arthroplasty: A Narrative Review

Cementless primary stems in revision hip arthroplasties may be conservative options to preserve bone stock and provide adequate reconstruction of the hip biomechanics. However, there is still little evidence about indications, limitations, and outcomes. This narrative review showed that conventional standard stems were adopted in different revision settings, up to Paprosky IIIA grade bone defects. In cases of acceptable metaphyseal bone stock, when a scratch fit of at least 4 cm can be achieved, a conventional cementless stem may be an adequate solution. Mid-term clinical and radiographic outcomes and survival rates were similar to long revision stems, whereas complications, surgical time, and costs were lower among conventional stems. However, unsuitable contexts for conventional stems included canal diameters larger than 18 mm and failed revision stems with cortical weakening. Even short stems can be considered in revisions, in order to preserve bone stock and stay proximal to femoral remodeling zones and bone/cement plugs. Short stems were successfully adopted up to Paprosky IIIA bone defects, achieving mid-term survival rates not inferior to long revision stems. Ageing, osteoporosis, and intraoperative femoral fractures were the main negative prognostic factors. In very select cases, a downsizing technique (from longer to shorter stems) may be adopted to simplify the procedure and reduce complications.

Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis

BACKGROUND

Femoral reconstruction with long stems is widely accepted as the standard in revision total hip arthroplasty (rTHA). However, long stems can be technically challenging to insert and can compromise bone stock for future revision. This study aimed to identify whether there was a difference in outcomes with using a long versus primary or short femoral stem in revision.

METHODS

We performed a systematic review and meta-analysis of all articles comparing long and primary stem length in rTHA for Paprosky 1-3B femoral defects. The primary outcome measure was the reoperation rate after rTHA. Secondary outcomes included infection and dislocation rates, periprosthetic fracture, loosening, mortality, and patient-reported outcome measures (PROMs).

RESULTS

The results of 3,102 rTHAs performed in 2,982 patients were reported from 9 eligible studies in the systematic review, of which 6 were included in the meta-analysis. The mean patient age was 67.4 and the mean follow-up lasted 5 years (range, 1-15 years). There was no significant difference in the reoperation rate (odds ratio 0.78; 95% confidence interval, 0.28-2.17, P = 0.63). Similarly, there was no significant difference in dislocation or periprosthetic fracture risk. Harris Hip Score was better with primary stems by a mean difference of 14.4 points (P < 0.05). Pooled 5-year stem-related survival was 91.3% ± 3.5% (SD) for primary stems and 89.9% ± 6.7% (SD) for long stems.

CONCLUSIONS

A primary stem provided non-inferior outcomes compared with long stems in rTHA with Paprosky type 1-3B femoral defects. Primary stems may yield a more straightforward technique and preserve distal bone stock for future revision particularly in younger patients. In older patients with lower functional demands and who would benefit from a decreased risk of complications, a long cemented stem is recommended.

Clinical and radiographic outcomes of long monoblock, hydroxyapatite-coated stem in revision hip arthroplasty with extended trochanteric osteotomy: a multicenter study

BACKGROUND

The distally fixed stem used in revision total hip arthroplasty (rTHA) with extended trochanteric osteotomy (ETO) is subject to periprosthetic fracture, stem subsidence, and stress shielding. The prospective multicentric study aimed to assess the clinical and radiographic outcomes, and complications of using the Corail revision stem in rTHA with ETO.

METHODS

Sixty-four patients undergoing rTHA with ETO using the Corail revision stem between 2019 and 2020 were enrolled in the study. We performed a postoperative follow-up of the patient and obtained radiographs and Harris hip scores (HHSs). These results were used to analyze ETO union, Engh scores, bone remodeling, stem stability and hip function.

RESULTS

The mean follow-up duration was 34 months (range 23-41). Sixty-two patients who underwent ETOs achieved complete healing at the final follow-up. Fifty-nine hips had bony ingrowth from the osteotomy fragment to the stem without radiolucent lines. The postoperative Engh score was 21.3 ± 3.59 (range 15.5-27.0). Forty-three hips had regeneration in the proximal femur. Two patients had transient thigh pain postoperatively. The postoperative HHS improved from 40.7 ± 16.67 (range 0-67) preoperatively to 82.1 ± 6.83 (range 73-93).

CONCLUSION

Corail revision stems are a viable and reliable option in rTHA with ETO. This stem had excellent clinical and radiographic outcomes, resulting in a high rate of ETO union and stem survival. The revision stem enabled restoration of proximal bone stock in femurs with prerevision bone defects, which were prepared for the next revision operation. Level of evidence Level IIb, Prospective self-control study.

Cementless primary or revision stem in revision hip arthroplasty for aseptic stem loosening with Paprosky type I/II femoral defect?

BACKGROUND

The use of primary or revision stem during revision total hip arthroplasty (THA) for aseptic stem loosening with Paprosky type I/II femoral defect remains controversial. The aim of this study was to compare the outcomes of patients who underwent revision THA with a primary or revision stem.

METHODS

We retrospectively reviewed 78 patients who received revision THA for aseptic stem loosening using primary (N = 28) or revision stems (N = 50). The bone defects were classified as Paprosky type I or II. The mean follow-up duration was 72.3 ± 34.7 months. The primary outcome domains included surgical complications and implant failures. The secondary outcome domains included medical complications, 30- and 90-day readmission, and Harris hip score (HHS).

RESULTS

The use of revision stem was associated with a higher incidence than primary stem of patient complications (60.0% vs. 32.1%, p = 0.018), including intraoperative femur fracture (28.0% vs. 7.1%, p = 0.029) and greater trochanter fracture (16.0% vs. 0%, p = 0.045). The implant survival rate was comparable between groups. HHS at the final follow-up was similar.

CONCLUSION

With a lower risk of surgical complications and a similar rate of mid-term implant survival, cementless primary stem appears superior to revision stem in revision THA for aseptic stem loosening with Paprosky type I/II femoral defect.

Stay Short or Go Long in Revision Total Hip Arthroplasty With Paprosky Type II Femoral Defects: A Comparative Study With the Use of an Uncemented Distal Fixating Modular Stem and a Primary Monobloc Conical Stem With 5-Year Follow-Up

BACKGROUND

In the revisions for Paprosky type II femoral defects, diaphyseal fixating femoral stems are commonly used. To preserve bone stock, the use of a shorter primary conical stem could be an adequate alternative. The objective of this study is to compare the results of a primary conical stem to the more commonly used diaphyseal fixating modular revision stem in revision total hip arthroplasty surgery with Paprosky type II femoral defects.

METHODS

A total of 59 consecutive patients with Paprosky type II femoral defects from our prospective revision registry were included. Thirty patients who received a long distal fixating modular stem (Revision Stem, Lima Corporate) and 29 patients who received a primary conical short stem (Wagner Cone, Zimmer) were prospectively followed. Minimal follow-up time was 2 years for subsidence and patient-reported outcome measures and 5 years for complications, reoperation, and revision. We compared subsidence, perioperative complications, reoperations, femoral component survival, Oxford Hip Score, EuroQol 5 Dimension, visual analog scale (VAS) for pain at rest, and VAS for pain during activity between stems.

RESULTS

Both groups were comparable regarding demographic, clinical, and surgery-related characteristics. We found more perioperative complications and stem revisions with the modular revision stem than with the primary conical stem. There were no statistical differences in subsidence, EuroQol 5 Dimension, Oxford Hip Score, and VAS for pain at rest or during activity between both stems.

CONCLUSION

In revision total hip arthroplasty with Paprosky type II femoral defects, uncemented primary monobloc conical femoral stems showed the same clinical result as distal fixating modular stems with fewer complications and fewer stem revisions.

Long-term outcomes of cementless femoral stem revision with the Wagner cone prosthesis

Background

The procedure of femoral stem revision is challenging, and bone conservation with less stress shielding is a mandatory effort in these cases. Although there are several reports of stem revision with stems designed for primary total hip arthroplasty (THA), there is no report on stem revision with the Wagner cone prosthesis.

Methods

Between 1996 and 2008, 41 hips of 41 consecutive patients were subjected to femoral revision THA using the Wagner cone prosthesis. The mean age during revision surgery was 56.1 years, and the mean follow-up period was 14.8 years. The clinical results were evaluated, and the femoral component was assessed radiologically.

Results

The results showed that the average period from the first operation to revision THA was 8.0 years. Additionally, the mean Harris hip score improved from 52 points preoperatively to 83 points at the final follow-up. All stems showed bone integration in the radiological evaluation. A subsidence of more than 5 mm was observed in 3 out of 28 (10.7%) femoral stems. Two patients needed an acetabular revision for acetabular cup loosening during the follow-up period. Furthermore, one patient had recurrent dislocation and had to undergo revision surgery for soft tissue augmentation.

Conclusions

We achieved favorable clinical and radiological long-term outcomes in femoral stem revision using the Wagner cone prosthesis. This cementless femoral stem could be an option for femoral stem revision in cases with relatively good bone stock.

Comparison of Tri-Lock Bone Preservation Stem and the Conventional Standard Corail Stem in Primary Total Hip Arthroplasty

Objective

To compare the clinical and radiographic outcomes between the Tri‐Lock Bone Preservation Stem (BPS) and the conventional standard Corail stem in primary total hip arthroplasty (THA).

Methods

From March 2012 to May 2014, we retrospectively reviewed 84 patients (104 hips) who received Tri‐Lock (BPS) and 84 patients (115 hips) who received conventional standard Corail stem in THA. Their mean ages were 53.12 ± 2.32 years and 52.00 ± 2.11 years, respectively. The clinical outcomes were assessed by Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Pain Visual Analogue Scale (VAS) and Harris Hip Score (HHS). The radiological outcomes were evaluated by the radiological examination. Accordingly, Intraoperative and postoperative complications were observed as well.

Results

The mean follow‐up time was 48.23 ± 2.91 months in the Tri‐Lock (BPS) group and 49.11 ± 2.11 months in the Corail group, respectively. The bleeding volumes in two groups were comparable (169.22 ± 58.11 mL vs 179.30 ± 59.14 mL, P = 0.003), with more bleeding volume in Corail group patients, while no statistically significance with respect to operation time was observed (65.41 ± 6.24 min vs 63.99 ± 6.33 min, P = 0.567). The rates of intraoperative fracture was 8% for the Corail group while 1% for the Tri‐Lock (BPS) group (8% vs 1%, P = 0.030). At final follow‐up, no statistical differences in regard to HHS, WOMAC, and Pain VAS were revealed between the two groups (P > 0.05). The rate of thigh pain was higher in Corail group than in Tri‐lock (BPS) group (5% vs 0%, P = 0.043). However, incidence of stress shielding in grade 1 was higher in Tri‐Lock (BPS) than in the Corail group (76% vs 23%, P < 0.01), while those in grade 2 and 3 were lower compared to the Corail stem (15% vs 28%, P < 0.01; 9% vs 16%, P = 0.008, respectively). Intriguingly, other assessments in relation to radiographic outcomes and postoperative complications were not comparable between the two groups. The Kaplan–Meier survival rate (revision surgery performed for any reason was defined as the end point) was similar between the two groups (P = 0.57), with 98.8% (95% confidence interval, 92.3%–100%) in Tri‐lock (BPS) group and 97.6% (95% confidence interval, 94.6%–100%) in Corail group.

Conclusions

The Tri‐Lock (BPS) has similar clinic performances compared to the Corail stem. Furthermore, the Tri‐lock (BPS) stem has some advantages in achieving lower incidence of thigh pain, stress shielding and intra‐operative fracture. Therefore, we recommend the Tri‐lock (BPS) stem as a good alternative in primary total hip arthroplasty, especially taking into account patient factors, including bone deficiency and convenience of extraction of the stem in hip revision.

Results of hydroxyapatite ceramic coated primary femoral stem in revision total hip replacement

PURPOSE

The purpose of this study was to assess survival rate, functional and radiological outcomes when using a hydroxyapatite-ceramic fully coated primary femoral stem in revision total hip arthroplasty.

METHODS

Patients who underwent revision total hip arthroplasty using the Furlong hydroxyapatite-ceramic (HAC)-coated (Joint Replacement Instrumentation Ltd., Sheffield, UK) primary stem were retrospectively identified between 2013 and 2017. A total of 30 hips in 27 patients were identified and the mean follow-up duration was 44 months. Post-operative radiographs were scrutinized for signs of component loosening by two independent assessors. Patient's functional outcomes were assessed using the Oxford hip score and compared pre- and post-operatively. The prevalence of thigh pain was assessed at the latest follow-up.

RESULTS

The most common cause of revision was adverse reactions to metal debris (ARMD) (46.6%). The overall complication rate was 13.3%. Results at final follow-up demonstrated 100% survival rate and no reported incidence of thigh pain. Using paired t test, all patients had a statistically significant (P < 0.05) improvement in post-operative mean Oxford hip score of 35 compared to a mean pre-operative score of 14. Radiographic analysis of the latest follow-up radiographs revealed no signs of component loosening or component subsidence.

CONCLUSION

With a 100% survival rate and excellent reported functional outcomes, we believe that our experience and results support the use of primary cementless stems in selected revision cases.

High Incidence of Intraoperative Fractures With a Specific Cemented Stem Following Intracapsular Displaced Hip Fracture

BACKGROUND

To reduce costs of orthopedic implants, the government decided to standardize implants used across different specialties in a group of hospitals located in the same geographic area. The usual cemented stem used in the context of intracapsular displaced geriatric hip fractures was replaced by another stem. Abnormal intraoperative calcar and trochanteric fractures were noted. The purpose of this study is to determine the incidence of intraoperative periprosthetic fractures following an intracapsular displaced hip fracture treated with this specific cemented stem compared to the previous implant.

METHODS

This is a retrospective cohort study comparing an historic cohort of hip fractures treated with the OmniFit EON (Stryker, Kalamazoo, MI) cemented stem with a new cohort of patients who received the Corail (DePuy Synthes, Warsaw, IN) cemented stem. Four orthopedic surgeons reviewed operative reports and postoperative radiographs.

RESULTS

The treatment group included 348 patients who received the Corail stem. The control group included 77 patients. The 2 groups had similar baseline characteristics (P > .05) except for the presence of dementia. Incidence of intraoperative calcar or greater trochanteric fracture was 15.5% for the Corail group and 2.7% for the control group (P < .05). No patient-related factors or surgeon-related factors were related to a higher number of fractures in the treatment group (P > .05).

CONCLUSION

The Corail cemented stem presents an abnormal number of iatrogenic intraoperative fractures following displaced femoral neck fracture in our geriatric population. No external factor seems to explain this high number of fractures. Implant design should be questioned.

LEVEL OF EVIDENCE

III.