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Barça F, Demir EB, İbolar M, Atilla HA, Akdoğan M. Do all short stem types restore biomechanical parameters of the hip? Comparison according to femoral neck osteotomy levels. INTERNATIONAL ORTHOPAEDICS 2024; 48:1723-1731. [PMID: 38589708 DOI: 10.1007/s00264-024-06176-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE There is no consensus on ideal short femoral stem design. A classification system proposed by Feyen and Shimmin divides short stems in two types according to femoral neck osteotomy levels: subcapital (IIIA) and standard (IIIB). The study aims to determine which design type is more successful in restoring native biomechanical parameters and whether stem type has an impact on clinical results. METHODS In this retrospective comparative study, patients that have undergone short stem hip arthroplasty were evaluated according to stem types: type IIIA (n = 52, 66.7%) (Mathys Optimys) and IIIB (n = 26, 33.3%) (Implantcast Aida and Smith & Nephew SMF). Pelvis X-rays were assessed in terms of femoral neck length, horizontal and vertical hip centres of rotation, horizontal and vertical femoral offsets, abductor lever arm lengths, leg lengths, and stem-shaft angles. Improvement in Harris hip scores, differences between post-operative and pre-operative measurements, and stem-shaft angles were evaluated and compared between two groups. RESULTS Mean femoral neck resection (8.27 ± 6.68 mm in IIIA and 15 ± 6.33 mm in IIIB) was significantly different between both groups (p < 0.001). Harris hip scores were increased at post-operative six months in both groups with no difference (84.4 ± 6.4 and 84.6 ± 5.5, p = 0.4). The absolute values of differences between pre-operative and post-operative horizontal centres of rotation (p = 0.63), vertical centers of rotation (p = 0.75), horizontal femoral offsets (p = 0.78), vertical femoral offsets (p = 0.83), abductor lever arm distances (p = 0.63), and leg length (p = 0.21) measurements were not different between both groups. Stem positions were both varus with no statistically significant difference between groups (p = 0.14). CONCLUSION We found no difference regarding restoration of biomechanical parameters between short stem designs with different levels of neck osteotomy. Additionally, short stem can mostly result in varus component positioning regardless of the level of neck osteotomy.
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Affiliation(s)
- Fatih Barça
- Ankara Etlik City Hospital, Varlık Mah. Halil Sezai Erkut Cd. Yenimahalle, 06170, Ankara, Turkey.
| | - Ekin Barış Demir
- Ankara Etlik City Hospital, Varlık Mah. Halil Sezai Erkut Cd. Yenimahalle, 06170, Ankara, Turkey
| | - Mithat İbolar
- Bitlis State Hospital, Ministry of Health of Turkey, Beşminare Mah. 160 Evler Mevkii, 13000, Bitlis, Turkey
| | - Halis Atıl Atilla
- Ankara Etlik City Hospital, Varlık Mah. Halil Sezai Erkut Cd. Yenimahalle, 06170, Ankara, Turkey
| | - Mutlu Akdoğan
- Ankara Etlik City Hospital, Varlık Mah. Halil Sezai Erkut Cd. Yenimahalle, 06170, Ankara, Turkey
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Nishi M, Atsumi T, Yoshikawa Y, Nakanishi R, Watanabe M, Kudo Y. Long-term outcomes of the mayo conservative hip system in patients aged 30 years or less with osteonecrosis of the femoral head: mean follow-up of more than 10 years. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05339-w. [PMID: 38709289 DOI: 10.1007/s00402-024-05339-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Historically, total hip arthroplasty (THA) in very young patients has been associated with lower survivorship. However, the long-term outcomes of THA using short stems for osteonecrosis of the femoral head (ONFH) in very young patients remain unclear. Therefore, this study aimed to investigate the long-term outcomes of the Mayo conservative hip system, a short metaphyseal stabilised stem, in patients with ONFH aged ≦30 years. MATERIALS AND METHODS We retrospectively reviewed 104 joints in 76 patients with ONFH who underwent THA using the Mayo conservative hip system with a minimum follow-up of 8 years. The mean follow-up period was 12.5 (range, 8-19) years. Patients were categorised into two age groups (≦30 years, n = 21 and > 30 years, n = 83). Radiographic evaluation was used to assess stem sinking, stress shielding, and spot welds. The clinical evaluations were performed using the Japanese Orthopedic Association (JOA) hip score. Postoperative major complication and revision surgery rates were also assessed. RESULTS The patient characteristics were similar between the two groups, except for the age. Revision surgeries were performed in five cases, with similar implant survival rates between the groups. Dislocations occurred in the older age group alone (four joints). One case of intra-operative periprosthetic femoral fracture was found in the younger age group. Stem sinking of > 3 mm occurred in one and seven joints in the younger and older age groups, respectively. Spot welds were observed in most joints (93.2%) in modified Gruen zones 2 and 6 without significant differences between the groups. Stress shielding showed no significant differences in the frequency of occurrence or location between the two groups. Furthermore,the JOA score showed no significant difference between the two groups. CONCLUSION The use of short stems in patients aged ≤ 30 years with ONFH showed favourable long-term outcomes.
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Affiliation(s)
- Masanori Nishi
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan.
- Department of Orthopaedic Surgery, Sassa General Hospital, 4-24-15 Tanashicyo, Nishitokyo-shi, Tokyo, 188-0011, Japan.
| | - Takashi Atsumi
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
- Department of Orthopaedic Surgery, Sassa General Hospital, 4-24-15 Tanashicyo, Nishitokyo-shi, Tokyo, 188-0011, Japan
| | - Yasushi Yoshikawa
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Ryosuke Nakanishi
- Department of Orthopaedic Surgery, Sassa General Hospital, 4-24-15 Tanashicyo, Nishitokyo-shi, Tokyo, 188-0011, Japan
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City, Kanagawa, 227-8501, Japan
| | - Minoru Watanabe
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City, Kanagawa, 227-8501, Japan
| | - Yoshifumi Kudo
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
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Marqués López F, Pares Alfonso I, Donaire Hoyas D, Ruiz Morales G, Tey Pons M, Lizano Díez X, León García A. Total Hip Replacement with a Fully Hydroxyapatite-Coated Shortened Stem: Five- to Thirteen-Year Follow-Up Results. J Clin Med 2024; 13:2657. [PMID: 38731186 PMCID: PMC11084338 DOI: 10.3390/jcm13092657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Shortened femoral stems aim to mimic the biomechanical performance of traditional stems while preserving more bone and minimizing soft tissue damage. Our objective is to assess the outcomes of patients treated with a shortened stem (Furlong Evolution, JRI Orthopaedics, Sheffield, UK) to analyze the implant's efficacy and survivorship. Methods: This retrospective observational study included all patients aged 18 to 70 undergoing uncemented shortened stem total hip replacement at Hospital del Mar between 2010 and 2018. Hip function and pain were assessed with the Merle d'Aubigné-Postel scale and visual analog scale, respectively. A radiographic analysis measured stem and cup orientation, leg length discrepancy, stem subsidence, and radiolucencies around the cup. Perioperative complications, prosthetic failures, and reoperations were documented. Results: A total of 109 patients (74 male, 35 female) of a mean age of 51.8 ± 8.8 years were included. The average follow-up was 91 ± 17.4 months. Radiographically, 71 (65.1%) of the stems had been inserted at the appropriate angulation (±3°), and 102 (93.6%) of the cups had been placed in the Lewinnek safety zone. Leg length discrepancy was observed in 19 (17.4%) cases. The mean Merle d'Aubigné-Postel score improved from 13.1 ± 1.39 preoperatively to 17.8 ± 0.49 at 6 months postoperatively (p < 0.001). Merle d'Aubigné-Postel subscales also reflected a statistically significant improvement (p < 0.001). The mean pain score 12 months postoperatively was 0.52 ± 1.22, with 95.4% of patients declaring themselves satisfied or highly satisfied. The expected 13-year survival according to a Kaplan-Meier analysis was 100% in the absence of infection and 91.3% if revision for any cause is taken as a survival endpoint. Conclusions: The shortened stem under analysis provides excellent functional results and long-term survival rates.
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Affiliation(s)
- Fernando Marqués López
- Parc de Salut Mar, 08003 Barcelona, Spain; (I.P.A.); (G.R.M.); (M.T.P.); (X.L.D.); (A.L.G.)
| | - Ivet Pares Alfonso
- Parc de Salut Mar, 08003 Barcelona, Spain; (I.P.A.); (G.R.M.); (M.T.P.); (X.L.D.); (A.L.G.)
| | | | - Gregorio Ruiz Morales
- Parc de Salut Mar, 08003 Barcelona, Spain; (I.P.A.); (G.R.M.); (M.T.P.); (X.L.D.); (A.L.G.)
| | - Marc Tey Pons
- Parc de Salut Mar, 08003 Barcelona, Spain; (I.P.A.); (G.R.M.); (M.T.P.); (X.L.D.); (A.L.G.)
| | - Xavier Lizano Díez
- Parc de Salut Mar, 08003 Barcelona, Spain; (I.P.A.); (G.R.M.); (M.T.P.); (X.L.D.); (A.L.G.)
| | - Alfonso León García
- Parc de Salut Mar, 08003 Barcelona, Spain; (I.P.A.); (G.R.M.); (M.T.P.); (X.L.D.); (A.L.G.)
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Hong SH, Han SB. Midterm Comparative Analysis of Short Femoral Stem Survivorship in Dorr Type A Femurs. Clin Orthop Surg 2024; 16:201-209. [PMID: 38562642 PMCID: PMC10973610 DOI: 10.4055/cios23268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 04/04/2024] Open
Abstract
Background Proximal-distal mismatch has emerged as a prominent concern in Dorr type A femoral morphology, prompting the exploration of short stems as promising alternatives to conventional stems. This study aimed to evaluate clinical and radiographic outcomes of total hip arthroplasty (THA) using short femoral stems in Dorr type A proximal femoral morphology with a minimum follow-up of 5 years. Methods Patients with short femoral stems in Dorr type A between 2011 and 2017 were included. Patients with the Short Modular Femoral (SMF) stem and Metha stem were recruited and patients with a shortened tapered stem (Tri-Lock BPS) were matched by propensity score matching based on age, sex, body mass index, calcar to canal ratio, and diagnosis. Patient-reported outcomes and the presence of thigh pain were assessed at 5 years postoperatively. Revision rate, complication rate, and radiographic outcomes were also assessed and compared. Results Twenty-two cases (81%) in the SMF stem and 43 cases (65%) in the Metha stem had more than 5 years of follow-up data available. The SMF stem showed a higher failure rate than the other 2 groups, with 18% requiring revision surgery in the SMF stem compared to 4.6% in the Metha stem, and 2.3% in the Tri-Lock BPS. The SMF stem showed considerable complications such as stem position change and lateral cortical hypertrophy with inferior clinical outcomes than the other 2 stem groups. When the Metha stem and the Tri-Lock BPS groups were compared, more intraoperative fractures were observed in the Metha stem, whereas stress shielding and anterior thigh pain were significantly more prevalent in the Tri-Lock BPS. Conclusions The SMF stem might be less reliable than previously reported, showing a high failure rate and increased radiologic complications. Thus, its use for THA in Dorr Type A femurs needs caution. On the other hand, the Metha stem showed comparable outcomes to the shortened tapered Tri-Lock BPS.
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Affiliation(s)
- Seok Ha Hong
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Beom Han
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Kutzner KP, Walz A, Afghanyar Y, Drees P, Schneider M. Calcar-guided short-stem total hip arthroplasty in fractures of the femoral neck: a prospective observational study of 68 hips. Arch Orthop Trauma Surg 2024; 144:1793-1802. [PMID: 38172436 DOI: 10.1007/s00402-023-05170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION The indications for cementless short-stem total hip arthroplasty (THA) have been expanded due to encouraging results. However, no evidence in cases of femoral neck fractures (FNFs) is available. We aimed to prospectively obtain data on the safety and the clinical outcomes of a cementless calcar-guided short stem in patients with FNFs. MATERIALS AND METHODS We conducted a prospective observational study of 68 patients diagnosed with FNFs who underwent short-stem THA between 2016 and 2019 with a calcar-guided stem. Complications during follow-up leading to revision were documented, and patient reported outcome measurements recorded. Stem migration was analyzed using the Einzel-Bild-Röntgen-Analysis Femoral Component Analysis software. RESULTS The mean follow-up was 33.8 ± 14.8 months. The patient mortality at last follow-up was 10.6%. Two patients required stem revision, due to periprosthetic fracture and late aseptic loosening, respectively, corresponding to 96.2% stem survival. Survivorship for the endpoint of revision for any reason was 91.1% at 6 years. All revisions occurred in females. The mean Harris Hip Score at the last follow-up was 93.0 ± 8.9. The mean axial migration at last follow-up was 1.90 ± 1.81 mm. No significant influence on migration was found regarding gender, age, weight, and body mass index. CONCLUSIONS The clinical and radiological findings were satisfying and most patients benefited from the minimally invasive procedure. However, as for conventional THA as well, implant survivorship and mortality were markedly worse compared to results regarding osteoarthritis. Especially in elderly female patients with FNF, cementless short-stem THA is a concern and a cemented THA should be the first choice.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Alexander Walz
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Yama Afghanyar
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Michael Schneider
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
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Christiansen JD, Laursen M, Blunn GW, Nielsen PT. Stable fixation of an ultra-short femoral neck-preserving hip prosthesis: a 5-year RSA, DXA, and clinical prospective outcome study of 48 patients. Acta Orthop 2024; 95:138-146. [PMID: 38392247 PMCID: PMC10886218 DOI: 10.2340/17453674.2024.40074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 01/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND PURPOSE We previously showed promising primary stability and preservation of bone stock with the ultra-short neck-loading hip implant in total hip arthroplasty (THA). The aim of this study was to evaluate clinical outcome, implant stability, and bone mineral density (BMD). METHODS 50 patients were treated with the ultra-short neck Primoris hip implant at baseline and 48 were available for evaluation at 5-year follow-up. 5 different patient-reported outcome measures (PROMs) including hip-specific scores, disease-specific and generic quality of life outcome measures, and an activity score were used. Furthermore, implant stability using radiostereometric analysis (RSA) and assessment of periprosthetic BMD using dual-energy X-ray absorptiometry (DXA) were applied. RESULTS By 1-year follow-up, all PROMs showed improvements and remained high at 5-year follow-up. After initial distal translation (subsidence) and negative rotation around the z-axis (varus tilt) the implant showed stable fixation at 5-year follow-up with no further migration beyond 12 months. In the regions of interest (ROI) 3 and 4, BMD remained stable. In ROI 2, further bone loss of 12% was found at 5-year follow-up. CONCLUSION Clinical outcome including PROMs was satisfying throughout the 5-year follow-up period. The hip implant remains stable with both bone preservation and loss 5 years after surgery.
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Affiliation(s)
- Janus D Christiansen
- Department of Orthopaedic Surgery and Orthopaedic Surgery Research Unit, Aalborg University, Aalborg, North Region; Department of Clinical Medicine, Aalborg University, Aalborg, North Region, Denmark.
| | - Mogens Laursen
- Department of Orthopaedic Surgery and Orthopaedic Surgery Research Unit, Aalborg University, Aalborg, North Region; Department of Clinical Medicine, Aalborg University, Aalborg, North Region, Denmark
| | - Gordon W Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Poul T Nielsen
- Department of Orthopaedic Surgery and Orthopaedic Surgery Research Unit, Aalborg University, Aalborg, North Region
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Nakai T, Takeda Y, Niitsu S, Fujihara Y, Okahisa S, Tachibana T, Fukunishi S. Comparative Study for Postoperative Initial Fixation Patterns of Two Different Types of Cementless Short Stem Using Three-Dimensional Templating Software. Clin Orthop Surg 2024; 16:23-33. [PMID: 38304207 PMCID: PMC10825261 DOI: 10.4055/cios23100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 02/03/2024] Open
Abstract
Background While cementless short stems have become popular in total hip arthroplasty (THA), Metha is a relatively recent development that differs from other short stems in its initial fixation concept of partial collum-sparing metaphyseal anchorage. The purpose of this study was to quantify the contact state between Metha and the femur. Additionally, we investigated the difference in contact points between Meta and Fitmore, which is one of the more popular curved short stems. Methods We conducted a retrospective review of 42 hips that underwent THA using Metha and 41 hips using Fitmore. Stem-to-femur contact was evaluated by density mapping using a three-dimensional digital template system to quantify the contact condition according to the modified Gruen zone. The criterion for the stem-to-bone contact boundary was defined as a computed tomography value of 543 Hounsfield. Results Quantitative evaluation of Metha according to the modified Gruen zones showed the ratio of surface area with high cortical contact in each zone. The results were 4.6% ± 5.7% in zone 1, 0.9% ± 2.3% in zone 2, 19.1% ± 12.9% in zone 3, 1.4% ± 3.2% in zone 5, 29.6% ± 16.4% in zone 6, and 25.1% ± 17.7% in zones 7. Evaluation of Fitmore for the same zones was as follows: 1.6% ± 2.4%, 18.5% ± 16.9%, 20.8% ± 17.4%, 12.7% ± 12.8%, 3.7% ± 5.8%, and 13.3% ± 10.3%. Comparing the two groups, the contact area was significantly greater for Metha in zones 1, 6 and 7 and Fitmore in zones 2 and 5 (p < 0.05). Conclusions It is possible for Metha to achieve metaphyseal anchoring by contacting the cortical bone at the proximal femur, thus avoiding proximal offloading. To the best of our knowledge, no previous studies have quantitatively reported stem-to-cortical bone contact conditions in curved short stems.
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Affiliation(s)
- Takuya Nakai
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan
| | - Yu Takeda
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Saori Niitsu
- Department of Orthopedic Surgery, Goshi Hospital, Hyogo, Japan
| | - Yuki Fujihara
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Shohei Okahisa
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Shigeo Fukunishi
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan
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Girard J. What role for short stems in 2023? Orthop Traumatol Surg Res 2024; 110:103779. [PMID: 38040113 DOI: 10.1016/j.otsr.2023.103779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/23/2023] [Indexed: 12/03/2023]
Abstract
Current trends in total hip replacement aim at soft tissue and bone stock conservation. At the same time, mean patient age has been decreasing from decade to decade, raising the issue of iterative revision. Short stems seek to resolve the problem on the femoral side. Hopefully, revision of a short stem will be easier and bone stock depletion will be less than with a standard stem. Short stems also seem to have other advantages: automatically personalized biomechanical reconstruction, easier minimally invasive strategies, very low rate of hip pain, more harmonious distribution of bone stress, etc. Despite these advantages, however, use of short stems since their introduction in the late 1980s has varied from country to country, and is not widespread in France. The present study addressed several questions concerning these implants. Firstly, what is a "short" stem? Then, what are the indications and contraindications? Shortened standard stems do not come under the concept of short stem and will not be dealt with here. Furthermore, the learning curve and specificities of short stems need to be acquired. Implantation technique differs greatly from standard stems, and short stem implantation requires particular rigor. Results also need to be assessed, and especially the rate of complications as compared to standard stems. And lastly, it needs to be determined whether the advantages are real or only theoretical: this will determine their usefulness and role in the armamentarium, in which short stems are a new paradigm. LEVEL OF EVIDENCE: Expert opinion.
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Affiliation(s)
- Julien Girard
- Université Lille Nord de France, 59000 Lille, France; Service d'Orthopédie II, Hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France; Université Lille, Université Artois, Université Littoral Côte d'Opale, EA 7369, Unité de Recherche Pluridisciplinaire Sport Santé Société (URePSS), 59000 Lille, France.
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Grappiolo G, Gambaro FM, Spera M, Chiappetta K, Morenghi E, Loppini M. Clinical and radiological outcomes of an uncemented metaphyseal short stem at minimum 10 years of follow-up: a prospective observational study. Arch Orthop Trauma Surg 2024; 144:425-431. [PMID: 37526737 DOI: 10.1007/s00402-023-05012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE There is growing interest around short stems as they provide a less invasive approach for total hip arthroplasty preserving bone stock for a possible revision surgery if required. The main purpose of this work was to assess the long-term performance of an uncemented metaphyseal short stem in terms of survival rate and in addition its clinical and radiological outcomes. MATERIALS AND METHODS From January to December 2010, we prospectively enrolled all consecutive patients undergoing primary total hip arthroplasty with an uncemented metaphyseal short stem in our institution with a minimum follow-up of 10 years. The radiographic features investigated were the varus-valgus stem orientation, areas of osteolysis and radiolucencies, stress shielding, and heterotopic calcifications. The clinical outcomes were measured using the HHS. RESULTS A total of 163 patients (172 hips) were finally included and the measured survival rate at 10 years was 99.6%. The average HHS increased from 55.0 preoperatively to 97.8 at the last follow-up (p < 0.0001). Among them, 137 patients (164 hips) were also available for radiographic assessment. Mild varus malalignment was observed in 40% of cases and remained stable in the serial X-rays and was not associated with step loosening. Mild stress shielding was observed around 13 stems (9%) and moderate only around 3 implants. CONCLUSION In conclusion, the uncemented metaphyseal short stems showed excellent survival and clinical results at 10 years and at a radiographical level very low stress shielding was observed; moreover, besides the high frequency of varus alignment the implanted stems was not associated with revision surgery or with worse clinical outcomes.
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Affiliation(s)
- Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona-Università degli Studi di Genova, Via Magliotto 2, 17100, Savona, Italy
| | - Francesco Manlio Gambaro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Marco Spera
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Katia Chiappetta
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona-Università degli Studi di Genova, Via Magliotto 2, 17100, Savona, Italy
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
- Fondazione Livio Sciutto Onlus, Campus Savona-Università degli Studi di Genova, Via Magliotto 2, 17100, Savona, Italy.
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Diaz-Dilernia F, Lucero C, Slullitel PA, Zanotti G, Comba F, Piccaluga F, Buttaro M. Medium-term outcomes of conventional versus short uncemented femoral stems for primary total hip arthroplasty in patients younger than 55 years. Hip Int 2024; 34:82-91. [PMID: 37293776 DOI: 10.1177/11207000231177588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Short stems are designed with a bone preservation philosophy in mind. This study aims to compare the outcomes/complications and survival of a collarless fully hydroxyapatite (HA)-coated conventional tapered stem and a HA-coated partial neck-retaining uncemented short stem in patients ⩽55 years old at medium-term follow-up. METHODS We retrospectively studied 247 uncemented THAs operated between 2010 and 2014, comparing 146 patients treated with the fully HA-coated collarless stem (Group A) with 101 patients treated with a partial neck preserving, HA-coated short stem (Group B). 87 and 62 males were in groups A and B, respectively (p = 0.11). The mean age of the series was 46 years (17-55) (p =0.16). The mean follow-up of groups A and B were 9.9 (7-12) years and 9.7 (7-12) years, respectively (p =0.21). RESULTS Mean Harris Hip Score improved from 55 to 92 in group A (p <0.001) and from 54 to 95 in group B (p <0.001), without differences between groups. Mean femoral neck length preservation in groups A and B was 13.6 (0-28) mm and 26 (11-38) mm, respectively (p =0.001). 13 (8.9%) and 1 (1%) patients in groups A and B presented postoperative complications, respectively (p =0.008). The conventional stem group had more aseptic loosening (Group A 3.4% vs. Group B 0%, p =0.06) along with more Symptomatic radiolucent lines (Group A 3.4% vs. Group B 0%, p =0.06). CONCLUSIONS Both conventional and short stems showed excellent implant survival rates and functional outcomes at a mean follow-up of 9.8 years. However, complications and radiolucent lines were more frequent with a collarless conventional-length stem. Bone preservation of the femoral neck and diaphysis may be preferred in active young patients.
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Affiliation(s)
- Fernando Diaz-Dilernia
- Sunnybrook Health Sciences Centre/Holland Orthopaedic & Arthritic Centre, Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, ON, Canada
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Carlos Lucero
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Pablo A Slullitel
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gerardo Zanotti
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Fernando Comba
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Piccaluga
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Martin Buttaro
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Stadler C, Schauer B, Brabec K, Schopper C, Gotterbarm T, Luger M. A neck-sparing short stem shows significantly lower blood loss in total hip arthroplasty compared to a neck-resecting short stem. Sci Rep 2023; 13:19695. [PMID: 37951980 PMCID: PMC10640618 DOI: 10.1038/s41598-023-47008-9] [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: 03/23/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
Short stems are associated with a significantly lower blood loss (BL) compared to straight stems in total hip arthroplasty (THA). Different types of stems differ in design, fixation and level of femoral neck osteotomy. Therefore, we sought to evaluate the difference regarding the perioperative BL between two short stems with different designs in direct anterior approach (DAA). A total of 187 THA performed by a single surgeon were analysed. 107 patients received a neck-resecting (Group A) and 80 patients a neck-sparing short stem (Group B). Blood counts of the day before surgery and of two days after surgery were evaluated. Total blood volume and BL were calculated. Additionally, duration of surgery was analysed. The perioperative BL was significantly lower in Group B (451.4 ± 188.4 ml) compared to Group A (546.6 ± 232.7 ml; p = 0.002). The postoperative haematocrit (31.6 ± 3.7% vs. 30.4 ± 4.4%; p = 0.049) and haemoglobin-level (11.0 ± 1.3 g/dL vs. 10.4 ± 1.5 g/dL; p = 0.002) were significantly higher in Group B. Duration of surgery was significantly shorter in Group B (62.0 ± 11.4 min vs. 72.6 ± 21.8 min; p < 0.001). The use of a neck-sparing short stem leads to a significantly decreased BL compared to a neck-resecting short stem in DAA THA. A less extensively conducted capsular release necessary for optimal femoral exposition might lead to a lower perioperative BL and shorter durations of surgery.
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Affiliation(s)
- Christian Stadler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria.
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria.
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Katja Brabec
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Clemens Schopper
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
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Thöne P, Gruber MS, Kindermann H, Gussner W, Sadoghi P, Ortmaier R. Stem Design in Total Hip Arthroplasty Influences Ipsilateral Knee Valgus: A Retrospective Comparative Analysis of 2953 Cases. J Clin Med 2023; 12:6662. [PMID: 37892800 PMCID: PMC10607773 DOI: 10.3390/jcm12206662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) affects the biomechanics of the hip and the patient gait. The stem design influences femoral lever ratios and tissue trauma. Biomechanical changes such as these have the potential to induce knee arthritis. A varus or valgus configuration of knee arthritis is formed by asymmetric loadings. The aim of this study was to evaluate the impact of stem design in THA on knee valgus by comparing a standard implant with an implant with a short stem. METHODS A total of 2953 patients who underwent primary total knee arthroplasty for end-stage osteoarthritis between 2015 and 2021 were included in this retrospective data analysis. Patients were divided into three groups, depending on hip status (straight stem, short stem, and native joint). Leg alignment was distinguished as varus or valgus, and the degree of axial deviation was measured. Descriptive and explorative statistical analyses were performed, with a p value < 0.05 set as significant. RESULTS Ipsilateral knee valgus occurred significantly more often in patients with straight stems (57.2%) than in those with short stems (29%) and native joints (25.8%) (p < 0.001). Additionally, mean valgus deviation was significantly increased in patients with straight stems (8.9°) compared to those with short stems (6.4°) or native hip joints (6.7°). Both findings were accentuated in women. CONCLUSIONS Previous ipsilateral straight-stem THA is associated with knee valgus deformity, especially in women. Short-stem THA seems to be better suited to restoring physiological biomechanics and preventing the development of valgus osteoarthritis of the ipsilateral knee.
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Affiliation(s)
- Paul Thöne
- Medical Faculty, Johannes Kepler University Linz, 4020 Linz, Austria
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Michael Stephan Gruber
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Harald Kindermann
- Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, 4400 Steyr, Austria;
| | - Walter Gussner
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Patrick Sadoghi
- Department of Orthopedics and Trauma, Medical University of Graz, Austria Auenbruggerplatz 5, 8036 Graz, Austria
| | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
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13
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Mauch M, Brecht H, Clauss M, Stoffel K. Use of Short Stems in Revision Total Hip Arthroplasty: A Retrospective Observational Study of 31 Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1822. [PMID: 37893539 PMCID: PMC10608113 DOI: 10.3390/medicina59101822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Implantation of a short femoral stem in revision total hip arthroplasty (rTHA) could reduce the perioperative time, soft tissue damage, and preserve the bone stock of the proximal femur. The objective of this study was to describe the clinical and radiographic outcomes after the use of short stems in rTHA with a follow-up of 1 to 5 years. Materials and Methods: This retrospective, single center, and observational study analyzed the data of 31 patients (12 female, 19 male) with a median (interquartile range) age of 68.2 years (61.2-78.4) and BMI of 26.7 kg/m2 (24.6-29.4) who received an uncemented short femoral stem in rTHA between 2015 and 2020. Clinical outcomes were extracted from medical reports and assessed using the modified Harris Hip Score (mHHS), the numerical rating scale (NRS) for pain and satisfaction, and the UCLA Physical Activity Score. Radiographs were analyzed for stem subsidence, fixation, and bone parameters. The Wilcoxon test was used for pre-post rTHA differences (p < 0.05); clinical relevance was interpreted based on effect sizes according to Cohen's d. Results: All the clinical outcome measures improved significantly (p ≤ 0.001) at follow-up compared to preoperative status, with large effect sizes (Cohen's d) ranging from 2.8 to 1.7. At the last follow-up, the median (interquartile) mHHS was 80.9 (58.6-93.5). Stem fixation was stable in all cases. Complications included stem subsidence of 3 mm (n = 1) and 10 mm (n = 1), heterotopic ossification Brooker stage III (n = 2), intraoperative femur perforation (n = 1), periprosthetic fracture Vancouver type A (n = 1), and dislocation (n = 2). Conclusions: The good clinical results in our selective study population of patients with mild to moderate bone deficiency, supported by large effect sizes, together with a complication rate within the normal range, support the consideration of short stems as a surgical option after a thorough preoperative analysis.
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Affiliation(s)
- Marlene Mauch
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Hendrik Brecht
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
| | - Martin Clauss
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
- Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, 4031 Basel, Switzerland
| | - Karl Stoffel
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
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14
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Davey MS, Doyle TR, Murphy E, Fenelon C, Murphy CG, Cassar-Gheiti AJ. Battle of the titans: Survivorship analysis of the 3 most common types of uncemented femoral stems used across national registries. J Orthop 2023; 43:41-47. [PMID: 37564704 PMCID: PMC10409998 DOI: 10.1016/j.jor.2023.07.010] [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] [Received: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023] Open
Abstract
Background Although many institutions utilize uncemented stems as routine in performing total hip arthroplasty (THA), many surgeons continue to rely on outcomes reported in the literature in the form of small cohorts and patient series when analyzing survivorship for specific implants. The purpose of this study was to identify and analyze the survivorship of the 3 most common uncemented stem types (as opposed to brands) used across multiple national joint registries. Methods A review of data available from all national joint registries was carried out in July 2022. Analysis of each individual registry and classified uncemented implants into the seven different uncemented stem types. The 3 most common stem types were identified, and average cumulative revision rates calculated. Metal on metal bearings surface implants were excluded from this study due to high revision rates across all implant types. Results Our detailed review identified 6 out of 13 (NJR, AOANJRR, LROI, EPRD, MARCQI and the NZJR) international registries reporting implant specific survivorship on uncemented femoral stems; including 960,328 uncemented stems across all registries. The most common type of stem used was type 3c, accounting for 61% (583,724), followed by type 1 stems with 23% (217,897) and type 2 stems with 8% (79,257). Cumulative revision rates at 13 years follow-up for these stems ranged from 6.9% to 7.9%. Conclusion Although all stem types have comparable revision rates across all registries, the most common uncemented stem reported was the type 3c, tapered rectangular fully coated stem. Furthermore, out of all type 3c, the Müller design philosophy with full hydroxyapatite coating seems to be the most sought after worldwide. In this study we can conclude, thus far, that there does not appear to clinical or statistical differences in revision rates between the different stem types. Level of evidence III.
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Affiliation(s)
- Martin S. Davey
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Galway University Hospitals, Galway, Ireland
| | | | - Evelyn Murphy
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Colin G. Murphy
- Galway University Hospitals, Galway, Ireland
- University of Galway, Galway, Ireland
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15
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Mittelstaedt H, Anderl C, Ortmaier R, Johl C, Krüger T, Wallroth K, Weigert U, Schagemann JC. Subsidence analysis of a cementless short stem THA using EBRA-FCA - A seven-year prospective multicentre study. J Orthop 2023; 43:93-100. [PMID: 37575949 PMCID: PMC10415660 DOI: 10.1016/j.jor.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023] Open
Abstract
Background Metaphyseal fixation of short stem THA allows for minimally invasive surgery, less bone removal, improved bone load transfer and reduced stress shielding. Short stems facilitate the anatomic restoration i.a. of leg length, femoroacetabular offset, and center of rotation. However, metaphyseal fixation might cause impaired primary and/or secondary stability resulting in an inherent tendency for early axial migration and aseptic loosening eventually. The objective of this study was to investigate the long-term outcome and migration pattern of a calcar-guided short stem. Methods In a prospective multicenter study, 213 patients (224 THAs) were enrolled. Patients were followed for up to 84 months postoperatively. Clinical outcome was assessed using the Harris Hip Score and the VAS for pain and satisfaction. Standardized and calibrated radiographs were screened i.a. for stress shielding and loosening. Einzel-Bild-Roentgen-Analyse - femoral component analysis (EBRA-FCA) was used to detect longitudinal subsidence. Results At 7 year follow-up, n = 139/224 cases were available for analysis. All clinical parameters improved significantly (p < 0.001) and improvement persisted. There were no radiographic changes indicating stress shielding. EBRA-FCA revealed a mean subsidence of -1.44 mm followed by a stabilization. Weight >80 kg (p = 0.115), BMI <30 kg/m2 (p = 0.282), male gender (p = 0.246), and age <65 years (p = 0.304) seemed to be associated with a higher risk for migration. The cumulative revision rate was 2.23%. Revisions due to stem migration (0.89%) occurred early (mean time between index surgery and revision: 3.3 months). Conclusions If at all, there appears to be a pronounced initial subsidence, which stabilizes thereafter. Stem migration was rarely a compelling reason for failure or revision. Demographics do not seem to have a significant effect on migration pattern. The absence of radioluce lines, resorption or hypertrophy of the proximal femora support the hypothesis of a reduced stress shielding for metaphyseal anchoring short stems.
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Affiliation(s)
- Hagen Mittelstaedt
- UKSH Campus Lübeck, Klinik für Orthopädie und Unfallchirurgie Sektion Orthopädie, Ratzeburger Allee, Lübeck, Germany
| | - Conrad Anderl
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Seilerstätte, Linz, Austria
| | - Reinhold Ortmaier
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Seilerstätte, Linz, Austria
| | - Carsten Johl
- Klinikum Dahme-Spreewald GmbH, Lübben (Spreewald), Germany
| | - Thomas Krüger
- Helios Klinik Köthen, Hallesche Straße, Köthen (Anhalt), Germany
| | - Karsten Wallroth
- Kreiskrankenhaus Stollberg GmbH, Jahnsdorfer Straße Stollberg, Stollberg, Germany
| | - Ulrich Weigert
- Praxis für Orthopädie und Unfallchirurgie, Friedrichstraße, Erkner, Germany
| | - Jan C. Schagemann
- UKSH Campus Lübeck, Klinik für Orthopädie und Unfallchirurgie Sektion Orthopädie, Ratzeburger Allee, Lübeck, Germany
- Christophorus Kliniken Coesfeld, Südring 41, 48653, Coesfeld, Germany
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16
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Van Veghel MHW, Hannink G, Van Oldenrijk J, Van Steenbergen LN, Schreurs BW. A comparison of uncemented short versus standard stem length in total hip arthroplasty: results from the Dutch Arthroplasty Register. Acta Orthop 2023; 94:330-335. [PMID: 37417696 DOI: 10.2340/17453674.2023.13652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND PURPOSE We aimed to compare revision rates between uncemented short and standard stems in total hip arthroplasties (THAs) and the corresponding patient-reported outcome measures (PROMs). PATIENTS AND METHODS We included all short (C.F.P., Fitmore, GTS, Metha, Nanos, Optimys, Pulchra, and Taperloc Microplasty) and standard stems in uncemented THAs registered between 2009 and 2021 in the Dutch Arthroplasty Register. Kaplan-Meier survival and multivariable Cox regression analyses were performed with overall and femoral stem revision as endpoints. RESULTS Short stems were used in 3,352 and standard stems in 228,917 hips. 10-year overall revision rates (4.8%, 95% confidence interval [CI] 3.7-6.3 vs. 4.5%, CI 4.4-4.6) and femoral stem revision rates (3.0%, CI 2.2-4.2 vs. 2.3%, CI 2.2-2.4) were comparable for short- and standard-stem THAs. Today's predominant short stems (Fitmore and Optimys) showed short-term revision rates similar to that of standard-stem THAs. Other, less frequently used short stems had higher 10-year overall (6.3%, CI 4.7-8.5) and femoral stem (4.5%, CI 3.1-6.3) revision rates. Multivariable Cox regression also showed a higher risk for overall (HR 1.7, CI 1.0-2.9) and femoral stem revision (HR 2.0, CI 1.1-3.5) using the latter short stems compared with standard stems. An exploratory analysis of PROMs showed no difference. CONCLUSION There was no overall difference in revision rates but a tendency toward increased revision of short stems both for the whole THA and for the stem itself. The less frequently used short stems had increased revision risk. No difference in PROMs was shown.
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Affiliation(s)
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen
| | - Jakob Van Oldenrijk
- Erasmus University Medical Center, Department of Orthopedics and Sport Medicine, Rotterdam
| | - Liza N Van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), 's-Hertogenbosch, the Netherlands
| | - B Willem Schreurs
- Department of Orthopedics, Radboud University Medical Center, Nijmegen; Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), 's-Hertogenbosch, the Netherlands
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Nooh A, Hart A, Tanzer M. Intermediate to Long-Term Outcomes of a Short, Tapered, Highly Porous, Proximally Coated Cementless Femoral Stem. J Arthroplasty 2023:S0883-5403(23)00351-0. [PMID: 37044224 DOI: 10.1016/j.arth.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Short cementless stems in total hip arthroplasty have gained increasing popularity, yet on-going studies of many of these implants are lacking. The aim of this study was to evaluate the minimum 5 year clinical and radiological results of a short, highly porous single tapered-wedge cementless femoral implant. METHODS A retrospective study of 281 hips in 256 patients who had a minimum 5-year follow-up and underwent primary total hip arthroplasty (THA) between 2010 and 2016 were evaluated. Clinical and radiological results, complications, and the presence of postoperative thigh pain were evaluated. RESULTS The mean follow-up was 8 years (range, 5 to 12 years). Clinically, patients had significant improvement in the average patient related outcome scores (PROMS) postoperatively (Harris Hip Score: pre 47 vs post 95, University of California Los Angeles (UCLA) activity scale: pre 4 vs post 6, Western Ontario and McMaster Universities Arthritis Index (WOMAC): pre 51 vs post 3, SF-12 Physical Component Summary (PCS): pre 32 vs post 52, SF-12 Mental Component Summary (MCS): pre 49 vs post 55 (P<0.001)). Radiographic signs of ingrowth were present in all hips. There were three patients (1.1%) who developed transient thigh pain postoperatively, all of which resolved with non-operative management. CONCLUSION This study provides the longest follow-up of this short, highly porous single tapered-wedge cementless femoral stem in the literature. This short single wedge stem with its highly porous coating demonstrated reproducible bone ingrowth in all patients, and significant functional improvement with a very low rate of transient thigh pain.
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Affiliation(s)
- Anas Nooh
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada; Department of Orthopaedic Surgery, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Adam Hart
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
| | - Michael Tanzer
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
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18
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Luger M, Feldler S, Pisecky L, Klasan A, Gotterbarm T, Schopper C. Periprosthetic Femoral Fractures in Cementless Short Versus Straight Stem Total Hip Arthroplasty: A Propensity Score Matched Analysis. J Arthroplasty 2023; 38:751-756. [PMID: 36283514 DOI: 10.1016/j.arth.2022.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent studies indicate a decreased risk of periprosthetic femoral fractures (PFFs) in cementless total hip arthroplasty (THA) for short compared to straight stems. However, the results are still inconclusive. Therefore, we retrospectively investigated the rate of PFFs within the first year between cementless short and straight stem THA. METHODS A 1:1 propensity score matching of 3,053 THAs was performed. Two groups including 1,147 short stem THAs implanted through a minimally invasive antero-lateral approach and 1,147 straight stem THAs implanted through a transgluteal Hardinge approach were matched. The rates of PFFs and fracture patterns were compared between both stem types. Risk factors for PFFs were analyzed by multivariate regression analyses. RESULTS The overall rate of PFFs was 1.7% in short stem THA and 3.2% in straight stem THA (P = .015). Postoperatively detected Vancouver A fractures occurred significantly more often in straight stem THA (P = .002), while the occurrence Vancouver B fractures did not differ significantly (P = .563). The risk of PFFs was significantly increased for women in straight stem THA (Odds ratio (OR) 2.620; Confidence Interval (CI) 1.172-5.856; P = .019). Increasing age showed a significantly increased odds ratio in short stem (OR 1.103; CI 1.041-1.169, P < .001) and straight stem THA (OR 1.057; CI 1.014-1.101, P = .008). CONCLUSION Short stem THA reduces Vancouver Type A PFFs in the trochanteric region compared to straight stem THA, while Vancouver Type B fractures are comparable. Increasing age is a significant risk factor for both stem types, while the risk for PFFs in women was only significantly increased in the straight stem group.
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Affiliation(s)
- Matthias Luger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria; Johannes Kepler University Linz, Linz, Austria
| | - Sandra Feldler
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria; Johannes Kepler University Linz, Linz, Austria
| | - Lorenz Pisecky
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria; Johannes Kepler University Linz, Linz, Austria
| | - Antonio Klasan
- Johannes Kepler University Linz, Linz, Austria; AUVA Traumahospital Styria, Graz, Austria
| | - Tobias Gotterbarm
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria; Johannes Kepler University Linz, Linz, Austria
| | - Clemens Schopper
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria; Johannes Kepler University Linz, Linz, Austria
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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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Fawley DW, Croker S, Irving JF, Swank ML. Intermediate-Term Survivorship of Total Hip Arthroplasty With a Proximally Coated Tapered-Wedge Femoral Stem: A Retrospective, Multi-Center Registry Review. Cureus 2023; 15:e36623. [PMID: 37155454 PMCID: PMC10122831 DOI: 10.7759/cureus.36623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Short tapered-wedge stems have been used frequently over the past decade, but long-term follow-up data are not readily available in the literature. METHODS A retrospective outcomes review was conducted to assess survivorship and clinical outcomes for the TRI-LOCK® Bone Preservation Stem (TRI-LOCK BPS; DePuy Synthes, Warsaw, IN, USA), a proximally coated, tapered-wedge femoral stem. RESULTS In a cohort of 2,040 hips, Kaplan-Meier survivorship estimates (95% CI {confidence interval}; N with further follow-up, where N is the number of hips remaining at each post-operative interval), with survivorship defined as no revision of any component for any reason were 96.6% (92.8%,98.4%; 45) at eight years under the clinical assumption and 98.6% (97.9%,99.1%; 90) at 14 years under the registry assumption. With survivorship defined as stem revision for any reason, estimates were 97.7% (93.7%,99.2%; 45) at eight years under the clinical assumption and 99.2% (98.6%,99.5%; 90) under the registry assumption. Mean Harris Hip Scores and WOMAC scores were 90.08 and 21.98, respectively, at 10 years postoperatively. CONCLUSION Our evaluation demonstrates excellent construct and stem survivorship and clinical outcomes at intermediate-term postoperative follow-up.
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Affiliation(s)
| | - Sean Croker
- Clinical Research, DePuy Synthes, Warsaw, USA
| | - John F Irving
- Orthopaedic Surgery, Connecticut Orthopaedics, Hamden, USA
| | - Michael L Swank
- Orthopaedic Surgery, Cincinnati Orthopaedic Research Institute, Cincinnati, USA
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21
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Zhang X, Wang Y, Zhang L, Yu K, Ding Z, Zhang Y, Chen X, Xiong C, Ji Y, Zhang D, Ma X. Biomechanical Properties of Bionic Collum Femoris Preserving Hip Prosthesis: A Finite Element Analysis. Orthop Surg 2023; 15:1126-1135. [PMID: 36797648 PMCID: PMC10102311 DOI: 10.1111/os.13653] [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: 07/12/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE Compared with total hip replacement, conventional collum femoris preserving prosthesis has a better bone retention effect. However, damage to the trabecular bone of the proximal femur leads to inevitable abnormal stress distribution, which leads to increased risks of femoral neck bone absorption, periprosthetic fracture, prosthesis loosening, rotation, and sinking. Thus, we compare the biomechanical properties of collum femoris preserving (CFP) and bionic collum femoris preserving (BCFP) hip prostheses. METHODS The Sawbone digital model (#3503, left, medium) was selected as the research object. We used the Mimics 21.0 software to reconstruct the digital model of the femur and the SolidWorks 2019 software to build and assemble the three-dimensional models of CFP and BCFP prostheses. With the ANSYS Workbench 2021R1 software, the models were meshed and assigned values to simulate the load of a single foot under slow walking. We measured the mechanical distribution of the whole model and obtained the stress nephogram. RESULTS For CFP prosthesis, the peak stresses of the medial interface of the stem neck, the lateral interface of the stem neck, and the end of the stem were 64.894, 32.199, and 8.578 MPa, respectively; the peak stresses of the medial surface of the femoral shaft, the lateral surface of femoral shaft, the medial femoral neck bone-prosthesis interface (osteotomy interface), the lateral femoral neck bone-prosthesis interface (basal area), the lateral femoral neck bone-prosthesis interface (osteotomy interface), and the greater trochanter area were 28.093, 24.790, 14.388, 5.118, 4.179, and 8.245 MPa, respectively; the valley stress of the greater trochanter area was 1.134 MPa. For BCFP prosthesis, the peak stresses of the medial interface of the stem neck, the lateral interface of the stem neck, and the end of the stem were 47.015, 26.771, and 47.593 MPa, respectively; the peak stress of tension screw was 15.739 MPa; the peak stresses of the medial surface of the femoral shaft, the lateral surface of femoral shaft, the medial femoral neck bone-prosthesis interface (osteotomy interface), the lateral femoral neck bone-prosthesis interface (basal area), the lateral femoral neck bone-prosthesis interface (osteotomy interface) and the greater trochanter area were 28.581, 25.364, 15.624, 6.434, 4.986, and 8.796 MPa, respectively; the valley stress of the greater trochanter area was 1.419 MPa; the peak stress of bone-metal interface between the tension screw and the lateral surface of the femur was 5.858 MPa. CONCLUSION Compared with the CFP prosthesis, the design of the BCFP prosthesis is based on the lever balance theory. With the bionic reconstruction of tension trabeculae, BCFP prosthesis makes up for the defects of CFP prosthesis design, optimizes the stress distribution, and reduces the stress shelter effect of the proximal femur, which has better biomechanical properties.
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Affiliation(s)
- Xiaomeng Zhang
- Key Laboratory of Ministry of Education for Trauma Treatment and Nerve Regeneration, National Center for Trauma Medicine, Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Yanhua Wang
- Key Laboratory of Ministry of Education for Trauma Treatment and Nerve Regeneration, National Center for Trauma Medicine, Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Lijia Zhang
- Department of Orthopaedics, Peking Union Medical College Hospital, Beijing, China
| | - Kai Yu
- Department of Orthopaedics, Tianjin Fifth Central Hospital, Tianjin, China
| | - Zhentao Ding
- Key Laboratory of Ministry of Education for Trauma Treatment and Nerve Regeneration, National Center for Trauma Medicine, Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Yichong Zhang
- Key Laboratory of Ministry of Education for Trauma Treatment and Nerve Regeneration, National Center for Trauma Medicine, Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Xiaofeng Chen
- Key Laboratory of Ministry of Education for Trauma Treatment and Nerve Regeneration, National Center for Trauma Medicine, Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Chen Xiong
- Key Laboratory of Ministry of Education for Trauma Treatment and Nerve Regeneration, National Center for Trauma Medicine, Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Yun Ji
- Key Laboratory of Ministry of Education for Trauma Treatment and Nerve Regeneration, National Center for Trauma Medicine, Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Dianying Zhang
- Key Laboratory of Ministry of Education for Trauma Treatment and Nerve Regeneration, National Center for Trauma Medicine, Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China.,Department of Orthopaedics, Tianjin Fifth Central Hospital, Tianjin, China
| | - Xinlong Ma
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
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22
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Ding Z, Wang J, Wang Y, Zhang X, Huan Y, Zhang D. Bionic reconstruction of tension trabeculae in short-stem hip arthroplasty: a finite element analysis. BMC Musculoskelet Disord 2023; 24:89. [PMID: 36732725 PMCID: PMC9893650 DOI: 10.1186/s12891-023-06205-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Short-stem hip arthroplasty (SHA) is characterized by metaphyseal load transfer that effectively preserves the bone stock, but still suffers from stress shielding in the proximal femur. We designed a tension screw to mimic tension trabeculae in the new bionic collum femoris preserving (BCFP) short stem for bionic reconstruction, aiming to restore the biomechanics of hip joint. METHODS Native femur finite element model was constructed to investigate the biomechanics of hip joint based on computed tomography (CT) data. The maximum absolute principal stress/strain cloud chart allowed the direction of stress/strain to be assessed. Six BCFP models with different screw angles (5°, 10°, 15°, 20°, 25°, and 30°) and the Corail model were created. The stress/strain distribution and overall stiffness were compared between each of the BCFP and Corail implanted models. RESULTS The native model visualized the transfer pathways of tensile and compressive stress. The BCFP stems showed significantly higher stress and strain distribution in the greater trochanteric region compared to conventional total hip arthroplasty (THA). In particular, the BCFP-5° stem demonstrated the highest average strain in both medial and lateral regions and the overall stiffness was closest to the intact femur. CONCLUSIONS Stress transfer pathways of trabecular architecture provide biomechanical insight that serves as the basis for bionic reconstruction. The tension screw improves load transfer pattern in the proximal femur and prevents stress reduction in the greater trochanteric region. The BCFP-5° stem minimizes the stress shielding effect and presents a more bionic mechanical performance.
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Affiliation(s)
- Zhentao Ding
- grid.411634.50000 0004 0632 4559Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing, 100044 China ,grid.411634.50000 0004 0632 4559National Centre for Trauma Medicine, Peking University People’s Hospital, Beijing, 100044 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044 China
| | - Jun Wang
- grid.9227.e0000000119573309State Key Laboratory of Nonlinear Mechanics (LNM), Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190 China ,grid.410726.60000 0004 1797 8419School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Yanhua Wang
- grid.411634.50000 0004 0632 4559Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing, 100044 China ,grid.411634.50000 0004 0632 4559National Centre for Trauma Medicine, Peking University People’s Hospital, Beijing, 100044 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044 China
| | - Xiaomeng Zhang
- grid.411634.50000 0004 0632 4559Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing, 100044 China ,grid.411634.50000 0004 0632 4559National Centre for Trauma Medicine, Peking University People’s Hospital, Beijing, 100044 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044 China
| | - Yong Huan
- grid.9227.e0000000119573309State Key Laboratory of Nonlinear Mechanics (LNM), Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190 China ,grid.410726.60000 0004 1797 8419School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Dianying Zhang
- grid.411634.50000 0004 0632 4559Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing, 100044 China ,grid.411634.50000 0004 0632 4559National Centre for Trauma Medicine, Peking University People’s Hospital, Beijing, 100044 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044 China
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23
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Gabrion M, Rattier S, Blondin E, Michaud A, Mertl P, Gabrion A. Survival and radioclinical evaluation of the Optimys™ short stem at more than 6years' mean follow-up: A retrospective study of 108 cases. Orthop Traumatol Surg Res 2023; 109:103470. [PMID: 36336294 DOI: 10.1016/j.otsr.2022.103470] [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: 01/08/2022] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The short stems developed in recent years offer an interesting alternative to standard long stems. The Optimys™ short stem has been widely studied, but not according to the National Institute for Health and Care Excellence (NICE) criteria. We therefore conducted a retrospective study of Optimys™ at a minimum 5years' follow-up, to assess: (1) survival on NICE criteria, (2) complications, (3) functional results, and (4) subsidence, restoration of offset and bone remodeling. HYPOTHESIS Optimys™ shows survival comparable to that of other non-cemented standard and short stems, with a<0.5% per year revision rate or<2.5% at 5years on NICE criteria. MATERIAL AND METHODS A single-center retrospective study included 108 Optimys™ stems at a mean 76.5months' follow-up (range: 60-112months). Clinical [Harris, Oxford-12 and forgotten hip (French version: SHO-12) scores] and radiologic data were collected pre- and postoperatively. Analysis focused on implant survival, complications, functional results and radiological results (restoration of offset, bone remodeling, subsidence and osseointegration) and risk factors for stem migration. RESULTS At a mean 76.5months' follow-up (range: 60-112months), Optimys™ survival was 97.7% (95% CI: 0.945-1). Oxford and Harris scores improved significantly: respectively, 16.1 vs. 44.7 [Δ=28.598; 95% CI: 27.410-29.785 (p<0.001)] and 45.3 vs. 95 [Δ=49.662; 95% CI: 47.442-51.882 (p<0.001)]. Mean forgotten hip score (SHO-12) at last follow-up was 82.7±19.6 (range: 35.4-100.0). There was 1 case of aseptic revision at 11months for femoral osseointegration defect. Mean subsidence was 1.64mm (range: 0-20.63mm); no predisposing factors could be identified. Femoral offset increased by a mean 2.41±4.53mm (range: -10.10 to 14.70mm). CONCLUSION The present study reports good survival for the Optimys™ stem, which meets NICE criteria. Radiologic and clinical results were encouraging, with a low rate of subsidence, comparable to other series, but with increased femoral offset. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Matthieu Gabrion
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France.
| | - Simon Rattier
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Emile Blondin
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Audrey Michaud
- Direction de la recherche clinique et de l'innovation, site Sud - Hall 1 - 1(er) étage zone administrative, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Patrice Mertl
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, pôle santé, 3, rue des Louvels, CS 13036, 80036 Amiens, France
| | - Antoine Gabrion
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, pôle santé, 3, rue des Louvels, CS 13036, 80036 Amiens, France
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Nelson JT, Zheng H, Hallstrom BR, Hughes RE, Mont MA, Masini MA. Are Short Stems Associated With Higher Fracture Rates and Early Revision Rates in Primary Total Hip Arthroplasty? A Noninferiority Analysis. J Arthroplasty 2023:S0883-5403(23)00008-6. [PMID: 36639113 DOI: 10.1016/j.arth.2023.01.008] [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: 07/06/2022] [Revised: 11/22/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This study aimed to determine if "short" femoral stems were noninferior to (at least as good as) standard-length stems in regards to 90-day periprosthetic fracture and 1-year revision rates. METHODS Using the MARCQI implant registry, a retrospective study of statewide data was carried out on 64,084 total hip arthroplasties (THAs) between 2012 and 2017. We noticed an increase in the use of "short" uncemented femoral hip stems during THA. Chi-square tests were used to test homogeneity of categorical variables. The covariates included in the analyses were identified using modern epidemiological methods. A Type I probability of 0.05 was used as the level of statistical significance. Inverse probability of treatment weighting (IPTW) was used to mitigate confounding variables. RESULTS One hundred and seven stems were implanted by surgeons in the state of Michigan. They were classified according to the Khanuja Classification System as Type 2A (trapezoidal, double-tapered calcar loading, n = 3,281), Type 3 (calcar loading with lateral flare, n = 1,898), and Type 4 (shortened, tapered, conventional, n = 19,580), and were compared to standard-length, type 5, stems (n = 33,322) in regards to the 2 outcomes (periprosthetic fractures and 1-year revision rates). Overall, 1-year revision and the 90-day fracture rates were 1.3% (791/57,853) and 1.1% (631/57,968), respectively. Noninferiority was established for all short stems at the clinical threshold of an odds ratio (OR) of 1.5 with P-values <0.05 for 90-day fractures. In regards to 1-year revision rates, noninferiority was also established for Type 3 and 4 stems (P < .05). CONCLUSION The increased use of "short stems" in Michigan did not lead to increased 1-year revision or 90-day fracture rates.
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Affiliation(s)
- Joseph T Nelson
- Dignity Health Medical Group, Arizona Creighton University School of Medicine- Phoenix, Phoenix, Arizona
| | - Huiyong Zheng
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brian R Hallstrom
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Richard E Hughes
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael A Mont
- Northwell Health Orthopaedic Institute at Lenox Hill, New York, New York
| | - Michael A Masini
- Department of Orthopedic Surgery, St. Joseph Mercy Hospital, Ann Arbor, Michigan
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Kutzner KP, Maurer SM, Meinecke I, Heers G, Bosson D. Survivorship, complications and patient-reported outcomes in calcar-guided short-stem THA: prospective mid-term multicenter data of the first 879 hips. Arch Orthop Trauma Surg 2023; 143:1049-1059. [PMID: 35076767 PMCID: PMC9925563 DOI: 10.1007/s00402-022-04354-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/06/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Short stems are a bone and soft-tissue preserving alternative to conventional stems. The aim of this multicenter study is to present the mid-term outcomes of a calcar-guided short stem. MATERIALS AND METHODS This is a prospective case series of the first 879 total hip arthroplasties performed on 782 patients across 5 centers using identical calcar-guided short stems. In a mid-term follow-up (6 years), rates and reasons for complications and revisions were documented. The Harris Hip Score (HHS) was obtained; patients reported pain and satisfaction using a visual analog scale. RESULTS A total of 43 patients died in the study cohort for non-related reasons; 26 patients (3.0%) required at least 1 revision after the index procedure. The survival rate for endpoint stem revision at mid-term was 98.4%. The main reasons for stem revision were aseptic loosening and early periprosthetic fractures. Sex had no influence on stem survival. Older patients or those with a high body mass index showed increased risk for stem revision during follow-up. Dorr type A morphology revealed a significantly lower risk of stem revision than Dorr type B or C (p = 0.0465). The HHS, satisfaction, and load pain at mid-term were 96.5 (SD 8.0), 9.7 (SD 0.9), and 0.5 (SD 1.9), respectively. CONCLUSIONS This short stem produced highly satisfactory outcomes at mid-term, with 98.4% implant survival for any cause of stem revision and low complication rates. Long-term results are required to further evaluate these promising mid-term results.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany. .,Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Steven Mark Maurer
- grid.477516.60000 0000 9399 7727Department of Orthopedic Surgery, Bürgerspital Solothurn, Schöngrünstr. 38, 4500 Solothurn, Switzerland
| | - Ingmar Meinecke
- Helios Park-Clinic Leipzig, Strümpellstr. 41, 04289 Leipzig, Germany
| | - Guido Heers
- Department of Orthopedic Surgery and Arthroplasty, Vitos Orthopaedic Clinic Kassel, Wilhelmshöher Allee 345, 34131 Kassel, Germany
| | - Dominique Bosson
- grid.418680.30000 0004 0417 3996Clinique de Genolier, Route du Muids 3, 1272 Genolier, Switzerland
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Fukunishi S, Takeda Y, Fukui T, Nishio S, Tachibana T, Fujihara Y. Long term results of the Bicontact D stem in dysplastic osteoarthritis: a 10-15 year follow-up study. Arch Orthop Trauma Surg 2022; 142:3987-3993. [PMID: 34817670 DOI: 10.1007/s00402-021-04262-8] [Citation(s) in RCA: 2] [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: 04/30/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the present study was to investigate the results of total hip arthroplasty (THA) using the Bicontact D stem with a minimum 10 year follow-up that focused on patients with developmental dysplasia of the hip (DDH). METHODS One hundred five patients with osteoarthritis due to DDH who underwent primary THA were included in this study. The mean final follow-up period was 12.7 ± 1.2 years (range 10-15 years). All cases were evaluated both clinically and radiographically, and Kaplan-Meier survivorship was determined as stem revision for any reason as the end point. RESULTS Modified Harris hip score averaged 89.0 ± 1.1 (range 60-98) at the final follow-up. The survivorship was 99.0% (95% confidence interval 93.4-99.9%) at 15.0 years, and only one hip with a well-fixed stem required stem revision due to recurrent dislocations. Cortical hypertrophy (CH) was observed in 40 of 105 hips (38.1%), and stress shielding (SS) progressed to grade 3 or 4 in six hips (6 of 105 hips: 5.7%) during the study period. Among the six hips with progressed SS, Dorr type C proximal femoral geometry was seen in five hips. CONCLUSION This study of 105 THAs using the Bicontact D stem that focused on DDH patients with a minimum 10 year follow-up period achieved satisfactory clinical and radiological outcomes. Dorr type C proximal femoral geometry could be considered a risk factor for progressed SS.
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Affiliation(s)
- Shigeo Fukunishi
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, 1-4, Ohama-cho, Nishinomiya, Hyogo, 662-0957, Japan.
| | - Yu Takeda
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, 1-4, Ohama-cho, Nishinomiya, Hyogo, 662-0957, Japan
| | - Tomokazu Fukui
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Shoji Nishio
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuki Fujihara
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Roškar S, Antolič V, Mavčič B. Implant Survival of 680 Consecutive EcoFit ® Flat Single-Wedge Cementless Femoral Stems is Equivalent to the Taperloc ® Total Hip Arthroplasty Series. Indian J Orthop 2022; 56:1969-1977. [PMID: 36310558 PMCID: PMC9561451 DOI: 10.1007/s43465-022-00733-1] [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: 05/29/2022] [Accepted: 08/23/2022] [Indexed: 02/04/2023]
Abstract
Introduction The EcoFit® total hip endoprosthesis has recently been approved for clinical use in the USA as a substantially equivalent implant to the Taperloc® Hip System, but no report has directly compared their long-term results so far. The primary aim of the presented single-hospital EcoFit® cohort analysis was to determine femoral stem survival rates at 5/10 years of follow-up in comparison to eight Taperloc® studies published within the last decade (2011-2021). The secondary aim was to find out whether femoral stem survival depended on the patients' age, gender and the operating surgeon. Materials and Methods The retrospective surgeon-stratified observational cohort study included 680 consecutive patients with primary EcoFit® femoral stem implanted at the same operating theatre block of a single tertiary hospital between April 2009 and December 2015. Survival analyses after 6-12 years of follow-up were performed with the Kaplan-Meier method and the Cox regression. Results The cumulative proportion of revision-free surviving EcoFit® femoral stems 5/10 years after the primary implantation was 96/94%, respectively, and the cumulative proportion of unremoved stems was 99/98%, respectively. The EcoFit® stem revision rate of 0.46 per 100 components-years was not significantly different from most Taperloc® cohorts. Higher age increased the risk of subsequent EcoFit® femoral stem revision (hazard ratio 1.039, p = 0.048) while the impact of gender and the operating surgeon was not statistically significant. Conclusions The study presents the first surgeon-stratified cohort analysis of the EcoFit®-Implantcast femoral stem from a single hospital with 5851 component years of observation. Long-term EcoFit® survival rates are comparable to the Taperloc® hip system. Caution is warranted when using such flat cementless single-wedge stems in the elderly population.
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Affiliation(s)
- Samo Roškar
- Faculty of Medicine, University of Ljubljana, Zaloška 9, SI-1000 Ljubljana, Slovenia
| | - Vane Antolič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, Zaloška 9, SI-1000 Ljubljana, Slovenia
| | - Blaž Mavčič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, Zaloška 9, SI-1000 Ljubljana, Slovenia
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Nishioka ST, Andrews SN, Mathews K, Nakasone CK. Varus malalignment of short femoral stem not associated with post-hip arthroplasty fracture. Arch Orthop Trauma Surg 2022; 142:3533-3538. [PMID: 34846588 DOI: 10.1007/s00402-021-04244-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/31/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Periprosthetic femoral fractures are an increasingly common post-operative complication of total hip arthroplasty (THA). Though varus malalignment is known to increase fracture risk in standard-length femoral stems, varus malalignment is not as well studied in short stems. Therefore, the purpose of this study was to determine if varus malalignment contributes to early periprosthetic fracture risk in a cementless taper-wedged, short femoral stem. MATERIALS AND METHODS This retrospective review included 366 consecutive patients (441 THAs) having undergone THA via anterior approach by a single surgeon between July 2014 and December 2016. All patients received the same short, cementless femoral stem. Femoral component angle was measured on 6-week post-THA weight-bearing radiographs, with malalignment defined as a femoral component angle exceeding 0° ± 3°. Periprosthetic femoral fracture and aseptic loosening occurring within 2 years post-THA were recorded. RESULTS The final data analysis included 426 hips with a mean follow-up time of 32.9 ± 10.2 months. Varus and neutral alignment occurred in 84 (19.6%) and 342 (79.9%) of stems, respectively. Three (0.7%) periprosthetic femoral fractures occurred within 2 years, all occurring in patients with neutrally aligned femoral stems. One (0.2%) stem failed due to aseptic loosening and was malaligned. CONCLUSION Despite nearly 20% of stems placed in varus alignment, three of the four early complications occurred in a neutrally aligned stem. Based on these results, forceful intraoperative realignment of a short femoral stem with good initial fixation may present an unnecessary increased risk of intraoperative fracture.
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Affiliation(s)
- Scott T Nishioka
- Bone & Joint Center, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA
| | - Samantha N Andrews
- Bone & Joint Center, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA. .,Department of Surgery, University of Hawai'i, John A. Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
| | - Kristin Mathews
- Bone & Joint Center, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA
| | - Cass K Nakasone
- Bone & Joint Center, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA.,Department of Surgery, University of Hawai'i, John A. Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA
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Kim YH, Park JW, Jang YS, Kim EJ. Does an Ultra-Short Anatomic Cementless Femoral Stem Improve Long-Term (Up to 17 Years) Results in Patients Younger Than 30 Years? J Arthroplasty 2022; 37:2225-2232. [PMID: 35691512 DOI: 10.1016/j.arth.2022.06.003] [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: 04/26/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this long-term (up to 17 years) follow-up study was to determine: (1) clinical results and evidence of clicking or squeaking sounds; (2) radiographic results, including rates of osseointegration, bone remodeling, and osteolysis; (3) rates of complications including thigh pain, periprosthetic fracture, and ceramic fracture; (4) rates of revision; and (5) survival rates of implants in patients younger than 30 years. METHODS We analyzed the results of 240 consecutive primary total hip arthroplasty in 180 patients (118 men and 62 women who had a mean age of 27 years (range, 21 to 30 years)). The mean follow-up was 16 years (range, 14 to 17 years). RESULTS Mean Harris hip score, Western Ontario and McMaster Universities score, and University of California, Los Angeles activity score were 93 points, 18 points, and 7 points, respectively, at final follow-up. Radiographically, all of the acetabular components and all but two femoral components were well-fixed at the final follow-up. No hip had osteolysis or exhibited Grade 3 stress shielding. All but two patients had no groin or thigh pain. No hip had a periprosthetic or ceramic fracture. Eight hips (3%) exhibited squeaking sounds. Two acetabular components and two femoral stems were revised. The survival of the acetabular and femoral component was 99.2% (95% confidence interval, 94 to 100%). CONCLUSION The results of the present long-term study of ultra-short anatomic cementless femoral stems suggest excellent clinical and radiographic results in patients younger than 30 years.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center of Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Young-Soo Jang
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Eun-Jung Kim
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
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Does femoral stem choice influence fracture type or incidence for direct anterior approach total hip arthroplasty? Arch Orthop Trauma Surg 2022; 142:3515-3521. [PMID: 34729641 DOI: 10.1007/s00402-021-04236-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Despite similar fracture rates, the incidence of intraoperative and post-operative fractures between standard (ST) length and short (SH) femoral stems remains unclear. Therefore, this study compared the incidence of intraoperative and early postoperative fractures between three ST and a single tapered-wedge SH femoral stem. MATERIALS AND METHODS Data were retrospectively collected on 1113 patients (1306 hips) having undergone total hip arthroplasty, via the anterior approach on a fracture table, between 2014 and 2019. One surgeon completed all ST procedures (314 hips), using one of three implants without discretion. One surgeon completed all SH procedures (992 hips), using one implant design. Differences between ST and SH groups were evaluated by independent t tests (continuous variables) and Chi-square tests (categorical variables). RESULTS Patients in the SH group were significantly older (p < 0.001) and had a lower body mass index (p = 0.001) compared to the ST group. The total number of fractures was 12 (3.8%) and 14 (1.4%) in the ST and SH groups, respectively. The 12 ST fractures occurred intraoperatively, compared to two (0.2%) in the SH group. The remaining seven (0.7%) SH fractures occurred post-operatively. There was no difference in fracture rate between the three ST designs (p = 0.882). Interestingly, five (0.5%) insufficiency fractures were diagnosed in the SH group. CONCLUSION The risk of intraoperative and post-operative fractures following anterior total hip arthroplasty may be biased toward ST and SH implants, respectively. These results, along with the presence of five insufficient fractures, identify potential fracture risks and mechanisms for specific implant designs.
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Selecting a Press-fit Stem for Total Hip Arthroplasty: The Rationale and Evolution of the Modern Femoral Prosthesis. J Am Acad Orthop Surg 2022; 30:e1279-e1290. [PMID: 35962989 DOI: 10.5435/jaaos-d-22-00074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Noncemented press-fit femoral stems predominate in total hip arthroplasty for all age groups with generally excellent long-term survivorship. The 2021 American Joint Replacement Registry reports that 96% of all elective primary total hip arthroplasties used noncemented femoral implant fixation. 1 Today, there are many styles of press-fit stems, each with supposed benefits, based on a range of design philosophies. Design aspects to consider when selecting a stem are numerous, including stem geometry, stem length, collared or collarless, material properties, and surface structure. Although most stem designs demonstrate excellent results, the differences in stem designs are intimately linked to additional factors such as ease of use/implantation, percentage of surface osseointegration, overall bone removal versus bone stock preservation, subsequent femoral stress shielding, and consideration of complexity of later revision. A surgeon with a broad understanding and appreciation of femoral stem designs should be prepared to select between the multitude of options to best serve individual patients.
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Luger M, Stiftinger J, Allerstorfer J, Hochgatterer R, Gotterbarm T, Pisecky L. High varus stem alignment in short-stem total hip arthroplasty: a risk for reconstruction of femoro-acetabular offset, leg length discrepancy and stem undersizing? Arch Orthop Trauma Surg 2022; 142:2935-2944. [PMID: 34554313 PMCID: PMC9474344 DOI: 10.1007/s00402-021-04176-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/09/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE Short stems are increasingly used in in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Short stems can be inserted in a more varus position compared to conventional straight stems. This poses the risk of final varus misplacement of the femoral component, which is not intended in all femoral short stems. METHODS We wanted to evaluate the effect of a high varus stem positioning in MIS THA on hip offset, leg length and femoral canal fill index. A series of 1052 consecutive THAs with a singular cementless femoral short stem and press-fit cup was retrospectively screened for inclusion. One hundred six patients with unilateral THA and a contralateral healthy hip met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior-posterior postoperative radiographs. Patients were divided into Group A (varus stem alignment ≤ 3°) and Group B (varus stem alignment > 3°). RESULTS Hip offset (HO) increased significantly in Group B by 4 mm (p = 0.013). No influence on leg length difference was detected in both groups. Preoperative CCD angle was significantly lower in Group B (p < 0.001). Canal Fill Indices (CFI) were significantly lower in Group B (CFI I: p < 0.001; CFI II p = 0.003; CF III p = 0.002). CONCLUSION High varus stem alignment > 3° leads to a statistically significant but minor increase in HO and poses the risk of stem undersizing. A preoperatively low genuine CCD angle pose a risk for varus stem positioning.
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Affiliation(s)
- Matthias Luger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria. .,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria. .,Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria.
| | - Julian Stiftinger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Jakob Allerstorfer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Rainer Hochgatterer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Lorenz Pisecky
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
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Kanaizumi A, Suzuki D, Nagoya S, Teramoto A, Yamashita T. Patient-specific three-dimensional evaluation of interface micromotion in two different short stem designs in cementless total hip arthroplasty: a finite element analysis. J Orthop Surg Res 2022; 17:437. [PMID: 36175915 PMCID: PMC9524017 DOI: 10.1186/s13018-022-03329-5] [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: 04/23/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Evaluation of micromotion in various activities in daily life is essential to the assessment of the initial fixation of cementless short stems in total hip arthroplasty. This study sought to evaluate three-dimensionally the micromotion of two types of cementless short stems. Methods Two types of stems were used: the Fitmore stem with a rectangular cross-section (rectangular stem) and the octagonal-oval GTS stem with fins (finned stem). Finite element analysis was used to calculate the micromotion of two activities that place a heavy load on the stem (single-leg stance and stair climbing). Three values were measured: the magnitude of micromotion (mean and 95th percentile), the location of micromotion above the 95th percentile value, and the directions of the micromotion vector. Results 1. There was no significant difference in the magnitude of the micromotion between the rectangular stem and finned stem groups for single-leg stance or stair climbing. 2. In both groups, the micromotion was greatest at the proximal and distal ends. 3. The direction of the micromotion was similar in both groups; internal rotation occurred from the distal to the middle of the stem during stair climbing. Conclusions The rectangular stem had comparable initial fixation to that of the finned stem. In both models, the micromotion was greater at the proximal and distal ends. The direction of the micromotion was not dependent on the stem shape but on the direction of the load on the artificial femoral head. These results will be important for stem selection and future stem development. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03329-5.
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Affiliation(s)
- Arata Kanaizumi
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, 291, Minami 1 Jo Nishi 16 Chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Daisuke Suzuki
- Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, 2-10-10 Satomi, Chitose, Hokkaido, 066-0055, Japan
| | - Satoshi Nagoya
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Minami 1 Jo Nishi 17 Chome, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, 291, Minami 1 Jo Nishi 16 Chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, 291, Minami 1 Jo Nishi 16 Chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Del Río-Arteaga M, Payo-Ollero J, Vallejo M, Serrano-Toledano D, García-Benítez B, Ribera J. Short neck-preserving femoral stem for total hip arthroplasty: medium-term results of a 68-case series. Arch Orthop Trauma Surg 2022; 142:2093-2101. [PMID: 34302520 DOI: 10.1007/s00402-021-04069-7] [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: 04/03/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Short stems seem to be a good alternative for young patients as they offer promising results, rapid recovery and preservation of metaphyseal bone stock. This is one of the few studies in the literature to report medium-term clinical-radiological results for short hip stems. MATERIALS AND METHODS This prospective study evaluated 68 short femoral stems in 63 patients treated with total hip replacement. Clinical, functional and quality-of-life outcomes were measured at 6 and 12 months, and annually thereafter until the end of follow-up. The radiological analysis included measurements of potential leg length discrepancies, stem alignment and signs compatible with stress shielding. RESULTS Fifty-four males (59 hips) and nine females (9 hips) of an average age of 44.3 years (range, 25-68) were studied. The most common diagnosis was osteoarthritis (51.5%). Mean overall follow-up was 7.8 years (range, 5.8-9.8). The overall survival rate was 97.1% (95% CI 88.7-99.7%). Surgery resulted in an increase of 42.3 ± 1.1 points in the modified Harris Hip Score and 21.9 ± 0.6 points in the Oxford Hip Score (p < 0.001, respectively). Moreover, the pain score as measured on a numerical rating scale (NRS) improved from 95.8 to 36.3. As regards function, an improvement was observed from 3.2 ± 0.8 points to 6.8 ± 1.14 points on the University of California at Los Angeles activity score (p < 0.001, respectively). The radiological analysis showed an absence of radiolucencies or stress-shielding throughout the series. The complications rate at the end of follow-up was 5.7%. CONCLUSIONS The use of ultra-short cylindrical stems with complete anchorage in the femoral neck was shown to offer promising medium-term results. Such stems appear to be a good option for young patients, who are likely to require several revisions over their lifetime.
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Affiliation(s)
- Marta Del Río-Arteaga
- Orthopaedic Surgery and Traumatology Department, Hospital San Juan de Dios del Aljarafe, Av. San Juan de Dios, s/n, 41930, Bormujos, Sevilla, Spain.
| | - Jesús Payo-Ollero
- Orthopaedic Surgery and Traumatology Department, Hospital Viamed Santa Ángela de la Cruz, Av. de Jerez, 59, 41014, Sevilla, Spain
| | - Mercedes Vallejo
- Musculoskeletal Radiology Department, Hospital Virgen del Rocio, Av. Manuel Siurot s/n, 41013, Sevilla, Spain
| | - David Serrano-Toledano
- Orthopaedic Surgery and Traumatology Department, Hospital Viamed Santa Ángela de la Cruz, Av. de Jerez, 59, 41014, Sevilla, Spain
| | - Boris García-Benítez
- Orthopaedic Surgery and Traumatology Department, Hospital San Juan de Dios del Aljarafe, Av. San Juan de Dios, s/n, 41930, Bormujos, Sevilla, Spain
| | - Juan Ribera
- Orthopaedic Surgery and Traumatology Department, Hospital Viamed Santa Ángela de la Cruz, Av. de Jerez, 59, 41014, Sevilla, Spain
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Suksathien Y, Chuvanichanon P, Tippimanchai T, Sueajui J. Insufficient lateral stem contact is an influencing factor for significant subsidence in cementless short stem total hip arthroplasty. World J Orthop 2022; 13:444-453. [PMID: 35633743 PMCID: PMC9124996 DOI: 10.5312/wjo.v13.i5.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/25/2022] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Subsidence is one of the concerning early complications in cementless femoral stem. Few publications have studied the influencing factors for subsidence in short cementless stems, due to their metaphyseal anchoring without diaphyseal invasion, they might demonstrate different subsidence patterns than with the conventional stems.
AIM To analyze the factors associated with significant subsidence in short stems, including any radiographic parameters.
METHODS The digitized radiographs of 274 consecutive short stem total hip arthroplasties were retrospectively reviewed. Subsidence, neck-filling ratio (NFR), seating height and lateral stem contact were evaluated after a minimum of two years follow-up. A threshold of subsidence > 3 mm was considered a clinically significant migration.
RESULTS For the entire cohort, subsidence occurred in 75 cases (27.4%) with the mean stem subsidence of 0.5 mm. (0-12.7, 1.68). Twelve hips (4.4%) had significant subsidence (> 3 mm). The univariate regression analysis demonstrated that age, diagnosis, BMI, Dorr’s type B, NFR, and seating height had no significant influence on significant subsidence, whereas insufficient lateral stem contact (≥ 1 mm) did have a statistically significant influence [Odds ratio (OR) = 5.02; 95%CI: 1.3-18.9; P = 0.017]. The multivariate regression analysis also demonstrated that insufficient lateral stem contact was a statistically significant influencing factor (OR = 5.5; 95%CI: 1.4-21.4; P = 0.014). There was no femoral stem revision for aseptic loosening in our cohort.
CONCLUSION This study demonstrated that insufficient lateral stem contact was a statistically significant influencing factor on significant subsidence. Therefore, it is a particularly important step to create proper lateral cortical contact when performing the short stem total hip arthroplasty.
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Affiliation(s)
- Yingyong Suksathien
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Muang 30000, Nakhon Ratchasima Province, Thailand
| | - Pattawat Chuvanichanon
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Muang 30000, Nakhon Ratchasima Province, Thailand
| | - Thanut Tippimanchai
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Muang 30000, Nakhon Ratchasima Province, Thailand
| | - Jithayut Sueajui
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Muang 30000, Nakhon Ratchasima Province, Thailand
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Liu Y, Wei WX, Zeng Y, Ma J, Yang J, Shen B. Comparison of Femoral Bone Mineral Density Changes around 3 Common Designs of Cementless Stems after Total Hip Arthroplasty-A Retrospective Cohort Study. Orthop Surg 2022; 14:1059-1070. [PMID: 35466536 PMCID: PMC9163965 DOI: 10.1111/os.13265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
Objective The aim of this study was to compare the periprosthetic BMD changes around Tri‐Lock “Bone Preserving Stem” with the other two common and longer stems (Corail and Summit) after THA. Methods It was a retrospective cohort study followed patients underwent the total hip arthroplasty from January 2013 to December 2015. They were selected and followed from January 2013 to Janaury 2020. Patients without osteoporosis underwent hip replacements with three aimed stems were included. Among the 138 patients included, 49 patients received the Tri‐Lock stem, 44 patients received the Corail stem, and 45 patients received the Summit stem. The periprosthetic BMD changes evaluated by the Dual energy X‐ray absorptiometry (iDXA) measurement according to the seven Gruen zones was the primary outcome. The Radiographic changes including spot welds, pedestal sign and grade of stress shielding was evaluated by the consecutive hip images. Einzel‐Bild‐Roentgen‐Analyze‐femoral component analysis (EBRA‐FCA) was used to measure the stem migration at 5 years postoperatively. Patient‐reported outcomes (PROMs) and adverse events were assessed and compared in three groups. Finally, the subgroups for the periprosthetic BMD changes, radiological and clinical outcomes were made based on the age, gender and length of follow‐up. Results A total of 138 patients were retrospectively followed for an average of 4.66 years. Excepting the different stems used in three groups, the age, gender and other characteristics of patients included were similar between groups. There was no significant difference between the three groups in periprosthetic BMD changes over postoperative 5 years. The Summit stem shown more BMD loss in Gruen zone 1 compared with the Tri‐Lock and Corail stems without significant difference (7.49%, −1.89% and −2.62%, respectively, P = 0.42). And the most prominent BMD loss was found in Gruen zone 7 for all three stems (−12.60%, −11.84%, and −9.56%, respectively, P = 0.91). The spot weld was significantly more common around the Corail stem, while there was no difference in the stem migration between three groups. Patient reported outcomes (PROMs) were significantly improved compared with the preoperative values. Regarding the rate of postoperative complications, two patients underwent the dislocation and 25 patients sometimes felt mild to moderate thigh pain. Subgroup analysis showed that female patients older than 50 years lost more BMD and had lower clinical scores, while the stem stability was not good enough in male patients. Conclusions The Tri‐Lock Bone Preserving Stem did not show significant difference in periprosthetic BMD changes compared with the other two conventional longer stems at 5 years after THA.
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Affiliation(s)
- Yuan Liu
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wen-Xing Wei
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Zeng
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Ma
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bin Shen
- Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Rivera F, Comba LC, Bardelli A. Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review. World J Orthop 2022; 13:388-399. [PMID: 35582154 PMCID: PMC9048494 DOI: 10.5312/wjo.v13.i4.388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/31/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The direct anterior approach for total hip arthroplasty (DAA-THA) is increasing in popularity due to some advantages such as less surgical trauma, minimal dissection of soft tissues, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation. On the other hand, the literature reports a high rate of intraoperative complications, with many different rates and complication types in the published papers.
AIM To analyze our complications comparing results with the literature; to report measures that we have taken to reduce complications rate.
METHODS All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre, between January 2010 and December 2019 were included in this retrospective study. All surgeries were performed using cementless short anatomical or straight stems and press fit cups. Patients’ follow-up was performed, at 6 wk, 3 mo, then annually post-surgery with clinical and radiological evaluation. Primary outcomes were stem revision for aseptic loosening and all-cause stem revision. Second outcome was intra-operative and post-operative complications identification.
RESULTS A total of 394 patients underwent DDA-THA from January 2010 and December 2019, for a total of 412 hips; twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study. The average age at the time of surgery was 61 years (range from 28 to 78 years). Mean follow-up time was 64.8 mo (range 12-120 mo). Seven stems were revised. One cortical perforation, one trochanteric and lateral cortical wall intraoperative fracture, one diaphyseal fracture, three clinically symptomatic early subsidence and one late aseptic loosening. We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification. Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage, one early infection, one case of late posterior dislocation, 18 case of asymptomatic stem subsidence, 6 cases of lateral cutaneous femoral nerve dysesthesia.
CONCLUSION DAA is associated to good outcomes and lower incidence of dislocation. Complication rate can be reduced by mindful patient selection, thorough preoperative planning, sufficient learning curve and use of intraoperative imaging.
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Affiliation(s)
- Fabrizio Rivera
- Department of Orthopedic Trauma, SS Annunziata Hospital, Savigliano 12038, Italy
| | - Luca C Comba
- Department of Orthopedic Trauma, Università degli Studi di Torino, Torino 10124, Italy
| | - Alessandro Bardelli
- Department of Orthopedic Trauma, SS Annunziata Hospital, Savigliano 12038, Italy
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Tottas S, Ververidis A, Kougioumtzis I, Tilkeridis K, Tsigalou C, Karaglani M, Drosos G. MINIMA Short Stem Versus Standard Profemur (TL) Stem in Primary Total Hip Replacement: A Comparative Study. Cureus 2022; 14:e23771. [PMID: 35509762 PMCID: PMC9062282 DOI: 10.7759/cureus.23771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 12/28/2022] Open
Abstract
Background: The objective of our study was to compare a novel squared section, tapered design - with four conicity - short stem, the MINIMA® short stem with the cementless Profemur® TL standard femoral stem in primary total hip arthroplasty (THA) in terms of functional outcomes, radiologic evaluation and other peri-operative and post-operative data. Material and methods: This is a comparative study including 46 patients undergoing primary THA. In 23 patients, the MINIMA® short stem was used. These patients were matched with another 23 patients in whom a cementless Profemur® TL standard femoral stem was used. The levels of the pain were evaluated according to the Visual Analog Scale/Numerical Rating Scale (VAS/NRS). The functional and clinical evaluation of the patients was performed with Harris Hip Score (HHS), Charnley’s Hip score, EuroQol (EQ-5D)-(EQ-100), Patient Health Questionnaire (PHQ-9), and neuropathic pain questionnaire (DN-4). The rest of the comparison data included demographic data, the American Society of Anesthesiologists score (ASA), Charlson Index score, the pre-operative diagnosis, radiographic evaluation, the days of hospitalization, the operating time, incision length, blood loss, and blood transfusion requirements and complication rates. Results: The two cohorts had comparable results regarding all patients’ peri-operative data. The radiographic assessment revealed considerable higher levels of femoral offset and femoral subsidence for the MINIMA group, but within acceptable limits for both cohorts. The majority of the functional and other scores did not give strong prominence to one specific femoral stem. Conclusion: Our comparative study underlined the efficacy of the MINIMA® short stem, due to the fact that it revealed comparable and, in some cases, relatively better short-term outcomes compared with the TL standard femoral stem. Yet, more well-designed long-term research is required in order to further establish its effectiveness.
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Affiliation(s)
- Stylianos Tottas
- Orthopeadics, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, GRC
| | - Athanasios Ververidis
- Orthopeadics, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, GRC
| | - Ioannis Kougioumtzis
- Orthopeadics, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, GRC
| | - Konstantinos Tilkeridis
- Orthopeadics, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, GRC
| | - Christina Tsigalou
- Medical-Molecular Microbiology, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, GRC
| | - Makrina Karaglani
- Laboratory of Pharmacology, Medical School/Democritus University of Thrace, Alexandroupolis, GRC
| | - Georgios Drosos
- Orthopeadics, University General Hosital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, GRC
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Kutzner KP, Freitag T, Bieger R. Defining 'undersizing' in short-stem total hip arthroplasty: the importance of sufficient contact with the lateral femoral cortex. Hip Int 2022; 32:160-165. [PMID: 32644828 PMCID: PMC8978469 DOI: 10.1177/1120700020940276] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Undersizing is 1 of the main reasons for early implant failure. Adequate sizing in short-stem total hip arthroplasty can be challenging and, so far, lacks key decision criteria. METHODS We included 191 calcar-guided short stems. All patients underwent standardised digital anteroposterior imaging pre- and post-surgery and during follow-up. Preoperative planning was performed digitally. Planned stem sizes were retrospectively assessed and compared with the implanted sizes. Additionally, adequate sizing was analysed by determining whether the stem made intraoperative contact with the lateral distal femoral cortex. Implant migration was assessed by Ein-Bild-Roentgen-Analysis Femoral-Component-Analysis 5 years after surgery. Influence of different Dorr types and postoperative centrum-collum-diaphyseal angle (CCD) categories on lateral femoral cortical contact were analysed. Additionally, the Harris Hip Score (HHS) was assessed at final follow-up. Stem-revision rate was documented. RESULTS Implanted stems were at least 2 sizes smaller than those at the preoperative planning in 49 (25.7%) cases. The stem made contact with the lateral distal femoral cortex in only 130 hips (68.1%). Mean subsidence was significantly higher in the no-contact group (2.07 mm, range -7.7 to 1.7) than in the contact group (1.23 mm, range -4.5 to 1.8) at the final follow-up (p = 0.0018). Stems at least 2 sizes smaller than those at preoperative planning showed a significantly higher prevalence of non-contact (46.9% vs. 26.8%) (p = 0.009). Those undersized stems were more likely found in varus hips. No influence of the Dorr classification and the different CCD categories on the probability of achieving sufficient cortical contact was found. HHS showed no intergroup differences. CONCLUSIONS Stems that did not make intraoperative contact with the lateral femoral cortex showed significantly increased axial migration at mid-term follow-up. Thus, the investigated criteria regarding the definition of undersizing in short-stem THA should be acknowledged. No obvious mid-term consequences were noted regarding revision rate. Long-term results are mandatory.
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Affiliation(s)
- Karl P Kutzner
- Department of Orthopaedic Surgery, St.
Josef’s Hospital Wiesbaden, Wiesbaden, Hessen, Germany,Karl P Kutzner, Department of Orthopaedic
Surgery, St. Josef’s Hospital Wiesbaden, Beethovenstraße 20, Wiesbaden, Hessen
65189, Germany.
| | - Tobias Freitag
- Department of Orthopaedic Surgery,
University of Ulm, Ulm, Baden-Württemberg, Germany
| | - Ralf Bieger
- Department of Orthopaedic Surgery,
University of Ulm, Ulm, Baden-Württemberg, Germany
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Yoo JI, Cha Y, Lee YK, Ha YC, Koo KH. Do Cementless Short Tapered Stems Reduce the Incidence of Thigh Pain After Hip Arthroplasty? Systematic Review and Meta-Analysis. J Korean Med Sci 2022; 37:e41. [PMID: 35166078 PMCID: PMC8845099 DOI: 10.3346/jkms.2022.37.e41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine whether short tapered stems reduce the rate of thigh pain through a systematic review and meta-analysis of comparative studies between short tapered stems and standard-length tapered stems. METHODS We conducted a meta-analysis of comparative studies: 1) retrospective studies and 2) randomized controlled trials (RCTs), on 2 stem designs: short tapered stem versus standard-length tapered stem. Studies were selected by means of the following criteria: 1) study design: retrospective comparative studies, prospective comparative studies, RCTs; 2) study population: patients with total hip arthroplasty or hemiarthroplasty for hip disease or hip fracture; 3) intervention: short tapered stem and standard tapered stem; and 4) outcomes; thigh pain, other clinical results. RESULTS Among the 250 articles that were identified at the initial search, 6 studies, 4 RCTs and 2 retrospective comparative studies, were included in this meta-analysis. In the analysis of retrospective studies, the short tapered stem reduced the risk of thigh pain compared to the standard tapered stem (risk ratio [RR] = 0.13; 95% confidence interval [CI], 0.02-0.09; Z = -2.07; P = 0.039). However, in the analysis of RCTs, the incidence of thigh pain was similar between the two stem designs (RR = 1.21; 95% CI, 0.76-1.93; Z = 0.82; P = 0.410). Overall meta-analysis including all studies showed that the short tapered stem did not reduce the incidence of thigh pain compared to the standard-length tapered stem (RR = 0.91; 95% CI, 0.59-1.40; Z = -0.44, P = 0.663). CONCLUSIONS We did not find a significant difference in the incidence of thigh pain between short tapered stem and standard tapered stem in hip arthroplasty. TRIAL REGISTRATION PROSPERO Identifier: CRD42021231240.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Erivan R, Villatte G, Dartus J, Mertl P, Piriou P, Tracol P, Vernizeau M, Mulliez A, Puch JM, Girard J, Descamps S, Boisgard S. French Hip & Knee Society classification of short-stem hip prostheses: Inter- and intra-observer reproducibility. Orthop Traumatol Surg Res 2022; 108:103126. [PMID: 34700060 DOI: 10.1016/j.otsr.2021.103126] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In total hip replacement (THR), a short stem theoretically provides more physiological force transfer to the proximal femur, conserves bone stock and facilitates minimally invasive surgery. On the other hand, such implants involve a learning curve and incur risk of malpositioning or fracture and of secondary mobilization. There are several types of short stem, and classification is needed. Classifications exist, but are based more on implant length than on anchorage zone, and most have not been tested for reproducibility. The French Hip & Knee Society (SFHG) developed a short-stem classification based on anchorage zone inside the femur. The objectives of the present study were: (1) to present the classification, (2) to apply it to the short-stem models available in France and those widely used worldwide, and (3) to assess reproducibility. HYPOTHESIS The SFHG short-stem classification enables reproducible comparison. MATERIAL AND METHOD A short-stem classification according to anchorage zone was drawn up by an expert group. The stems and the classification were presented to 12 surgeons performing THR, who classified the stems according to the classification; a retest was performed 2 months later. RESULTS The classification is based on femoral stem anchorage site, in 5 types: type 1, cephalic; type 2, isolated cervical; type 3, Calcar femorale; type 4, metaphyseal; and type 5, conventional metaphyseal-diaphyseal, with shortened stems. Inter-observer reproducibility was 92.7% [95%CI: 91.7%-93.6%], with kappa 0.785 [95%CI: 0.755-0.814], and Lin test-rest concordance correlation coefficient 0.852 [95%CI: 0.836-0.869]. Intra-observer reproducibility was 94.0% [95%CI: 91.9%-96.1%], with kappa 0.820 [95%CI: 0.759-0.882], and Lin test-retest concordance correlation coefficient 0.820 [95%CI: 0.792-0.849]. DISCUSSION This new classification enables femoral implants to be reproducibly compared according to anchorage zone. LEVEL OF EVIDENCE IV; retrospective study without control group.
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Affiliation(s)
- Roger Erivan
- Hôpital Gabriel Montpied, Université Clermont Auvergne, CHU de Clermont Ferrand, BP 69, 63003 Clermont-Ferrand, France.
| | - Guillaume Villatte
- Hôpital Gabriel Montpied, Université Clermont Auvergne, CHU de Clermont Ferrand, BP 69, 63003 Clermont-Ferrand, France
| | - Julien Dartus
- Service d'orthopédie, Hôpital Roger-Salengro, Centre Hospitalier et Universitaire de Lille, Université de Lille Nord de France, France, place de Verdun, 59000 Lille, France
| | - Patrice Mertl
- Service d'orthopédie-traumatologie, CHU d'Amiens, Site Sud, 80054 Amiens cedex, France
| | | | - Philippe Tracol
- Cité Santé Plus, 1021, avenue Pierre-Mendès-France, 84300 Cavaillon, France
| | | | - Aurélien Mulliez
- Délégation à la Recherche Clinique, Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Jean-Marc Puch
- Clinique Saint-Georges, 2, avenue de Rimiez, 06100 Nice, France
| | - Julien Girard
- Service d'orthopédie, Hôpital Roger-Salengro, Centre Hospitalier et Universitaire de Lille, Université de Lille Nord de France, France, place de Verdun, 59000 Lille, France
| | - Stéphane Descamps
- Hôpital Gabriel Montpied, Université Clermont Auvergne, CHU de Clermont Ferrand, BP 69, 63003 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Hôpital Gabriel Montpied, Université Clermont Auvergne, CHU de Clermont Ferrand, BP 69, 63003 Clermont-Ferrand, France
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Afghanyar Y, Kutzner KP, Pfeil J, Drees P, Rehbein P, Dargel J. Cementless Short Stems in Total Hip Arthroplasty: Chances and Limits. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022. [PMID: 35104904 DOI: 10.1055/a-1678-7684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In recent decades, a large number of cementless short stems have been introduced to the market. The concept aims at saving soft tissue using minimally invasive surgery and at the same time preserving as much bone as possible. In particular, the latest generation of short stems, which are implanted using a calcar-guided round-the-corner technique, are attracting increasing attention. An individualised resection level allows individual stem alignment and thus an ideal reconstruction of the hip anatomy. The early clinical results of short-stem total hip arthroplasty (THA) are promising and have led to an expansion of the indications and limitations for the use of short stems. In particular, the individual positioning in valgus or varus and the resulting individual metaphyseal or metadiaphyseal anchorage offers various possibilities to reconstruct even abnormal joint morphologies. Consequently, short stems are increasingly used in patients with complex anatomical variations or in cases of osteonecrosis of the femoral head. In some various cases, they can also be used in revision or conversion arthroplasty. In some patients, short stems can also be used after femoral neck fracture. Currently, scientific data on those areas of indication of short-stem THA is scarce.
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Affiliation(s)
- Yama Afghanyar
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Karl Philipp Kutzner
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland.,Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Joachim Pfeil
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Philipp Drees
- Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Philipp Rehbein
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Jens Dargel
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
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De Santis V, Bonfiglio N, Basilico M, Tanzi Germani G, Matrangolo MR, Carosini A, Malerba G, Maccauro G. Clinical and radiographic outcomes after total hip arthroplasty with the NANOS neck preserving hip stem: a 10 to 16-year follow-up study. BMC Musculoskelet Disord 2022; 22:1061. [PMID: 35012499 PMCID: PMC8750837 DOI: 10.1186/s12891-021-04953-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Short-stem Hip Arthroplasty (SHA) are increasingly implanted in recent years thanks to their potential advantage in preserving metaphyseal bone-stock. Among them, the NANOS® short-stem implant demonstrated satisfactory results to short and mid-term. The purpose of this retrospective study was to evaluate the clinical and radiographic outcome of the Nanos® short stem at a minimum follow-up of 10 years. METHODS Sixty-seven patients aged 53 ± 20 years were enlisted in the study, for a total of 72 hips. Primary outcomes were survivorship of the implant and clinical outcome measured using the Hip disability and Osteoarthritis Outcome scores (HOOS) and the Short Form Survey (SF12) questionnaire. The secondary outcome was a radiological evaluation calculating the inclination and the anteversion angle of the acetabular cup for each implant and investigating osteolysis, heterotopic ossifications and stem position. RESULTS We observed a 95.5% stem survivorship. The complication rate was 7.6% and three implants underwent revision because of an aseptic loosening, an infection and a periprosthetic fracture due to trauma. Among 58 patients (63 hips) evaluated in an outpatient visit 10-16 years after surgery, improvement in clinically relevant scores comparing with baseline was observed: HOOS score increased after surgery in all its subcategories (from 32.25 ± 14.07% up to 91.91 ± 9.13%) as well as SF12 which increased by more than 18 percentage points. On clinical assessment, the range of motion (ROM) was restored at follow-up, 1 patient (1.7%) showed a squeaking hip and 2 (3.4%) reported leg-length discrepancy. Neutral stem positioning was achieved in 58 hips and heterotopic ossifications occurred in 10 hips (16%). CONCLUSIONS The current study reports good clinical and radiological outcomes following NANOS® short-stem hip implant at minimum 10 years-follow-up. Since the high rate of stem survivorship, the low complication rate demonstrated and the overall patient satisfaction, our results suggest NANOS® neck-preserving prostheses should be considered as a valid alternative to standard implants.
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Affiliation(s)
- Vincenzo De Santis
- Department of Orthopaedics, Mater Olbia Hospital, Olbia, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nadia Bonfiglio
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Mattia Basilico
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | | | - Maria Rosaria Matrangolo
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Angelo Carosini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Giuseppe Malerba
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy.
| | - Giulio Maccauro
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
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Nyström A, Kiritopoulos D, Mallmin H, Lazarinis S. Continuous periprosthetic bone loss but preserved stability for a collum femoris-preserving stem: follow-up of a prospective cohort study of 21 patients with dualenergy X-ray absorptiometry and radiostereometric analysis with minimum 8 years of follow-up. Acta Orthop 2022; 93:206-211. [PMID: 34984482 PMCID: PMC8815616 DOI: 10.2340/17453674.2021.1080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - We previously described a decrease in bone mineral density (BMD) in the calcar region 2 years after insertion of the collum femoris-preserving (CFP) stem, but the implants were stable. Now we have examined the long-term changes in periprosthetic BMD and stability of the CFP stem. Patients and methods - We conducted a minimum 8-year follow-up of 21 patients from our original investigation. We examined periprosthetic BMD by dual-energy X-ray absorptiometry (DEXA) and implant stability by radiostereometric analysis (RSA). Results - Between 2 and 8 years 1 stem was revised due to aseptic loosening. Between 2 and 8 years we found a 14% (95% confidence interval [CI] 9-19) reduction in BMD in Gruen zone 6 and 17% (CI 6-28) in Gruen zone 7. From baseline the reduction in BMD was 30% (CI 23-36) in Gruen zone 6, 39% (CI 31-47) in Gruen zone 7, and 19% (CI 14-23) in Gruen zone 2. Between 2 and 8 years, RSA (n = 17) showed a mean translation along the stem axis of 0.02mm (CI -0.02 to 0.06) and a mean rotation around the stem axis of 0.08° (CI -0.26 to 0.41). From baseline mean subsidence was 0.07 mm (CI -0.16 to 0.03) and mean rotation around the stem axis was 0.23° (CI -0.23 to 0.68) at 8 years. Interpretation - There was continuous loss of proximomedial BMD at 8 years while the CFP stem remained stable. Proximal periprosthetic bone loss cannot be prevented by this stem.
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Affiliation(s)
- Andreas Nyström
- Department of Surgical Sciences/Section of Orthopaedics, Uppsala University, Uppsala, Sweden.
| | - Demostenis Kiritopoulos
- Department of Surgical Sciences/Section of Orthopaedics, Uppsala University, Uppsala, Sweden.
| | - Hans Mallmin
- Department of Surgical Sciences/Section of Orthopaedics, Uppsala University, Uppsala, Sweden.
| | - Stergios Lazarinis
- Department of Surgical Sciences/Section of Orthopaedics, Uppsala University, Uppsala, Sweden.
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Kim YH. Ultra-Short Bone Conserving Cementless Femoral Stem. Hip Pelvis 2021; 33:181-189. [PMID: 34938687 PMCID: PMC8654591 DOI: 10.5371/hp.2021.33.4.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
Excellent long-term results have been reported with conventional length cementless femoral stems in total hip arthroplasty; however, proximal stress shielding and thigh pain are still a concern. Metaphyseal engaging bone conserving short stems provide theoretical benefits compared with conventional length cementless stems, including avoiding proximal-distal mismatch, decreasing proximal stress shielding, and limiting perioperative fractures. The purpose of the ultra-short bone conserving cementless stem was to reproduce natural load transfer with an ultra-short stem obtaining optimal stability using the morphology of the proximal femur. Loss of stability of the stem and failure of osseous ingrowth is a potential concern with the use of ultra-short proximal loading cementless femoral stems. Ultra-short, metaphyseal-fitting anatomic or non-anatomic cementless femoral stems provided stable fixation without relying on diaphyseal fixation in young and elderly patients, suggesting that metaphyseal-fitting alone is sufficient in young and elderly patients who have good bone quality.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, Seoul Metropolitan SeoNam Hospital, Seoul, Korea
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46
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The morphology of the proximal femur in cementless short-stem total hip arthroplasty: No negative effect on offset reconstruction, leg length difference and implant positioning. J Orthop Surg Res 2021; 16:730. [PMID: 34930358 PMCID: PMC8686665 DOI: 10.1186/s13018-021-02876-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Correct reconstruction of hip offset (HO) and leg length are important for clinical–functional outcome and patient satisfaction in total hip arthroplasty (THA). The morphology of the proximal femur can pose a risk for increased leg length difference (LLD) in cementless straight-stem THA. We therefore wanted to evaluate, if this is also applicable in THA with a cementless meta-diaphyseal short stem. Methods In a retrospective study, 106 patients (index surgery 2014–2019) with unilateral THA and a morphologically healthy hip as a reference (Kellgren–Lawrence ≤ 1) were included. The same cementless short stem with meta-diaphyseal fixation and cementless press-fit cup was implanted. The proximal femur was rated by Dorr’s classification, and subgroups were formed afterward. Measurements were carried out on preoperative and 3 months postoperative anterior–posterior radiographs of the pelvis. Kruskal–Wallis test, Fisher’s exact test and binary logistic regression were performed to evaluate the influence of the anatomical shape on postoperative leg length difference and offset reconstruction. Results The Dorr type did not show any significance influence on LLD (p = 0.532), or postoperative difference in femoral offset (p = 0.243), acetabular offset (p = 0.106) and hip offset (p = 0.698). Stem alignment (p = 0.705) and canal fill indices (CFI I: p = 0.321; CFI II: p = 0.411; CFI III: p = 0.478) were also without significant differences. Logistic regression did not show any significant increased risk for a LLD ≥ 5 mm or ≥ 10 mm as well as HO ≥ 5 mm or ≥ 10 mm. Conclusion Reconstruction of hip offset and postoperative leg length difference is not negatively influenced by Dorr type, canal flare index, cortical index and canal-to-calcar ratio in cementless short-stem THA. Implant positioning and canal fill are also not negatively affected by the anatomical shape of the proximal femur. Level of evidence: Level IV.
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Liu B, Wang H, Zhang N, Zhang M, Cheng CK. Femoral Stems With Porous Lattice Structures: A Review. Front Bioeng Biotechnol 2021; 9:772539. [PMID: 34869289 PMCID: PMC8637819 DOI: 10.3389/fbioe.2021.772539] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/29/2021] [Indexed: 01/16/2023] Open
Abstract
Cementless femoral stems are prone to stress shielding of the femoral bone, which is caused by a mismatch in stiffness between the femoral stem and femur. This can cause bone resorption and resultant loosening of the implant. It is possible to reduce the stress shielding by using a femoral stem with porous structures and lower stiffness. A porous structure also provides a secondary function of allowing bone ingrowth, thus improving the long-term stability of the prosthesis. Furthermore, due to the advent of additive manufacturing (AM) technology, it is possible to fabricate femoral stems with internal porous lattices. Several review articles have discussed porous structures, mainly focusing on the geometric design, mechanical properties and influence on bone ingrowth. However, the safety and effectiveness of porous femoral stems depend not only on the characteristic of porous structure but also on the macro design of the femoral stem; for example, the distribution of the porous structure, the stem geometric shape, the material, and the manufacturing process. This review focuses on porous femoral stems, including the porous structure, macro geometric design of the stem, performance evaluation, research methods used for designing and evaluating the femoral stems, materials and manufacturing techniques. In addition, this review will evaluate whether porous femoral stems can reduce stress shielding and increase bone ingrowth, in addition to analyzing their shortcomings and related risks and providing ideas for potential design improvements.
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Affiliation(s)
- Bolun Liu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Huizhi Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ningze Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Min Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Cheng-Kung Cheng
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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Kim HS, Lee YK, Ha JH, Park SJ, Park JW, Koo KH. Distribution and outliers of anteversion of short-length cementless stem. INTERNATIONAL ORTHOPAEDICS 2021; 46:725-732. [PMID: 34799778 DOI: 10.1007/s00264-021-05265-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Inadequate stem version might lead to impingement and instability after cementless total hip arthroplasty (THA). We evaluated (1) the distribution of short-stem anteversion, (2) the proportion of stems with an anteversion less than 5° or larger than 25°, (3) combined cup and stem anteversion, and (4) dislocation rate. MATERIALS AND METHODS We evaluated the native femoral anteversion and stem anteversion in 340 patients (340 THAs): 144 men and 196 women. Their mean age was 56.2 (22-87) years and mean body mass index was 25.1 (15.2-40.7) kg/m2. The femoral neck anteversion was measured on pre-operative CT scan and the stem anteversion was obtained during the operation. The safe zone of the stem anteversion was defined as 5 to 25°. RESULTS The femoral neck anteversion ranged from -15 to 61° (mean, 15.0°; SD, ±10.6°). The stem anteversion ranged -7 to 50° (mean, 15.7°; SD, ±9.5°). It was optimal (5-25°) in 71.2% (242/340), insufficient (<5°) in 13.3% (45/340), and excessive (>25°) in 15.6% (53/340). The stem anteversion had a medium correlation with the femoral neck anteversion (correlation coefficient = 0.449). The combined anteversion was 42.0° (range, 35.2-52.3°; SD, ±2.8°). During two to four year follow-up, no hip dislocated. CONCLUSIONS Short-length stem had a great variability in the anteversion and considerable portion (28.9%, 98/340) of stems had an anteversion outside the safe zone. Surgeons should be aware of this variability of stem anteversion to compensate for abnormal stem anteversion, which might lead to impingement and instability after THA.
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Affiliation(s)
- Hong-Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Joo-Hyung Ha
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea
| | - Se Jin Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea.
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Downsizing in total hip arthroplasty. A short stem as a revision implant. DER ORTHOPADE 2021; 51:230-238. [PMID: 34581833 PMCID: PMC8894309 DOI: 10.1007/s00132-021-04168-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/09/2022]
Abstract
Background Short stems have constantly gained popularity in primary total hip arthroplasty (THA) over the last decade. Although cementless short stems are not primarily designed to be used as revision implants, there may be certain indications for which downsizing the femoral component in failed conventional THA is potentially advantageous. Methods In this single center retrospective case series, six patients who underwent revision using a calcar-guided short stem after failed THA are presented. The mean follow-up was 3.32 years (SD 0.63 years). The health status was evaluated by the EQ-5D-5L score. Patient reported outcome measurements (PROM) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain and satisfaction were assessed using a visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignment and signs of aseptic loosening. Complications were documented. Results At last follow-up the mean EQ-5D-5L index was 0.851 (SD 0.098). Clinical outcome was excellent (HHS ≥ 90) in 4 patients and moderate (HHS 71 and 79) in 2 patients. The mean WOMAC score was 9.20% (SD 12.61%). Pain and satisfaction on VAS were 1.00 (SD 1.15) and 9.17 (SD 0.37), respectively. No major complications occurred. To date, no further revision surgery was needed. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fractures were obvious. Conclusion The present case series indicates that in failed conventional THA downsizing may be considered a treatment option, using short stem THA in selected cases.
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Freitag T, Bieger R, Kiefer H, Dornacher D, Reichel H, Ignatius A, Dürselen L. Biomechanics of a calcar loading and a shortened tapered femoral stem: Comparative in-vitro testing of primary stability and strain distribution. J Exp Orthop 2021; 8:74. [PMID: 34491456 PMCID: PMC8423873 DOI: 10.1186/s40634-021-00388-1] [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: 06/19/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The most common femoral short stems available on the market can, in principle, be divided with regard to their anchoring concepts into a calcar loading and a shortened tapered design. The purpose of this study was to compare the primary stability and stress-shielding of two short stems, which correspond to these two different anchoring concepts. Methods Using seven paired fresh frozen human cadaver femurs, primary axial and rotational stabilities under dynamic load (100–1600 N) were evaluated by miniature displacement transducers after 100,000 load cycles. Changes in cortical strains were measured before and after implantation of both stem types to detect implant-specific load transmission and possible stress-shielding effects. Results Reversible and irreversible micromotions under dynamic load displayed no significant differences between the two implants. Implantation of either stem types resulted in a reduction of cortical strains in the proximal femur, which was less pronounced for the calcar loading implant. Conclusions Both short stems displayed comparable micromotions far below the critical threshold above which osseointegration may disturbed. Neither short stem could avoid proximal stress-shielding. This effect was less pronounced for the calcar loading short stem, which corresponds to a more physiological load transmission.
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Affiliation(s)
- Tobias Freitag
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Ralf Bieger
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Hartmuth Kiefer
- Department of Trauma and Orthopaedic Surgery, Lukas Hospital, Buende, Germany
| | - Daniel Dornacher
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, Ulm University Medical Centre, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University Medical Centre, Helmholtzstr. 14, 89081, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University Medical Centre, Helmholtzstr. 14, 89081, Ulm, Germany
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