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Van Beers LWAH, Scheijbeler E, Van Oldenrijk J, Geerdink CH, Niers BBAM, Willigenburg NW, Poolman RW. Short versus conventional straight stem in uncemented total hip arthroplasty: functional outcomes up to 5 years and survival up to 12 years: secondary results of a randomized controlled trial. Acta Orthop 2024; 95:99-107. [PMID: 38318961 PMCID: PMC10846089 DOI: 10.2340/17453674.2024.39964] [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: 02/02/2023] [Accepted: 02/14/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND AND PURPOSE To date, the mid- and long-term outcomes of the Collum Femoris Preserving (CFP) stem compared with conventional straight stems are unknown. We aimed to compare physical function at a 5-year follow-up and implant survival at an average of 10-year follow-up in an randomized controlled trial (RCT). METHODS This is a secondary report of a double-blinded RCT in 2 hospitals. Patients aged 18-70 years with hip osteoarthritis undergoing an uncemented primary THA were randomized to a CFP or a Zweymüller stem. Patient-reported outcomes, clinical tests, and radiographs were collected at baseline, 2, 3, 4, and 5 years postoperatively. Primary outcome was the Hip disability and Osteoarthritis Outcome Score (HOOS) function in activities of daily living (ADL) subscale. Secondary outcomes were other patient-reported outcomes, clinical tests, adverse events, and implant survival. Kaplan-Meier and competing risk survival analyses were performed with data from the Dutch Arthroplasty Registry. RESULTS We included 150 patients. Mean difference between groups on the HOOS ADL subscale at 5 years was -0.07 (95% confidence interval -5.1 to 4.9). Overall survival was 92% for the CFP and 96% for the Zweymüller stem. No significant difference was found. CONCLUSION No significant differences were found in physical function at 5-year and implant survival at 10-year follow-up between the CFP and Zweymüller stems. When taking cup revisions into account, the CFP group showed clinically inferior survival.
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Affiliation(s)
- Loes W A H Van Beers
- Department of Orthopaedic Surgery, OLVG, Amsterdam; Department of Orthopaedic Surgery, St Antonius Hospital, Utrecht.
| | | | | | | | - Bob B A M Niers
- Department of Orthopedic Surgery, Ikazia Hospital, Rotterdam
| | | | - Rudolf W Poolman
- Department of Orthopaedic Surgery, OLVG, Amsterdam; Department of Orthopedic Surgery, LUMC, Leiden, The Netherlands
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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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