1
|
Jacquot L, Machenaud A, Bonnin MP, Chouteau J, Vidalain JP, Ramos-Pascual S, Saffarini M, Dubreuil S. Survival and Clinical Outcomes at 30 to 35 Years Following Primary Total Hip Arthroplasty With a Cementless Femoral Stem Fully Coated With Hydroxyapatite. J Arthroplasty 2022; 38:880-885. [PMID: 36496046 DOI: 10.1016/j.arth.2022.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/28/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of the present study was to update and report clinical outcomes and survival of primary total hip arthroplasty using a cementless double-tapered titanium fully hydroxyapatite-coated stem at a follow-up > 30 years. METHODS The outcomes of this series of 347 primary total hip arthroplasties were already published at a follow-up > 25 years, during which only 12 stems were revised. Since then, there were two additional stem revisions, bringing the total to 14 stem revisions (all of which also required cup revision). Patients still living with the original stem were assessed using the modified Harris Hip Score and patient satisfaction (very satisfied, satisfied, dissatisfied, and very dissatisfied). Revision incidence was calculated using the Kaplan-Meier (KM) method and Cumulative Incidence Function (CIF) at 35 years. RESULTS At a mean follow-up of 33 years (range, 31 to 35 years), 32 patients (34 hips) were still living with the original stem. Their mean modified Harris Hip Score was 86 points (range, 46 to 100) and all patients (100%) were very satisfied or satisfied with surgery. The revision incidence at 35 years considering (a) stem revision for any reason was 9.5% using KM and 4.5% using CIF; (b) stem revision for aseptic loosening was 3.1% using KM and 2.1% using CIF; and (c) reoperation or revision of any component for any reason was 45.3% using KM and 26.3% using CIF. CONCLUSION The present study has demonstrated excellent survival at 35 years for a cementless double-tapered titanium fully hydroxyapatite-coated stem. LEVEL OF EVIDENCE Level IV, Retrospective cohort study.
Collapse
Affiliation(s)
- Laurent Jacquot
- Artro Institute, Annecy Le Vieux, France; Clinique d'Argonay, Ramsay Santé, Annecy, France
| | - Alain Machenaud
- Artro Institute, Annecy Le Vieux, France; Clinique d'Argonay, Ramsay Santé, Annecy, France
| | - Michel P Bonnin
- Artro Institute, Annecy Le Vieux, France; Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Julien Chouteau
- Artro Institute, Annecy Le Vieux, France; Clinique d'Argonay, Ramsay Santé, Annecy, France
| | -
- ReSurg SA, Nyon, Switzerland
| | - Jean-Pierre Vidalain
- Artro Institute, Annecy Le Vieux, France; Clinique d'Argonay, Ramsay Santé, Annecy, France
| | | | | | | |
Collapse
|
2
|
Yacovelli S, Ottaway J, Banerjee S, Courtney PM. Modern Revision Femoral Stem Designs Have No Difference in Rates of Subsidence. J Arthroplasty 2021; 36:268-273. [PMID: 32863074 DOI: 10.1016/j.arth.2020.07.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Both modular and monoblock tapered fluted titanium (TFT) stems have gained popularity over fully porous-coated cylindrical (FPCC) femoral stem designs, but limited data exist comparing subsidence rates following revision total hip arthroplasty (THA). The purpose of this study is to determine differences in subsidence and clinical outcomes among 3 revision femoral stem designs. METHODS We reviewed a consecutive series of 335 patients who underwent femoral component revision to a cementless modular TFT (n = 225), monoblock TFT (n = 63), or FPCC (n = 47) stem between 2012 and 2019. We evaluated radiographic subsidence rates, re-revision rates, and patient-reported outcomes between the 3 stems. A multivariate regression analysis was performed to determine the independent effect of stem type on the risk of subsidence >5 mm. RESULTS At an average follow-up of 39 months (range, 12 to 96 months), there were no differences in mean subsidence rates (3.5 vs 2.4 vs 2.1 mm, P = .14), HOOS Jr scores (78 vs 74 vs 64 points, P = .15), or aseptic re-revision rates (4% vs 3% vs 0%, P = .29) between modular TFT, monoblock TFT, and FPCC stems. Although modular TFT stems were more often used in patients with extensive femoral bone loss (Paprosky III and IV), there were no differences in subsidence rates >5 mm among the 3 stems (P > .05) in multivariate analysis. CONCLUSION Modular TFT, monoblock TFT, and FPCC femoral stem designs all perform well in revision THA with no difference in clinical outcomes or subsidence rates. Surgeons should select the stem which they feel is the most clinically appropriate.
Collapse
Affiliation(s)
- Steven Yacovelli
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jesse Ottaway
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Samik Banerjee
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA
| |
Collapse
|
3
|
Song JH, Jo WL, Lee KH, Cho YJ, Park J, Oh S. Subsidence and perioperative periprosthetic fractures using collarless hydroxyapatite-coated stem for displaced femoral neck fractures according to Dorr type. J Orthop Surg (Hong Kong) 2020; 27:2309499019877530. [PMID: 31578134 DOI: 10.1177/2309499019877530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hydroxyapatite (HA)-coated stem has been introduced to decrease complications and eventually achieve quicker implant ingrowth and long-term stability. The aim of this study was to determine subsidence rate and incidence of perioperative periprosthetic fracture (PPF) of uncemented collarless Corail stem for displaced femoral neck fractures according to Dorr type. METHODS A retrospective review of plain radiographs and clinical data was carried out to identify consecutive patients who underwent uncemented hip hemiarthroplasty using collarless HA-coated Corail stem between March 2010 and August 2014. The risk of subsidence and PPF according to Dorr type was evaluated. RESULTS Dorr types A, B, and C were found in 66 (median age 74, 29.7%), 107 (median age 77, 48.2%), and 49 (median age 80, 22.1%) cases, respectively. Subsidence of stem occurred in eight (3.6%) cases. Dorr type had significant relationship (p < 0.05) with subsidence. Type C canals had higher rates of subsidence. PPFs occurred in 11 (5.0%) cases without showing significant difference among Dorr types not significant (n.s.). Female gender was not influential on subsidence (n.s.) and PPF (n.s.). CONCLUSION Dorr type C had higher risk of subsidence when using uncemented collarless HA-coated stem. Dorr canal type had no bearing on risk of PPFs. Women did not have significantly higher risk of both subsidence and PPFs compared to men. A collarless fully HA-coated Corail stem had 3.6% of radiological subsidence and 5.0% of PPF risk.
Collapse
Affiliation(s)
- Joo-Hyoun Song
- Department of Orthopaedic Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kee-Haeng Lee
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Yoon-Joo Cho
- Department of Orthopaedic Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Joonyoung Park
- Department of Orthopaedic Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Seungbae Oh
- Department of Orthopaedic Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| |
Collapse
|
4
|
Fazal MA, Shah S, Subramanian P. Hydroxyapatite coated hip hemiarthroplasty: Morbidity and mortality. J Clin Orthop Trauma 2020; 11:S568-S572. [PMID: 32774030 PMCID: PMC7394800 DOI: 10.1016/j.jcot.2020.04.020] [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: 12/26/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Use of uncemented femoral stems for treating displaced intra capsular hip fractures in elderly is increasing worldwide. The aim of our study is to evaluate morbidity and mortality of treatment with a modular fully hydroxyapatite-coated collared femoral stem. MATERIAL AND METHODS 259 consecutive patients were included in the study. Patients were followed up for12 months. Outcomes were perioperative mortality, perioperative fractures, 30, 120 and 365-day mortality, revision surgery within 30 days and twelve months, length of stay, discharge destination and mobility. RESULTS Mean age was 85.4 years. 71.8% were female. 63.3% of patients were ASA grade III and IV. 87.6% of patients were operated within 36 h of attendance to hospital. The mortality rate at 30, 120, and 365 days was 8.2%, 15%, and 18.4% respectively with no peri-operative mortality. 0.8% of the patients sustained a peri-operative fracture below the lesser trochanter. Infection and dislocation were 1.1% and 1.5% respectively. 3.4% of the patient underwent further surgery within thirty days but no further surgery in next twelve months. Mean inpatient acute length of stay was 16.8 days, 41.5% of the patients returned to their own or sheltered accomodation within thirty days. 68% of the patients were mobile outdoors prior to the fracture that dropped to 25% at one year after surgery. DISCUSSION Our study demonstrates that treatment of displaced intracapsular femoral neck fractures in elderly with a full hydroxyapatite coated collared stem has satisfactory outcomes, no perioperative mortality, low one-year mortality and low revision hence a dependable option.
Collapse
Affiliation(s)
- Muhammad Ali Fazal
- Corresponding author. Department of Trauma & Orthopaedics, Royal Free NHS Foundation Trust, The Ridgeway, Enfield, EN2 8JL, United Kingdom.
| | | | | |
Collapse
|
5
|
Rubio I, Bellostas L, García-Rey E. Radiological subsidence and acetabular erosion after tapered uncemented hemiarthroplasty in femoral neck fractures a 10- to 13- year follow-up study. Injury 2020; 51 Suppl 1:S37-S41. [PMID: 32067774 DOI: 10.1016/j.injury.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Contemporary uncemented hemiarthroplasties are being used after displaced femoral neck fractures, however, their functional and radiological results remain controversial. The aim of this study was to evaluate the clinical and radiological results of a tapered uncemented stem combined with a uni- or bipolar hemiarthroplasty after a minimum follow-up of ten years. PATIENTS AND METHODS 135 patients underwent uncemented hip hemiarthroplasty after a displaced femoral neck fracture between 2004 and 2007. Their mean age was 81.5 years old (range, 70 to 90). 38 patients were evaluated with a minimum follow-up of ten years. We analysed the complications and the postoperative clinical result according to the Merle D´Aubigné and Postel scale. Radiological femoral type according to Dorr et al., femoral canal filling and the appearance of stem loosening, subsidence and acetabular erosion according to Baker et al., were also assessed. RESULTS There were two early periprosthetic femoral fractures. The mean clinical score was 15.8 (range, 9 to 17). Six hips were converted to a total hip arthroplasty due to acetabular erosion, and three stems were revised due to an infection, a late periprosthetic fracture and one aseptic loosening. The survival rate for any cause was 85.4% (Confidence interval (CI) 76 - 92.4%). The survival rate for revision surgery on the acetabular side at 10 years was 92.6% (CI 85 - 100%) and on the femoral side was 97.6% (CI 94.4 - 100%). 14 hips showed non-progressive radiological subsidence and 9 acetabular erosion. Stem subsidence was related to a femoral canal filling < 80% (p = 0.035) and acetabular erosion to a cylindrical femur (p = 0.024). CONCLUSION Bone fixation can be obtained with a contemporary uncemented stem in hemiarthroplasty for patients over 70 years old with a femoral neck fracture. Acetabular erosion was frequent after ten years, however, the rate of revision surgery was low.
Collapse
Affiliation(s)
- Israel Rubio
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario La Paz, P °Castellana 261, 28064 Madrid, Spain
| | - Lorena Bellostas
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario La Paz, P °Castellana 261, 28064 Madrid, Spain
| | - Eduardo García-Rey
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario La Paz, P °Castellana 261, 28064 Madrid, Spain.
| |
Collapse
|
6
|
Laflamme M, Angers M, Vachon J, Pomerleau V, Arteau A. High Incidence of Intraoperative Fractures With a Specific Cemented Stem Following Intracapsular Displaced Hip Fracture. J Arthroplasty 2020; 35:485-489. [PMID: 31594703 DOI: 10.1016/j.arth.2019.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/06/2019] [Accepted: 09/11/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To reduce costs of orthopedic implants, the government decided to standardize implants used across different specialties in a group of hospitals located in the same geographic area. The usual cemented stem used in the context of intracapsular displaced geriatric hip fractures was replaced by another stem. Abnormal intraoperative calcar and trochanteric fractures were noted. The purpose of this study is to determine the incidence of intraoperative periprosthetic fractures following an intracapsular displaced hip fracture treated with this specific cemented stem compared to the previous implant. METHODS This is a retrospective cohort study comparing an historic cohort of hip fractures treated with the OmniFit EON (Stryker, Kalamazoo, MI) cemented stem with a new cohort of patients who received the Corail (DePuy Synthes, Warsaw, IN) cemented stem. Four orthopedic surgeons reviewed operative reports and postoperative radiographs. RESULTS The treatment group included 348 patients who received the Corail stem. The control group included 77 patients. The 2 groups had similar baseline characteristics (P > .05) except for the presence of dementia. Incidence of intraoperative calcar or greater trochanteric fracture was 15.5% for the Corail group and 2.7% for the control group (P < .05). No patient-related factors or surgeon-related factors were related to a higher number of fractures in the treatment group (P > .05). CONCLUSION The Corail cemented stem presents an abnormal number of iatrogenic intraoperative fractures following displaced femoral neck fracture in our geriatric population. No external factor seems to explain this high number of fractures. Implant design should be questioned. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Melissa Laflamme
- Department of Orthopaedic Surgery, CHU de Québec - Centre Hospitalier de l'Université Laval (CHUL), Québec City, Québec, Canada
| | - Michèle Angers
- Department of Orthopaedic Surgery, CHU de Québec - Centre Hospitalier de l'Université Laval (CHUL), Québec City, Québec, Canada
| | - Jessica Vachon
- Department of Orthopaedic Surgery, Hôtel-Dieu-de-Lévis, Lévis, Québec, Canada
| | - Veronica Pomerleau
- Department of Surgery, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - Annie Arteau
- Department of Orthopaedic Surgery, CHU de Québec - Hôtel-Dieu-de-Québec, Québec, Québec, Canada
| |
Collapse
|
7
|
Wood TJ, Alzahrani M, Marsh `JD, Somerville LE, Vasarhelyi EM, Lanting BA. Use of the Corail stem for revision total hip arthroplasty: evaluation of clinical outcomes and cost. Can J Surg 2019; 62:78-82. [PMID: 30697990 DOI: 10.1503/cjs.002318] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background With the growing number of total hip arthroplasty (THA) procedures performed, revision surgery is also proportionately increasing, resulting in greater health care expenditures. The purpose of this study was to assess clinical outcomes and cost when using a collared, fully hydroxyapatite-coated primary femoral stem for revision THA compared to commonly used revision femoral stems. Methods We retrospectively identified patients who underwent revision THA with a primary stem between 2011 and 2016 and matched them on demographic variables and reason for revision to a similar cohort who underwent revision THA. We extracted operative data and information on in-hospital resource use from the patients’ charts to calculate average cost per procedure. Patient-reported outcomes were recorded preoperatively and 1 year postoperatively. Results We included 20 patients in our analysis, of whom 10 received a primary stem and 10, a typical revision stem. There were no significant between-group differences in mean Western Ontario and McMaster Universities Osteoarthritis Index score, Harris Hip Score, 12-Item Short Form Health Survey (SF-12) Mental Composite Scale score or Physical Composite Scale score at 1 year. Operative time was significantly shorter and total cost was significantly lower (mean difference –3707.64, 95% confidence interval –5532.85 to –1882.43) with a primary stem than with other revision femoral stems. Conclusion We found similar clinical outcomes and significant institutional cost savings with a primary femoral stem in revision THA. This suggests a role for a primary femoral stem such as a collared, fully hydroxyapatite-coated stem for revision THA.
Collapse
Affiliation(s)
- Thomas J. Wood
- From the Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, University Campus, Western University, London, Ont. (Wood, Alzahrani, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (Alzahrani); the School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont. (Marsh); and the Bone and Joint Institute, Western University, London, Ont. (Marsh, Vasarhelyi, Lanting)
| | - Mohammad Alzahrani
- From the Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, University Campus, Western University, London, Ont. (Wood, Alzahrani, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (Alzahrani); the School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont. (Marsh); and the Bone and Joint Institute, Western University, London, Ont. (Marsh, Vasarhelyi, Lanting)
| | - `Jacquelyn D. Marsh
- From the Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, University Campus, Western University, London, Ont. (Wood, Alzahrani, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (Alzahrani); the School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont. (Marsh); and the Bone and Joint Institute, Western University, London, Ont. (Marsh, Vasarhelyi, Lanting)
| | - Lyndsay E. Somerville
- From the Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, University Campus, Western University, London, Ont. (Wood, Alzahrani, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (Alzahrani); the School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont. (Marsh); and the Bone and Joint Institute, Western University, London, Ont. (Marsh, Vasarhelyi, Lanting)
| | - Edward M. Vasarhelyi
- From the Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, University Campus, Western University, London, Ont. (Wood, Alzahrani, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (Alzahrani); the School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont. (Marsh); and the Bone and Joint Institute, Western University, London, Ont. (Marsh, Vasarhelyi, Lanting)
| | - Brent A. Lanting
- From the Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, University Campus, Western University, London, Ont. (Wood, Alzahrani, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (Alzahrani); the School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont. (Marsh); and the Bone and Joint Institute, Western University, London, Ont. (Marsh, Vasarhelyi, Lanting)
| |
Collapse
|
8
|
Jacquot L, Bonnin MP, Machenaud A, Chouteau J, Saffarini M, Vidalain JP. Clinical and Radiographic Outcomes at 25-30 Years of a Hip Stem Fully Coated With Hydroxylapatite. J Arthroplasty 2018; 33:482-490. [PMID: 29066107 DOI: 10.1016/j.arth.2017.09.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Little is known about the survival of total hip arthroplasty implants with bioactive coatings beyond the first 20 years. The authors aimed to report survival of a tapered hip stem fully coated with hydroxylapatite (HA) at follow-up of 25-30 years. METHODS Of the original series of 320 patients (347 hips), 12 patients (12 hips) had stem and cup revisions, 54 patients (55 hips) had cup revisions, 17 patients (17 hips) had liner exchange. A total of 207 patients (225 hips) died with stems in place and 21 patients (24 hips) could not be reached. This left a cohort of 80 patients (86 hips) with their original stem for assessment. Survival was analyzed using the Kaplan-Meier (KM) method and cumulative incidence function (CIF). RESULTS Considering stem revision as endpoint, the revision risk calculated using the KM method was 6.3%, whereas using the CIF it was 3.7%. Considering any reoperation as endpoint, the revision risk calculated using the KM method was 41.2%, whereas using the CIF it was 25.9%. The Harris Hip Score for 77 patients (18 hips) was 81.6 ± 15.2. Standard x-rays were available for 52 hips (49 patients), and 10 (19.2%) showed radiolucencies <2 mm thick. CONCLUSION This study is the first to report outcomes of an HA-coated stem beyond 25 years. The survival of stem compares favorably with long-term survival of the Charnley cemented stem, and with shorter-term registry studies. The stem achieved its intended purpose of total osteointegration in the long-term, although the proximolateral region remains susceptible to radiolucencies.
Collapse
Affiliation(s)
- Laurent Jacquot
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| | - Michel P Bonnin
- Artro Institute, Annecy Le Vieux, France; Ramsay Générale de Santé, Centre Orthopédique Santy, Hôpital PrivéJean Mermoz, Lyon, France
| | - Alain Machenaud
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| | - Julien Chouteau
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| | | | - Jean-Pierre Vidalain
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| |
Collapse
|
9
|
Power FR, Cawley DT, Curtin PD. Simultaneous bilateral total hip arthroplasties in nonagenarians. Ir J Med Sci 2017; 186:947-951. [PMID: 28185060 DOI: 10.1007/s11845-017-1572-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
Total hip arthroplasty (THA) is an effective and durable treatment option for hip osteoarthritis (OA). As life expectancy continues to increase, so too will the demand for joint arthroplasty in the 10th decade of life, frequently in cases involving osteoarthritis of both hips. Simultaneous bilateral total hip arthroplasty (SBTHA) is a valuable therapeutic option in appropriately selected patients with bilateral degenerative hip disease, although its use in the very elderly is poorly reported on in the literature. A case of bilateral hip OA successfully treated with SBTHA in a nonagenarian is presented and the literature is reviewed.
Collapse
Affiliation(s)
- F R Power
- Department of Trauma and Orthopaedic Surgery, St. Vincent's University Hospital, Dublin 4, Ireland.
| | - D T Cawley
- Department of Trauma and Orthopaedic Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - P D Curtin
- Department of Trauma and Orthopaedic Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| |
Collapse
|
10
|
Varus will have varus; a radiological study to assess and predict varus stem placement in uncemented femoral stems. Hip Int 2016; 26:554-560. [PMID: 27768218 DOI: 10.5301/hipint.5000412] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Varus inclination of the uncemented stem is not necessarily a technical error. The proximal femoral anatomy of hips with a coxa vara deformity frequently predisposes varus inclination. METHODS We reviewed a series of 200 patients undergoing primary uncemented THA with the Corail® hip system. Preoperative data were based on patient demographics, diagnosis, and radiographic information (preoperative templating-CT measurements), and compared postoperative alignment for each stem and type of stem used. Proximal femoral traits which can alert surgeons, when templating preoperatively, to potential varus alignment were noted. RESULTS All stems were inserted either in neutral or varus alignments. Low neck shaft angle is strongly predictive of increased varus stem alignment (p<0.001). Stems inserted with higher varus alignment were associated with the preoperative morphological traits associated with coxa vara hip deformities - increased femoral offset (p<0.001), greater trochanteric overhang (p<0.001), greater trochanteric height (p<0.046), and a lower canal flare index (p<0.046). CONCLUSIONS Varus stem alignment is neither unexpected nor necessarily a technical failure when using this particular uncemented stem system. Coxa vara deformities, due to a combination of morphological traits, are more likely to be inserted with higher varus alignment than hips with normal or higher neck shaft angles. Surgeons need to be aware of this when carrying out preoperative templating and intraoperative assessment, in order to prevent over-compensation for offset, length or stability.
Collapse
|
11
|
Sullivan NP, Hughes AW, Halliday RL, Ward AL, Chesser TJ. Early complications following cemented modular hip hemiarthroplasty. Open Orthop J 2015; 9:15-9. [PMID: 25685248 PMCID: PMC4323769 DOI: 10.2174/1874325001509010015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/06/2015] [Accepted: 01/12/2015] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Hemiarthroplasty is the recommended treatment for displaced, intracapsular, femoral neck fractures. This study aimed to evaluate the early complications following insertion of the JRI Furlong cemented hemiarthroplasty, a contemporary, modular, double tapered, polished prosthesis. METHOD A series of 459 consecutive patients (May 2006 - June 2009) treated with a JRI hemiarthroplasty with a minimum of one-year (1-4years) follow-up were evaluated. Data collected retrospectively from clinical records and hospital databases included patient demographics, mortality, deep infection, dislocation, periprosthetic fracture, and any requirement for revision or complications related to the prosthesis. RESULTS Full data were available for 429 of 459 (93%), partial data for 30 (7%). Average age was 83 years (52-100), 76% were female. One-year mortality was 24%. Intraoperative fractures occurred in 17 patients (3.7%). There were two intraoperative deaths. There were nine early deep wound infections (2%). There were two revisions to total hip replacement (THR), four patients required conversion to THR and one underwent an excision arthroplasty procedure. DISCUSSION Early surgical outcomes for the JRI hemiarthroplasty prosthesis are equivalent or superior to other major hemiarthroplasty prostheses previously reported however, there was a high intraoperative fracture rate of 3.7%. We recommend using a stem one size smaller than the final broach in fragile, osteoporotic bone. No patients re-presented with aseptic loosening or stem failure.
Collapse
Affiliation(s)
- Niall P.T Sullivan
- Department of Trauma and Orthopaedics, Southmead Hospital, North Bristol NHS Trust, Southmead Way, Bristol, BS10 5NB, UK
| | | | | | | | | |
Collapse
|
12
|
Grammatopoulos G, Wilson HA, Kendrick BJL, Pulford EC, Lippett J, Deakin M, Andrade AJ, Kambouroglou G. Hemiarthroplasty using cemented or uncemented stems of proven design. Bone Joint J 2015; 97-B:94-9. [DOI: 10.1302/0301-620x.97b1.34138] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
National Institute of Clinical Excellence guidelines state that cemented stems with an Orthopaedic Data Evaluation Panel (ODEP) rating of > 3B should be used for hemiarthroplasty when treating an intracapsular fracture of the femoral neck. These recommendations are based on studies in which most, if not all stems, did not hold such a rating. This case-control study compared the outcome of hemiarthroplasty using a cemented (Exeter) or uncemented (Corail) femoral stem. These are the two prostheses most commonly used in hip arthroplasty in the UK. Data were obtained from two centres; most patients had undergone hemiarthroplasty using a cemented Exeter stem (n = 292/412). Patients were matched for all factors that have been shown to influence mortality after an intracapsular fracture of the neck of the femur. Outcome measures included: complications, re-operations and mortality rates at two, seven, 30 and 365 days post-operatively. Comparable outcomes for the two stems were seen. There were more intra-operative complications in the uncemented group (13% vs 0%), but the cemented group had a greater mortality in the early post-operative period (n = 6). There was no overall difference in the rate of re-operation (5%) or death (365 days: 26%) between the two groups at any time post-operatively. This study therefore supports the use of both cemented and uncemented stems of proven design, with an ODEP rating of 10A, in patients with an intracapsular fracture of the neck of the femur. Cite this article: Bone Joint J 2015;97-B:94–9.
Collapse
Affiliation(s)
- G. Grammatopoulos
- Nuffield Orthopaedic Centre, Botnar
Research Centre, University of Oxford, Nuffield Orthopaedic
Centre, Windmill Road, OX3
7LD, UK
| | - H. A. Wilson
- Royal Berkshire NHS Foundation Trust, London
Road, Reading, Berkshire
RG1 5AN, UK
| | - B. J. L. Kendrick
- Nuffield Orthopaedic Centre, Botnar
Research Centre, University of Oxford, Nuffield Orthopaedic
Centre, Windmill Road, OX3
7LD, UK
| | - E. C. Pulford
- John Radcliffe Hospital, Headley
Way, Headington, Oxford
OX3 9DU, UK
| | - J. Lippett
- Royal Berkshire NHS Foundation Trust, London
Road, Reading, Berkshire
RG1 5AN, UK
| | - M. Deakin
- John Radcliffe Hospital, Headley
Way, Headington, Oxford
OX3 9DU, UK
| | - A. J. Andrade
- Royal Berkshire NHS Foundation Trust, London
Road, Reading, Berkshire
RG1 5AN, UK
| | - G. Kambouroglou
- John Radcliffe Hospital, Headley
Way, Headington, Oxford
OX3 9DU, UK
| |
Collapse
|
13
|
Kendrick BJL, Wilson HA, Lippett JE, McAndrew AR, Andrade AJMD. Corail uncemented hemiarthroplasty with a Cathcart head for intracapsular hip fractures. Bone Joint J 2013; 95-B:1538-43. [DOI: 10.1302/0301-620x.95b11.31609] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The National Institute for Health and Clinical Excellence (NICE) guidelines from 2011 recommend the use of cemented hemi-arthroplasty for appropriate patients with an intracapsular hip fracture. In our institution all patients who were admitted with an intracapsular hip fracture and were suitable for a hemi-arthroplasty between April 2010 and July 2012 received an uncemented prosthesis according to our established departmental routine practice. A retrospective analysis of outcome was performed to establish whether the continued use of an uncemented stem was justified. Patient, surgical and outcome data were collected on the National Hip Fracture database. A total of 306 patients received a Cathcart modular head on a Corail uncemented stem as a hemi-arthroplasty. The mean age of the patients was 83.3 years (sd 7.56; 46.6 to 94) and 216 (70.6%) were women. The mortality rate at 30 days was 5.8%. A total of 46.5% of patients returned to their own home by 30 days, which increased to 73.2% by 120 days. The implant used as a hemi-arthroplasty for intracapsular hip fracture provided satisfactory results, with a good rate of return to pre-injury place of residence and an acceptable mortality rate. Surgery should be performed by those who are familiar with the design of the stem and understand what is required for successful implantation. Cite this article: Bone Joint J 2013;95-B:1538–43.
Collapse
Affiliation(s)
- B. J. L. Kendrick
- Royal Berkshire NHS Foundation Trust, London
Road, Reading RG1 5AN, UK
| | - H. A. Wilson
- Royal Berkshire NHS Foundation Trust, London
Road, Reading RG1 5AN, UK
| | - J. E. Lippett
- Royal Berkshire NHS Foundation Trust, London
Road, Reading RG1 5AN, UK
| | - A. R. McAndrew
- Royal Berkshire NHS Foundation Trust, London
Road, Reading RG1 5AN, UK
| | | |
Collapse
|
14
|
Outcome of an uncemented hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures: a clinical and radiographic 2-year follow-up study. Hip Int 2013; 22:574-9. [PMID: 23100152 DOI: 10.5301/hip.2012.9745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Hemiarthroplasty is the preferred treatment for displaced femoral neck fractures (DFNF) in elderly patients. The use of uncemented stems remains controversial and issues regarding inferior fixation in osteoporotic bone, implant-related pain and decreased mobility have discouraged their use. There is limited evidence for the use of modern uncemented femoral stems in the treatment of DFNF, and we wished to investigate the clinical and radiographic performance of an uncemented hydroxyapatite coated hemiarthroplasty at 2-year follow-up. PATIENTS AND METHODS We included 97 consecutive patients who had an uncemented, hydroxyapatite coated hemiarthroplasty (Corail, Depuy) inserted during a 1-year period. Due to unwillingness or cognitive impairment (n = 6) and death before follow-up (n = 44), a total of 47 patients (39 females) with a mean age of 81 years were available. RESULTS At two year follow-up 38 of 47 patients lived in their own homes and the median New Mobility Score was 6 (range: 2-9). The median Visual Analogue Scale pain score was 0 (range: 0-5) at rest and 0 (range: 0-8) when walking. Patient satisfaction was a score of 9 (range: 2-10) on the VAS. Anterior or lateral thigh pain or groin pain was reported by 15 patients. The EQ-5D index score at follow-up was 0.72 (range: 0.16-1.00) and the EQ-5D Visual Analogue Score was 70 (range: 15-100). There were no signs of implant loosening in any of the 37 hips undergoing radiographic evaluation at follow-up. CONCLUSION The results suggest that an uncemented hydroxyapatite coated hemiarthroplasty can be used to treat displaced intracupsular femoral neck fractures with good clinical and radiographic outcomes at short term follow-up.
Collapse
|
15
|
Hossain M, Andrew JG. Is there a difference in perioperative mortality between cemented and uncemented implants in hip fracture surgery? Injury 2012; 43:2161-4. [PMID: 23000051 DOI: 10.1016/j.injury.2012.08.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 08/23/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although cemented implants have proven beneficial over uncemented implants for treatment of displaced sub-capital proximal femoral fractures, there are concerns regarding the haemodynamic consequence of using cemented implants in hip fracture patients. National Patient Safety Agency recently issued an alert regarding the use of cement in hip fracture surgery. We compared the incidence and pattern of 48 h perioperative mortality between patients receiving cemented and uncemented implants after hip fracture surgery. METHODS Using data prospectively recorded in hospital care records, we retrospectively reviewed the case records of all patients who died in hospital following hip fracture surgery between January 2005 and April 2010. We recorded demographic variables, type of fracture, implant used, medical co-morbidity, seniority of operating surgeon and anaesthetist, perioperative haemodynamic status, time and cause of death. RESULTS We identified 15 cases of perioperative death (PoD) over a 64-month period. PoD was 1% (15/1402). Eight of 15 deaths occurred following cemented hemiarthroplasty insertion. There were four cases of intra-operative death, two of them were following cemented hemiarthroplasty insertion. PoD following cemented hemiarthroplasty was 2.54% (8/314) and nil (0/168) following uncemented Austin-Moore hemiarthroplasty. Operations were performed by both trainees (six) and consultants (two). Both trainees (five) and consultants (three) anaesthetised the patients. None of the patients belonged to American Society of Anesthesiologists (ASA) I or II (ASA III 5 and IV 3). All patients had significant cardiovascular or pulmonary co-morbidity. Apart from the cases of immediate haemodynamic collapse and death, cemented implant insertion was followed by intra-operative haemodynamic instability in 2/15 and perioperative instability in 3/15 patients. Post-mortem was performed in 3/8 patients: 2/3 demonstrated pulmonary embolism (PE), 1/3 bronchopneumonia. Of the rest, 3/5 had suspected myocardial infarction (MI). CONCLUSION There was 1% risk of perioperative death after hip fracture surgery. Risk of perioperative death was significantly higher following cemented implant insertion. Mortality risk was exacerbated in patients with pre-existing cardiovascular morbidity and was independent of the seniority of the surgeon or the anaesthetist.
Collapse
Affiliation(s)
- M Hossain
- Department of Trauma and Orthopaedics, Ysbyty Gwynedd Hospital, Penrhosgarnedd Road, Bangor LL57 2LW, Wales, UK.
| | | |
Collapse
|