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Budde S, Derksen A, Hurschler C, Fennema P, Windhagen H, Plagge J, Flörkemeier T, von Lewinski G, Noll Y, Schwarze M. Very early migration of a calcar-guided short stem: a randomized study of early mobilization and the influence of a calcium phosphate coating with 60 patients. Sci Rep 2024; 14:3837. [PMID: 38360840 PMCID: PMC10869691 DOI: 10.1038/s41598-023-50829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/26/2023] [Indexed: 02/17/2024] Open
Abstract
This study analyzed the migration of a calcar-guided short stem to determine the course of very early migration, as well as evaluated the effect of an additional calcium phosphate (CP) coating on a titanium plasma spray (TPS) coating, which has not been analyzed previously. Sixty patients were enrolled in this study and were treated with the A2 calcar-guided short stem. The implant coating was randomized with either the TPS or an additional CP coating, and radiostereometric analysis was performed with the baseline measurement before initial weight-bearing, along with follow-up examinations at 1 week, 6 weeks, 3 months, and 6 months. Implant migrations were 0.27 mm (standard deviation [SD], 0.13 mm) and 0.74 mm (SD, 1.11 mm) at 1 week and 6 months post-surgery, respectively, and 65% and 87% of the implants reached their final position 1 week and 6 weeks after surgery, respectively. After 6 weeks, 3 months, and 6 months, a significant increase was noted in the migration of the CP coating group vs. that of the TPS coating group. Upon the final observation at 6 months, the groups displayed on average a 0.74-mm migration. Most of the analyzed implants ceased migration within the first week post-surgery, but the CP coating demonstrated a higher and more prolonged migration compared to the TPS coating.
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Affiliation(s)
- Stefan Budde
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
- Evangelisches Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Alexander Derksen
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Christof Hurschler
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Peter Fennema
- AMR Advanced Medical Research, Männedorf, Switzerland
| | - Henning Windhagen
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Jochen Plagge
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Thilo Flörkemeier
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Gabriela von Lewinski
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Yvonne Noll
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Michael Schwarze
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany.
- Department for Medical Technology, Hochschule Bremerhaven, An Der Karlstraße 8, 27568, Bremerhaven, Germany.
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Schader JF, Thalmann C, Maier KS, Schiener T, Stoffel K, Frigg A. Prospective evaluation of clinical and radiographic 10-year results of Fitmore short-stem total hip arthroplasty. J Orthop Surg Res 2023; 18:893. [PMID: 37993946 PMCID: PMC10666308 DOI: 10.1186/s13018-023-04359-3] [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: 08/03/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Short stems were introduced into total hip arthroplasty (THA) to preserve bone stock, to transmit more load to the proximal femur, and to enable minimal invasive approaches. This study is the first long-term study (with a follow-up of 10 years) of the survival as well as the clinical and radiographic outcomes of the Fitmore hip stem, a short curved uncemented stem. METHODS In total, 123 Fitmore hip stems were prospectively evaluated. At the final 10-year follow-up, 80 Fitmore stems (78 patients: 30 female, 48 male) were eligible for evaluation. Clinical parameters were thigh pain, EQ-5D, Harris Hip Score (HHS) and Oxford Hip Score. Radiographic parameters were cortical hypertrophy (CH), bone condensation, cortical thinning, radiolucency, reactive lines, calcar rounding, calcar resorption, subsidence and varus/valgus position. RESULTS After 10 years, there was a survival rate of 99% (1 revision because of aseptic stem loosening). HHS had improved from 59 to 94 and Oxford Hip Score from 22 to 43. CH rate after 1 year was 69% and after 10 years 74%. In the first year, radiolucency was found in 58% and in 17.5% after 10 years. Subsidence after 1 year was 1.6 ± 1.6 mm and 5.0 ± 3.1 mm after 10 years. CONCLUSIONS The Fitmore hip stem showed a survival rate of 99% as well as good clinical and radiographic outcomes in the long-term follow-up of 10 years.
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Affiliation(s)
- Jana F Schader
- Department of Orthopaedic Surgery, Cantonal Hospital Graubuenden, 7000, Chur, Switzerland.
| | - Caroline Thalmann
- Department of Orthopaedic Surgery, Cantonal Hospital Graubuenden, 7000, Chur, Switzerland
| | | | | | - Karl Stoffel
- University of Basel, 4001, Basel, Switzerland
- Department of Orthopaedic Surgery, University Hospital Basel, 4031, Basel, Switzerland
| | - Arno Frigg
- University of Basel, 4001, Basel, Switzerland
- Department of Orthopaedic Surgery, University Hospital Basel, 4031, Basel, Switzerland
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Rilby K, Mohaddes M, Kärrholm J. Similar results after five years with the use of the Fitmore or the CLS femoral components. Bone Jt Open 2023; 4:306-314. [PMID: 37130583 PMCID: PMC10154086 DOI: 10.1302/2633-1462.45.bjo-2023-0007.r1] [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] [Indexed: 05/04/2023] Open
Abstract
Although the Fitmore Hip Stem has been on the market for almost 15 years, it is still not well documented in randomized controlled trials. This study compares the Fitmore stem with the CementLeSs (CLS) in several different clinical and radiological aspects. The hypothesis is that there will be no difference in outcome between stems. In total, 44 patients with bilateral hip osteoarthritis were recruited from the outpatient clinic at a single tertiary orthopaedic centre. The patients were operated with bilateral one-stage total hip arthroplasty. The most painful hip was randomized to either Fitmore or CLS femoral component; the second hip was operated with the femoral component not used on the first side. Patients were evaluated at three and six months and at one, two, and five years postoperatively with patient-reported outcome measures, radiostereometric analysis, dual-energy X-ray absorptiometry, and conventional radiography. A total of 39 patients attended the follow-up visit at two years (primary outcome) and 35 patients at five years. The primary outcome was which hip the patient considered to have the best function at two years. At two and five years, more patients considered the hip with the CLS femoral component as superior but without a statistically significant difference. There were no differences in clinical outcome, magnitude of femoral component migration, or change of bone mineral density at five years. At three months, the Fitmore femoral component had subsided a median -0.71 mm (interquartile range (IQR) -1.67 to -0.20) and the CLS femoral component -0.70 mm (IQR -1.53 to -0.17; p = 0.742). In both groups the femoral head centre had migrated posteriorly (Fitmore -0.17 mm (IQR -0.98 to -0.04) and CLS -0.23 mm (IQR -0.87 to 0.07; p = 0.936)). After three months neither of the femoral components showed much further migration. During the first postoperative year, one Fitmore femoral component was revised due to aseptic loosening. Up to five years, we found no statistically significant difference in outcomes between the Fitmore and the CLS femoral components. The slightly worse outcomes, including one revised hip because of loosening, speaks against the hypothesis that the Fitmore femoral component should be advantageous compared to the CLS if more patients had been recruited to this study.
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Affiliation(s)
- Karin Rilby
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Department of Orthopaedic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Department of Orthopaedic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Department of Orthopaedic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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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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Fujii H, Hayama T, Abe T, Takahashi M, Amagami A, Matsushita Y, Otani T, Saito M. Do radiological findings around the Fitmore stem change over time? Bone Jt Open 2022; 3:20-28. [PMID: 35005984 PMCID: PMC9047072 DOI: 10.1302/2633-1462.31.bjo-2021-0122.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims Although the short stem concept in hip arthroplasty procedure shows acceptable clinical performance, we sometimes get unexplainable radiological findings. The aim of this retrospective study was to evaluate changes of radiological findings up to three years postoperatively, and to assess any potential contributing factors on such radiological change in a Japanese population. Methods This is a retrospective radiological study conducted in Japan. Radiological assessment was done in accordance with predetermined radiological review protocol. A total of 241 hips were included in the study and 118 hips (49.0%) revealed radiological change from immediately after surgery to one year postoperatively; these 118 hips were eligible for further analyses. Each investigator screened whether either radiolucent lines (RLLs), cortical hypertrophy (CH), or atrophy (AT) appeared or not on the one-year radiograph. Further, three-year radiographs of eligible cases were reviewed to determine changes such as, disappeared (D), improved (I), stable (S), and progression (P). Additionally, bone condensation (BC) was assessed on the three-year radiograph. Results CH was observed in 49 hips (21.1%), AT was observed in 63 hips (27.2%), and RLLs were observed in 34 hips (14.7%) at one year postoperatively. Among 34 hips with RLLs, 70.6% showed change of either D or I on the three-year radiograph. BC was observed in younger patients more frequently. Conclusion The Fitmore stem works well in a Japanese population with favourable radiological change on hips with RLLs. Longer-term follow-up is required to determine clinical relevance. Cite this article: Bone Jt Open 2022;3(1):20–28.
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Affiliation(s)
- Hideki Fujii
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuo Hayama
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiomi Abe
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Motoi Takahashi
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ayano Amagami
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yohei Matsushita
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takuya Otani
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Bostian PA, Grisez BT, Klein AE, Frye BM. Complex Primary Total Hip Arthroplasty: Small Stems for Big Challenges. Arthroplast Today 2021; 8:150-156. [PMID: 33786353 PMCID: PMC7994729 DOI: 10.1016/j.artd.2021.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/15/2022] Open
Abstract
Total hip arthroplasty is one of the most successful operations in all of medicine. Femoral deformities from malunion, prior osteotomy, and retained surgical implants all present unique challenges. Corrective osteotomy and hardware removal add significant morbidity to an operation that typically has a fast recovery. Short stems can be used in these cases to spare patients' increased morbidity. We present a case-based illustration and surgical technique for the use of short stems in complex primary total hip arthroplasty with femoral deformity and retained hardware. We discuss how these implants can spare significant morbidity, show radiographic examples of their use, and present short-term outcomes.
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Affiliation(s)
- Phillip A Bostian
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Brian T Grisez
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Adam E Klein
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Benjamin M Frye
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
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Hasler J, Flury A, Dimitriou D, Holweg I, Helmy N, Finsterwald M. Mid-term subsidence and periprosthetic radiolucency of the AMIStem: a 5-year EBRA-FCA analysis. J Orthop Surg Res 2021; 16:19. [PMID: 33413463 PMCID: PMC7792117 DOI: 10.1186/s13018-020-02104-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/19/2020] [Indexed: 01/22/2023] Open
Abstract
Background There has been an evolution in cementless total hip arthroplasty (THA) with newer short stem designs aimed to preserve metaphyseal bone stock and facilitate implantation through minimally invasive approaches. While early subsidence has been correlated to aseptic loosening in conventional stems, there is a paucity of data regarding short stems. The current study aims to report on stem subsidence and mid-term clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, specifically designed for the direct anterior approach (DAA). Methods Ninety-four consecutive patients (100 hips) with a minimum follow-up of 5 years following cementless THA were included in this single-center retrospective study. Subsidence was evaluated using the “Ein-Bild-Roentgen-Analyse” (EBRA). Periprosthetic radiolucency allocated to the zones of Charnley and Gruen was assessed. Additionally, demographic and implant-related factors potentially associated with increased subsidence and clinical outcomes were evaluated. Results At the last follow-up, the average stem subsidence was 1.98 ± 1.20 mm, with 48% of the implants demonstrating subsidence of > 2 mm. Periprosthetic radiolucency of > 2 mm was found in 26% of the implants in zone 1 and in 9% in zone 7, respectively. Neither the amount of subsidence nor proximal periprosthetic radiolucency was associated with aseptic loosening or worse clinical outcomes. Conclusions Comparable to other proximally fixed short stem designs, the highest subsidence was observed within the first 3 months following implantation. No demographic or implant-related factors were found to have a statistically significant influence on stem subsidence. Periprosthetic radiolucency and subsidence of the AMISstem is not correlated with worse clinical outcomes at 5-year follow-up.
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Affiliation(s)
- Julian Hasler
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland.
| | - Andreas Flury
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Dimitris Dimitriou
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Iris Holweg
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Naeder Helmy
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Michael Finsterwald
- Departement of Orthopaedics and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland
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Evola FR, Evola G, Sessa G. Use of short stems in revision of standard femoral stem: A case report. World J Orthop 2020; 11:528-533. [PMID: 33269220 PMCID: PMC7672800 DOI: 10.5312/wjo.v11.i11.528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/14/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Short stems are usually uncemented prosthetics and are recommended in the treatment of traumatic or degenerative diseases of hip. In revision procedures for elderly patients with serious comorbidity, applying a short stem could reduce peri- and post-operative secondary surgical risks to femoral osteotomy, which are necessary for the removal of parts of the implant or acrylic cement from the medullary canal. There are no cases in the literature that apply a short stem for prosthetic revision by acrylic cement anchorage.
CASE SUMMARY A male patient had a left hip replacement in 1995 due to coxarthrosis. At the age of eighty the patient reported an accidental trauma and walked with pain in the left thigh. The X-ray highlighted the stem breakage in the distal section without fracturing the femoral cortex. The patient had various comorbidities (diabetes, anaemia, heart deficiency, and arrhythmia) presenting a high operation risk (ASA 4). During the revision procedure, the distal apex of the stem could not be removed from the femoral cortex. Because of the poor general health of the patient, the surgeon decided not to perform a Wagner femoral osteotomy to remove the distal section of the stem and decided to implant a short stem to avoid removing the stem section of the previous implant. The patient had his left femur X-rayed 15 d post-trauma.
CONCLUSION A field of application of short stem may be the development of a cemented short stem to reduce the complexity of the revision procedure.
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Affiliation(s)
| | - Giuseppe Evola
- General and Emergency Surgery Department, Surgery Clinic, Catania 95124, Italy
| | - Giuseppe Sessa
- University of Catania, Department of Surgery, Clinic Orthopaedic, Catania 95124, Italy
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Kutzner KP, Ried E, Donner S, Bieger R, Pfeil J, Freitag T. Mid-term migration pattern of a calcar-guided short stem: A five-year EBRA-FCA-study. J Orthop Sci 2020; 25:1015-1020. [PMID: 32057589 DOI: 10.1016/j.jos.2020.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/15/2019] [Accepted: 01/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Short-term results of several short-stem designs have indicated early axial migration. Mid- and long-term results for most designs are lacking. The objective of this study was to evaluate the mid-term migration pattern of a calcar-guided short stem five years postoperative. METHODS Implant migration of 191 calcar-guided short stems was assessed by Ein-Bild-Roentgen-Analysis Femoral-Component- Analysis (EBRA-FCA) 5 years after surgery. Migration pattern of the whole group was analyzed and compared to the migration pattern of implants potentially being "at hazard" with a subsidence of more than 1.5 mm at 2 years postoperatively. Influence of preoperative Dorr types (A vs. B vs. C), age (<70 vs. >70 years), gender (female vs. male), weight (<90 kg vs. >90 kg), BMI (<30 vs. >30) and uni-vs. bilateral procedures on mid-term migration pattern was analyzed. Additionally outcome of varus- and valgus stem alignment was assessed. RESULTS Mean axial subsidence was 1.5 mm (SD 1.48 mm) at final follow-up. Two years after surgery 73 short stems were classified "at hazard". Of these stems, 69 cases showed secondary stabilisation in the following period, whereas 4 cases presented unstable with more than 1 mm of further subsidence. Stem revision was not required neither in the group of implants with early stabilisation nor the group with pronounced early onset migration. Male gender and heavy-weight patients had a significant higher risk for axial migration, as well as extensive valgus stem alignment, whereas for Dorr type B, compared to A, no statistical difference could be observed. CONCLUSIONS In most cases, even in the group of stems being "at hazard", settling could be documented. While different Dorr types did not show a statistically significant impact on axial migration, particularly in male and heavy-weight patients the risk of continuous subsidence is increased. In those 4 cases with further migration, undersizing of the stem could be recognized. At present, clinical consequences are still uncertain.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20. 65189 Wiesbaden, Germany.
| | - Emanuel Ried
- Division of Trauma Surgery, University Hospital Zürich (USZ), University of Zürich, Rämistr. 100. 8091 Zürich, Switzerland.
| | - Stefanie Donner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20. 65189 Wiesbaden, Germany.
| | - Ralf Bieger
- Department of Orthopaedic Surgery, University of Ulm (RKU), Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Joachim Pfeil
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20. 65189 Wiesbaden, Germany.
| | - Tobias Freitag
- Department of Orthopaedic Surgery, University of Ulm (RKU), Oberer Eselsberg 45, 89081, Ulm, Germany.
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Abstract
AIMS Short, bone-conserving femoral components are increasingly used in total hip arthroplasty (THA). They are expected to allow tissue-conserving implantation and to render future revision surgery more straightforward but the long-term data on such components is limited. One such component is the global tissue-sparing (GTS) stem. Following the model for stepwise introduction of new orthopaedic implants, we evaluated early implant fixation and clinical outcome of this novel short-stem THA and compared it to that of a component with established good long-term clinical outcome. METHODS In total, 50 consecutive patients ≤ 70 years old with end-stage symptomatic osteo-arthritis were randomized to receive THA with the GTS stem or the conventional Taperloc stem using the anterior supine intermuscular approach by two experienced hip surgeons in two hospitals in the Netherlands. Primary outcome was implant migration. Patients were followed using routine clinical examination, patient reported outcome using Harris Hip Score (HHS), Hip Disability And Osteoarthritis Outcome Score (HOOS), EuroQol five-dimension questionnaire (EQ5D), and Roentgen Stereophotogrammetric Analysis (RSA) at three, six, 12, and 24 months. This study evaluated the two-year follow-up results. RESULTS In addition to the initial migration pattern of distal migration (subsidence, Y-translation) and retroversion (Y-rotation) also exhibited by the Taperloc stem, the GTS stem showed an initial migration pattern of varization (X-translation combined with Z-rotation) and posterior translation (Z-translation). However, all components stabilized aside from one Taperloc stem which became loose secondary to malposition and was later revised. Clinical outcomes and complications were not statistically significantly different with the numbers available. CONCLUSION A substantially different and more extensive initial migration pattern was seen for the GTS stem compared to the Taperloc stem. Although implant stabilization was achieved, excellent long-term survival similar to that of the Taperloc stem should not be inferred. Especially in the absence of clinically proven relevant improvement, widespread usage should be postponed until long-term safety has been established. Cite this article: Bone Joint J 2020;102-B(6):699-708.
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Affiliation(s)
- Marc J Nieuwenhuijse
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Stephan B W Vehmeijer
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Nina M C Mathijsen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Stefan B Keizer
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
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11
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Floerkemeier T, Budde S, Lewinski GV, Windhagen H, HurSchler C, Schwarze M. Greater early migration of a short-stem total hip arthroplasty is not associated with an increased risk of osseointegration failure: 5th-year results from a prospective RSA study with 39 patients, a follow-up study. Acta Orthop 2020; 91:266-271. [PMID: 32106733 PMCID: PMC8023937 DOI: 10.1080/17453674.2020.1732749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Short-stem hip arthroplasty has been a viable alternative to standard stems for the treatment of hip osteoarthritis for over 10 years. This study assessed whether a correlation existed between a greater initial increase in implant migration and inferior clinical outcomes at 5 years postoperatively. Results on these patients after 2 years have been published previously.Patients and methods - Radiostereometry and clinical scoring were undertaken after surgery and at 3, 6, 12, and 24 months, and 5 years postoperatively. The migration and the clinical outcomes data from the patients with initial migrations at 3 months above the 75th percentile (≥ 75% group) were compared with those with migrations at 3 months of less than the 75th percentile (< 75% group).Results - Between 3 months and 5 years after surgery, the mean resultant implant migrations were 0.40 mm (SD 0.32) in the ≥ 75% group and 0.39 mm (SD 0.25) in the < 75% group. The mean Harris Hip Scores and SF-36 physical scores at 5 years postoperatively were 100 (SD 0.4) and 44 (SD 12), respectively, for the ≥ 75% group and 99 (SD 2) and 50 (SD 10), respectively, for the < 75% group. The differences between the patient groups were not statistically significant.Interpretation - There was no correlation between a greater initial migration and inferior clinical outcomes at 5 years postoperatively. Despite a greater initial migration, there were no risks of early aseptic loosening and inferior midterm clinical outcomes associated with a short-stem implant with a primary metaphyseal anchorage.
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Affiliation(s)
| | - Stefan Budde
- Department of Orthopaedic Surgery, Hannover Medical School, Germany;; ,Correspondence:
| | | | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Germany;;
| | | | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School
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Fulin P, Pokorny D, Hert J, Sosna A. Results of 198 primary total hip arthroplasties using the Delta PF-FIT system with ceramic-on-ceramic articulating surfaces with average seven years follow up. BMC Musculoskelet Disord 2020; 21:311. [PMID: 32429881 PMCID: PMC7236923 DOI: 10.1186/s12891-020-03253-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/31/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The lifetime implants is a key parameter that the surgeon should take into account at the time of the primary total hip arthroplasty (THA). The aim of this study was a clinical and radiographical evaluation of the Delta PF-FIT (LimaCorporate, Italy) THA system with ceramic-on-ceramic articulations. We have not found a clinical or radiographical assessment of this implant in available published literature. METHODS A total of 197 (F = 94, M = 103) primary THAs were evaluated in 163 patients with a mean follow-up of 7.7 years (range 5.1-11.2 years (SD ± 1.5)) Harris hip Score (HHS) and the Western Ontario and McMaster Universities Arthritis index (WOMAC) were used for the clinical evaluation. The statistical evaluation was processed by standard statistical methods. The study was approved by Ethic Committee of the University Hospital Motol (Reference No. EK-73/19). RESULTS The mean HHS score was found to be 97.59 points (61-100 range with a ± 5.13 SD, preoperative HSS was 51.21, range 28-73 with a ± 4,77 SD). 186 THAs were evaluated as excellent (90-100 points), 9 THAs rated as good (80-89 points), 1 THA was rated as fair (70-79) points and 1 THA rated as poor (less than 70 points). The mean WOMAC score was 97.38 points (65-100 range with a ± 5.18 SD, preoperative was 50,12, range 27-69 with a ± 4.85 SD). We documented an overall 99.49% Kaplan-Meier survival with a mean follow-up of 7.7 years with the FIT (LimaCorporate) stem revision and any component revision as the endpoint. With the Delta PF (LimaCorporate) cup revision as the endpoint, the survival was 100%. We have not found a previously published clinical or radiographical review of this THA system, the study shows a comparison with other THA implants. CONCLUSION Evaluation of the Delta-PF-FIT (LimaCorporate, Italy) THA system with the use of ceramic-on-ceramic BIOLOX®Delta articulation surfaces shows very good outcomes.
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Affiliation(s)
- Petr Fulin
- Orthopaedic Clinic 1st Faculty of Medicine Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - David Pokorny
- Orthopaedic Clinic 1st Faculty of Medicine Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Jan Hert
- Orthopaedic Clinic 1st Faculty of Medicine Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Antonin Sosna
- Orthopaedic Clinic 1st Faculty of Medicine Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
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13
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New Implant Introduction in Total Hip Arthroplasty Using Radiostereometric Analysis: A Cautionary Note. J Arthroplasty 2020; 35:643-646. [PMID: 31678017 DOI: 10.1016/j.arth.2019.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/22/2019] [Accepted: 10/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It has been proposed that the introduction of new hip implant technology in orthopedic surgery be conducted in a more controlled manner in order to properly ensure patient safety and the likelihood of favorable outcomes. This stepwise introduction would first require a prospective randomized study in a small cohort of patients, using radiostereometric analysis (RSA). The aim of this study is to determine if the recent literature supports the use of RSA as an early screening tool to accurately predict the long-term outcomes of cementless femoral stems. METHODS A review of the recent published literature identified 11 studies that used RSA to predict the long-term stability of a cementless femoral component. These RSA predictive data were compared to the 10-year revision rate reported in the Australian Registry or in the published literature to determine its reliability. RESULTS RSA data did not universally predict long-term stem fixation. In 2 of the 11 cases (18%), the RSA study incorrectly predicted the ability of the cementless stem to reliably osseointegrate. Of the 9 stems considered stable in the RSA studies, the 10 year registry and literature data confirmed that 6 implants had a low revision rate and were well performing. One stem has not performed well clinically and has been listed as having a higher than anticipated rate of revision in the registry. Two stems do not have sufficient follow-up. Of the 2 stems RSA predicted to do poorly, 1 is well performing at 10 years, and 1 has a high revision rate at 8 years. CONCLUSION In the stepwise introduction of new hip implants, RSA should be best considered as an adjunct tool in deciding whether or not an implant should be evaluated in a larger multicenter clinical studies, rather than the sole criterion.
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Thalmann C, Horn Lang T, Bereiter H, Clauss M, Acklin YP, Stoffel K. An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem. Hip Int 2020; 30:152-159. [PMID: 31010329 DOI: 10.1177/1120700019834336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although reported results on short stems sound very promising, the occurrence of distal femoral cortical hypertrophy is often observed. The aim of the present study was to report 5-year survival data of a commercially available trochanter sparing short stem and investigate the clinical impact of distal femoral cortical hypertrophy on the outcome. METHODS 123 total hip arthroplasties were performed on 120 patients from April 2008 to May 2010 (mean age 62, range 29-89 years; 71 hips from male patients, 58%). Clinical and radiological data were collected preoperative, at 6 weeks, 1, 2, 3, and 5 years postoperative to assess the outcome. Radiographs taken immediately postoperative as well as 1 and 5 years postoperative were used to identify and assess cortical hypertrophy. RESULTS 1 stem had to be revised due to aseptic loosening, resulting in a Kaplan-Meier survival analysis with endpoint for stem revision of 99.2% (95% Confidence Interval 94.1-99.9) at 5 years. 96 radiological and 95 clinical follow-ups were analysed 5 years postoperative. 68 (71%) hips showed distal femoral cortical hypertrophy after 5 years. The average Harris Hip Score and Oxford Hip Score improved 33 (standard deviation (SD) 15.1, range 2-70), 18 (SD 12.1, range -10-43) points, respectively. Overall 16% of the patients reported thigh pain, unrelated to the presence of cortical hypertrophy. DISCUSSION This short stem shows an excellent 5-year survival rate and good clinical outcome despite a high incidence of cortical hypertrophy. However, the question of the mechanism of load transfer arises.
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Affiliation(s)
| | - Tamara Horn Lang
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Heinz Bereiter
- Orthopaedic Surgery, Kantonsspital Graubünden, Chur, Switzerland
| | - Martin Clauss
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Yves P Acklin
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Karl Stoffel
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
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15
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Christiansen JD, Ejaz A, Nielsen PT, Laursen M. An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction. J Bone Joint Surg Am 2020; 102:128-136. [PMID: 31596796 DOI: 10.2106/jbjs.19.00104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) with a diaphyseal stem may risk bone loss. In order to save proximal bone stock in young patients with a high activity level and a long life expectancy, the interest in short stems has evolved. The purpose of this prospective observational cohort study was to evaluate the fixation of, and bone remodeling around, the Primoris femoral neck-preserving hip implant. METHODS Fifty younger patients with end-stage osteoarthritis were managed with the Primoris hip implant. We evaluated bone mineral density (BMD) using dual x-ray absorptiometry (DXA) and implant migration using radiostereometric analysis (RSA). A region-of-interest (ROI) protocol for 4 ROIs was applied to assess BMD. The association between BMD and migration was evaluated to determine the fixation of the Primoris implant and bone remodeling in the proximal part of the femur. Follow-up evaluation was performed at regular intervals from day 1 (baseline) until 24 months after surgery. RESULTS The major stem migrations were subsidence (Y axis; mean, 0.38 mm) at 6 weeks and varus tilt (rotation) (Z axis; mean, 0.93°) at 6 to 12 months. In ROI4 (the calcar area), a significant gain in bone was found with a mean difference of 4.1% (95% confidence interval [CI], 0.8% to 7.4%; p < 0.02) at 24 months postoperatively. Significant bone loss was found in ROI1 and ROI2, with a mean difference of -4.9% (95% CI, -7.4% to -2.4%; p = 0.0003) and -8.9% (95% CI, -11.5% to -6.2%; p = 0.0001), respectively. Linear regression and multivariate regression analysis showed a significant negative association between maximal total point motion and BMD (p = 0.02, R = 15%; and p < 0.05, R = 26%, respectively). CONCLUSIONS The Primoris component showed satisfactory primary stability with promising results at the 24-month follow-up. DXA scans showed limited stress-shielding with the proximal loading pattern of the Primoris. Better bone quality was associated with less implant migration. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Janus D Christiansen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ashir Ejaz
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul T Nielsen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark
| | - Mogens Laursen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Schaer MO, Finsterwald M, Holweg I, Dimitriou D, Antoniadis A, Helmy N. Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence. BMC Musculoskelet Disord 2019; 20:604. [PMID: 31831070 PMCID: PMC6909646 DOI: 10.1186/s12891-019-2980-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/29/2019] [Indexed: 01/14/2023] Open
Abstract
Background Early femoral stem subsidence following a cementless THA is correlated with aseptic loosening of the femoral component. The short femoral stems allow bone sparing and implantation through a minimally invasive approach; however, due to their metaphyseal anchoring, they might demonstrate different subsidence pattern than the conventional stems. Methods In this prospective single-center study, a total of 68 consecutive patients with an average age of 63 years, and a minimum follow-up of 5 years following a cementless THA with a metaphyseal-anchored short femoral stem were included. The femoral stem subsidence was evaluated using “Ein Bild Roentgen Analyse” (EBRA). Results Average stem migration was 0.96 +/− 0.76 mm at 3 months, 1.71 +/− 1.26 mm at 24 months, and 2.04+/− 1.42 mm at last follow-up 60 months postoperative. The only factor that affected migration was a stem size of 6 or more (r2 = 5.74; p = 0.039). Subdivision analysis revealed, that only in females migration appeared to be affected by stem size irrespective of weight but not in men (female stem size of 6 or more vs. less (Difference = − 1.48 mm, R2 = 37.5; p = 0.001). Migration did not have an impact on clinical outcome measures. Conclusions The examined metaphyseal-anchored short femoral stem showed the highest subsidence within the first 3 months postoperative, the implant began to stabilize at about 24 months but continued to slowly migrate with average total subsidence of 2.04 mm at 5 years following the THA. The amount of stem subsidence was not associated with worse clinical outcomes such as HHS, patient satisfaction, or pain.
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Affiliation(s)
- Michael O Schaer
- Department for Orthopedic Surgery and Traumatology, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland. .,Department for Orthopedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
| | - Michael Finsterwald
- Department for Orthopedic Surgery and Traumatology, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland
| | - Iris Holweg
- Department for Orthopedic Surgery and Traumatology, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland
| | - Dimitris Dimitriou
- Department for Orthopedic Surgery and Traumatology, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland
| | - Alexander Antoniadis
- Department for Orthopedic Surgery and Traumatology, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland
| | - Naeder Helmy
- Department for Orthopedic Surgery and Traumatology, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland
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Abstract
AIMS Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components. MATERIALS AND METHODS A literature review was performed using the EMBASE, Medline, and Cochrane databases. Strict inclusion and exclusion criteria were used to identify studies reporting clinical and radiological follow-up for short-stemmed hip arthroplasties. RESULTS A total of 28 studies were eligible for inclusion. This included 5322 hips in 4657 patients with a mean age of 59 years (13 to 94). The mean follow-up was 6.1 years (0.5 to 20). The mean Harris Hip Score improved from 46 (0 to 100) to 92 (39 to 100). The mean Oxford Hip Score improved from 25 (2 to 42.5) to 35 (12.4 to 48). The mean Western Ontario & McMaster Universities Osteoarthritis Index improved from 54 (2 to 95) to 22 (0 to 98). Components were aligned in a neutral coronal alignment in up to 90.9% of cases. A total of 15 studies reported component survivorship, which was 98.6% (92% to 100%) at a mean follow-up of 12.1 years. CONCLUSION Short-stemmed femoral implants show similar improvement in clinical and radiological outcomes compared with conventional length implants. Only mid-term survivorship, however, is known. An abundance of short components have been developed and used commercially without staged clinical trials. Long-term survival is still unknown for many of these components. There remains tension between innovation and the moral duty to ensure that the introduction of new implants is controlled until safety and patient benefit are demonstrated. Implant innovation and subsequent use should be driven by proven clinical outcomes, rather than market and financial forces, and ethical practice must be ensured. Cite this article: Bone Joint J 2019;101-B:502-511.
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Affiliation(s)
- S Lidder
- Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Australia
| | - D J Epstein
- Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Australia
| | - G Scott
- Bone and Joint Research Unit, The Royal London Hospital, London, UK
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Drosos GI, Touzopoulos P. Short stems in total hip replacement: evidence on primary stability according to the stem type. Hip Int 2019; 29:118-127. [PMID: 30569737 DOI: 10.1177/1120700018811811] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND: As the prevalence of total hip replacement is increasing in younger patients, less invasive implants (short stems) are becoming more favourable. However, despite the advantages of these stems, clinical results with a follow-up of more than 10 years are limited to a very few stem designs. There has been an increase in publications recently - mechanical and clinical studies - concerning the primary stability of short stems. Primary stem stability is an important factor as it reflects final stem stabilisation and is related to the clinical results of the prosthesis. METHOD: We conducted a systematic review of the literature to retrieve evidence concerning primary implant stability in short stems - as expressed by implant micromotion and stem subsidence - according to our previously proposed short-stem classification. RESULTS: Mechanical in vitro studies on stem micromotion are very few and limited to type 2 "partial collum" short stems. The results are comparable to those of stems with a known long-term excellent clinical course. Clinical results concerning stem migration patterns are also limited to some of the commercially available short stems. Although comparative studies are very few, the results for most of the short stems are similar to those of standard stems. CONCLUSION: There are promising results concerning biomechanical studies of the initial micromotion of short stems, as well as clinical results of stem migration patterns. Long-term clinical studies are needed in order to confirm these findings. The existing literature concerns very few of the many commercially available implants.
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Affiliation(s)
- Georgios I Drosos
- 1 Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,2 Democritus University of Thrace, Komotini, Greece
| | - Panagiotis Touzopoulos
- 1 Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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19
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Freitag T, Fuchs M, Woelfle-Roos JV, Reichel H, Bieger R. Mid-term migration analysis of a femoral short-stem prosthesis: a five-year EBRA-FCA-study. Hip Int 2019; 29:128-133. [PMID: 29739256 DOI: 10.1177/1120700018772277] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: The objective of this study was to evaluate the mid-term migration pattern of a femoral short stem. METHODS: Implant migration of 73 femoral short-stems was assessed by Ein-Bild-Roentgen-Analysis Femoral-Component-Analysis (EBRA-FCA) 5 years after surgery. Migration pattern of the whole group was analysed and compared to the migration pattern of implants "at risk" with a subsidence of more than 1.5 mm 2 years postoperative. RESULTS: Mean axial subsidence was 1.1 mm (-5.0 mm to 1.5 mm) after 60 months. There was a statistical significant axial migration until 2 years postoperative with settling thereafter. 2 years after surgery 18 of 73 Implants were classified "at risk." Nevertheless, all stems showed secondary stabilisation in the following period with no implant failure neither in the group of implants with early stabilisation nor the group with extensive early onset migration. CONCLUSION: In summary, even in the group of stems with more pronounced early subsidence, delayed settling occurred in all cases. The determination of a threshold of critical early femoral short stem subsidence is necessary because of the differing migration pattern described in this study with delayed settling of the Fitmore stem 2 years postoperatively compared to early settling within the first postoperative year described for conventional stems.
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Affiliation(s)
- Tobias Freitag
- 1 Department of Orthopaedic Surgery, University of Ulm, Germany
| | - Michael Fuchs
- 1 Department of Orthopaedic Surgery, University of Ulm, Germany.,2 Centre for Musculoskeletal Surgery, Orthopaedic Department Charite, Berlin, Germany
| | | | - Heiko Reichel
- 1 Department of Orthopaedic Surgery, University of Ulm, Germany
| | - Ralf Bieger
- 1 Department of Orthopaedic Surgery, University of Ulm, Germany
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20
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Age-related osseointegration of a short hip stem: a clinical and radiological 24 months follow-up. Arch Orthop Trauma Surg 2019; 139:405-410. [PMID: 30506094 DOI: 10.1007/s00402-018-3082-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE The purpose of this study was to examine potential differences between patients under and over 60 years who underwent a total short hip stem arthroplasty in a 24-month follow-up in a clinical setting. METHODS Sixty seven patients were included in this prospective study and divided in two groups. In the younger cohort 39 patients ≤ 59 years and in the older cohort 28 patients ≥ 60 years were included. Clinical and radiological examinations of the patients took place preoperatively, postoperatively and after 3, 6, 12 and 24 months. The Harris Hip Score (HHS) was raised as clinical examination. Changes of bone mass density (BMD), stress shielding, reactive lines, spot welds and sclerosing were examined as radiological analysis. RESULTS The HHS improved from 53.6 ± 8.2 preoperative to 93.2 ± 9.6 in the younger cohort and for the older cohort from 57.6 ± 14.8 to 94.1 ± 7.6 after 24 months. BMD growth was detectable in regions of interest (ROI) 3 and 6 for both groups. Different results between the cohorts could only be detected in ROIs 4 and 5. The older cohort showed a loss of BMD of 5.95% in ROI 4 and 3.17% in ROI 5 after 24 months, whereas the younger cohort showed no loss of BMD in both ROIs. CONCLUSIONS No significant differences or any influences of osseointegration and clinical outcome of the short hip stem for both groups were detectable. Lower losses (ROIs 1 and 2) and higher growths (ROIs 3, 4, 5) were discovered in younger patients and the HHS improved in both groups. Reasons for this result could be age, sex or the level of activity of the patients, but in both groups the short hip stem shows comparable results in clinical as well as in radiological examination. We conclude that the short hip stem seems to be an adequate treatment also for older patients.
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Jacobsen A, Seehaus F, Hong Y, Cao H, Schuh A, Forst R, Sesselmann S. Model-based roentgen stereophotogrammetric analysis using elementary geometrical shape models: 10 years results of an uncemented acetabular cup component. BMC Musculoskelet Disord 2018; 19:335. [PMID: 30223820 PMCID: PMC6142331 DOI: 10.1186/s12891-018-2259-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/12/2018] [Indexed: 11/16/2022] Open
Abstract
Background Non-cemented acetabular cup components demonstrated different clinical performance depending on their surface texture or bearing couple. However, clinical osseointegration needs to be proved for each total joint arthroplasty (TJA) design. Aim of this study was to detect the in vivo migration pattern of a non-cemented cup design, using model-based roentgen stereophotogrammetric analysis with elementary geometrical shape models (EGS-RSA) to calculate early cup migration. Methods Interchangeable applicability of the model-based EGS-RSA method next to gold standard marker-based RSA method was assessed by clinical radiographs. Afterwards, in vivo acetabular cup migration for 39 patients in a maximum follow up of 120 months (10 years) was calculated using model-based EGS-RSA. Results For the axes with the best predictive capability for acetabular cup loosening, mean (±SD) values were calculated for migration and rotation of the cup. The cup migrated 0.16 (±0.22) mm along the cranio-caudal axis after 24 months and 0.36 (±0.72) mm after 120 months, respectively. It rotated − 0.61 (±0.57) deg. about the medio-lateral axis after 24 months and − 0.53 (±0.67) deg. after 120 months, respectively. Conclusions Interchangeable applicability of model-based EGS-RSA next to gold standard marker-based RSA method could be shown. Model-based EGS-RSA enables an in vivo migration measurement without the necessity of TJA specific surface models. Migration of the investigated acetabular cup component indicates significant migration values along all the three axes. However, migration values after the second postoperative year were within the thresholds reported in literature, indicating no risk for later aseptic component loosening of this TJA design.
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Affiliation(s)
- Anne Jacobsen
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Frank Seehaus
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Yutong Hong
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Han Cao
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Alexander Schuh
- Muskuloskelettales Zentrum, Klinikum Neumarkt, Nürnberger Str. 12, 92318, Neumarkt i. d. OPf, Germany
| | - Raimund Forst
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Stefan Sesselmann
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany. .,Institute for Medical Technology, Ostbayerische Technische Hochschule Amberg-Weiden, Hetzenrichter Weg 15, 92637, Weiden, Germany.
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Klasan A, Sen A, Dworschak P, El-Zayat BF, Ruchholtz S, Schuettler KF, Schmitt J, Heyse TJ. Ten-year follow-up of a cemented tapered stem. Arch Orthop Trauma Surg 2018; 138:1317-1322. [PMID: 30043147 DOI: 10.1007/s00402-018-3002-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION This stem was cleared by the FDA in 2002 and has been implanted in cementless and cemented versions. Despite its long history, there are no long-term clinical results available for the cemented version of this implant. The aim of this study was to provide such data. It was hypothesized that this implant delivers clinical success comparable to other tapered cemented stems. MATERIALS AND METHODS A total of 113 hip replacements were performed in 106 patients between October 2007 and December 2009 using the cemented version of this stem. The mean age of the patients at operation was 74.8 years (range 50-91 years). The mean follow-up was 8.9 years with only two patients lost to follow-up. Implant survival was determined using the Kaplan-Meier analysis. RESULTS Stem survival with revision for any reason as the endpoint was 96.4% after 10 years. Survival for stem aseptic loosening was 100%. There were no cases of osteolysis. Clinical outcomes, as shown by Harris Hip Scores, were in line with previous investigations and the rate of adverse events was very low. CONCLUSIONS This is a modern cemented stem with an excellent survival rate and satisfactory functional outcomes. In this cohort, there were no failures related to the stem through the first decade.
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Affiliation(s)
- Antonio Klasan
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Ahmet Sen
- Department for Trauma, Clinic Jung-Stilling, Wichernstraße 40, 57074, Siegen, Germany
| | - Philipp Dworschak
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Bilal Farouk El-Zayat
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Karl F Schuettler
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Jan Schmitt
- Department for Orthopedics, Clinic Wetzlar, Forsthausstraße 1, 35578, Wetzlar, Germany
| | - Thomas J Heyse
- ORTHOmedic Frankfurt Offenbach, Herrnstr. 57, 63065, Offenbach, Germany
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Abstract
Over the last two decades, several conservative femoral prostheses have been designed. The goals of conservative stems include: the spearing of the trochanteric bone stock; a more physiological loading in the proximal femur reducing the risk of stress shielding; and to avoid a long stem into the diaphysis preventing impingement with the femoral cortex and thigh pain. All stems designed to be less invasive than conventional uncemented stems are commonly named ‘short stems’. However, this term is misleading because it refers to a heterogeneous group of stems deeply different in terms of design, biomechanics and bearing. In the short-term follow-up, all conservative stems provided excellent survivorship. However, variable rates of complications were reported, including stem malalignment, incorrect stem sizing and intra-operative fracture. Radiostereometric analysis (RSA) studies demonstrated that some conservative stems were affected by an early slight migration and rotation within the first months after surgery, followed by a secondary stable fixation. Dual-energy x-ray absorptiometry (DEXA) studies demonstrated an implant-specific pattern of bone remodelling. Although the vast majority of stems demonstrated a good osseointegration, some prostheses transferred loads particularly to the lateral and distal-medial regions, favouring proximal stress shielding and bone atrophy in the great trochanter and calcar regions.
Cite this article: EFORT Open Rev 2018;3:149-159. DOI: 10.1302/2058-5241.3.170052
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Italy; Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Italy
| | - Guido Grappiolo
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Italy
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Schwarze M, Budde S, von Lewinski G, Windhagen H, Keller MC, Seehaus F, Hurschler C, Floerkemeier T. No effect of conventional vs. minimally invasive surgical approach on clinical outcome and migration of a short stem total hip prosthesis at 2-year follow-up: A randomized controlled study. Clin Biomech (Bristol, Avon) 2018; 51:105-112. [PMID: 29287171 DOI: 10.1016/j.clinbiomech.2017.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/30/2017] [Accepted: 12/08/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
| | - Stefan Budde
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Gabriela von Lewinski
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Marie Christina Keller
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Frank Seehaus
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Thilo Floerkemeier
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
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Baert IAC, Lluch E, Van Glabbeek F, Nuyts R, Rufai S, Tuynman J, Struyf F, Meeus M. Short stem total hip arthroplasty: Potential explanations for persistent post-surgical thigh pain. Med Hypotheses 2017; 107:45-50. [PMID: 28915961 DOI: 10.1016/j.mehy.2017.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 12/22/2022]
Abstract
Short stem uncemented femoral implants were developed with the aim of preserving proximal bone stock for future revisions, improving biomechanical reconstruction, aiding insertion through smaller incisions and potentially decreasing or limiting the incidence of thigh pain. Despite all the advantages of short stem designs, it remains unclear whether they are able to limit post-surgical thigh pain. In patients with short stem hip arthroplasty and persistent thigh pain, it is of the utmost importance to understand the potential etiologies of this chronic pain for selecting the appropriate treatment strategy. Therefore, this manuscript explores the hypothetical etiologies of persistent thigh pain in short stem total hip arthroplasty, including both peripheral factors (structural or biomechanical causes) and central factors (involvement of the central nervous system). First, intrinsic causes (e.g. aseptic femoral loosening and prosthetic joint infection) and extrinsic sources (e.g. muscle pathology or spinal pathology) of persistent thigh pain related to hip arthroplasty are explained. In addition, other specific peripheral causes for thigh pain related to the short stem prosthetic reconstruction (e.g. stem malalignment and micro-motion) are unraveled. Second, the etiology of persistent thigh pain after short stem hip arthroplasty is interpreted in a broader concept than the biomechanical approach where peripheral structural injury is believed to be the sole driver of persistent thigh pain. Over the past decades evidence has emerged of the involvement of sensitization of central nervous system nociceptive pathways (i.e. central sensitization) in several chronic pain disorders. In this manuscript it is explained that there might be a relevant role for altered central nociceptive processing in patients with persistent pain after joint arthroplasty or revision surgery. Recognition of a potential role for centrally-mediated changes in pain processing in total hip replacement surgery has important implications for treatment. Comprehensive treatment addressing peripheral factors as well as neurophysiological changes occurring in the nervous system may help to improve outcomes in patients with short stem hip arthroplasty and chronic thigh pain. Working within a biopsychosocial approach in orthopaedic surgery, specifically in relation to total hip arthroplasty, could be very important and may lead to more satisfaction. Further research is warranted.
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Affiliation(s)
- Isabel A C Baert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Pain in Motion Research Group, Belgium(1).
| | - Enrique Lluch
- Pain in Motion Research Group, Belgium(1); Departments of Human Physiology and Rehabilitation Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Francis Van Glabbeek
- Department of Orthopaedic Surgery and Traumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Rudy Nuyts
- Department of Orthopaedic Surgery and Traumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Salim Rufai
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Joanna Tuynman
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Pain in Motion Research Group, Belgium(1); Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Stable migration pattern of an ultra-short anatomical uncemented hip stem: a prospective study with 2 years radiostereometric analysis follow-up. Hip Int 2017; 27:259-266. [PMID: 28165591 DOI: 10.5301/hipint.5000458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Shorter, anatomically shaped and proximally loading stems have been developed to achieve better stress distribution and be more bone preserving. The purpose of this prospective study was to evaluate the migration pattern of the Proxima™ ultra-short uncemented stem using radiostereometric analysis (RSA), and to review the literature regarding the migration of short stemmed hip arthroplasty. METHODS 25 patients (28 hips) with hip osteoarthritis received a Proxima stem during total hip arthroplasty (THA). To measure stem migration, repeated RSA examinations were done during a 2 year follow up period. The patients were evaluated with the hip specific (HOOS) and the generic health (EQ5D) scores up to 1 year, and clinically for 6 years postoperatively. RESULTS Almost all migration occurred within the first 3 months, with mean subsidence of 0.22 mm and varus rotation of 1.04°, being the primary effect variables. After the third postoperative month and up to the 2 year RSA follow up no further significant migration occurred. The outcome scores showed substantial improvement after 1 year. No revisions were performed or indicated for any stem after a mean clinical follow up of 72.1 months. CONCLUSIONS Like many other uncemented stems, the Proxima showed early migration up to 3 months hereafter osseointegration seems to have occurred. The achieved stability and clinical outcomes indicate favorable early results for this stem in younger patients who have good bone quality and average BMI. We found, however, the surgical technique to be slightly more demanding compared to conventional stems owing to the unique implant design that necessitates specific adjusted femoral cutting and broaching procedures.
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27
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The Influence of Tribological Pairings and Other Factors on Migration Patterns of Short Stems in Total Hip Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8756432. [PMID: 28497067 PMCID: PMC5406728 DOI: 10.1155/2017/8756432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/11/2017] [Accepted: 03/28/2017] [Indexed: 01/13/2023]
Abstract
Over the last decade, the number of short stem total hip arthroplasty procedures has increased. Along with the possible benefits associated with short stems is a smaller implant-bone contact surface, which may have a negative influence on primary stability and impair osseointegration. Previous studies observed migration of short stems, especially within the first three months. The variables that influence migration in short stem hip implants remain unknown. Therefore, the purpose of this study was to associate the migration of short stems with its possible influencing variables. Migration data from two different short stem studies were retrospectively analyzed. Migration within the first two postoperative years was determined by model-based Roentgen stereophotogrammetric analysis. Migration was correlated to bearing couple, type and size of stem, size of acetabular cup, and age, gender, weight, and height of patients using a multiple factor analysis. Eigenvalue analysis explained 80.7% of the overall variance for the first three dimensions. The four most dominant variables in the first dimension were weight, stem size, acetabular cup size, and patient height (correlations of 0.81, 0.80, 0.71, and 0.70, resp.). None of the analyzed parameters (bearing couple, type and size of stem, size of acetabular cup, and age, gender, weight, and height of patients) affected the migration pattern of short stem THA with primary metaphyseal fixation.
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28
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Gabarre S, Herrera A, Ibarz E, Mateo J, Gil-Albarova J, Gracia L. Comparative Analysis of the Biomechanical Behaviour of Two Cementless Short Stems for Hip Replacement: Linea Anatomic and Minihip. PLoS One 2016; 11:e0158411. [PMID: 27391328 PMCID: PMC4938462 DOI: 10.1371/journal.pone.0158411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/15/2016] [Indexed: 12/18/2022] Open
Abstract
A comparative study between two stems (Linea Anatomic and Minihip) has been performed in order to analyse the differences in their biomechanical behaviour, concerning stem micromotions and load transmission between stem and bone. From the corresponding finite element models, a parametric study was carried out to quantify ranges of micromotions taking into account: friction coefficient in the stem-bone interface, press-fit and two types of gait cycle. Micromotions were evaluated for each stem at six different levels along repeated gait cycles. An initial and marked stem subsidence at the beginning of the simulation was observed, followed by an asymptotic decrease due to friction forces. Once migration occurs, a repeated reversible cyclic micromotion is developed and stabilized as gait cycle times are simulated. The general motion pattern exhibited higher amplitude of micromotion for Minihip compared to Linea stem. The load transmission mechanism was analyzed, identifying the main internal forces. The results show higher local forces for Minihip stem up to 80% greater than for Linea stem. The differences of design between Minihip and Linea conditioned different distributions of load, influencing the posterior stress-shielding. Consequently, short stems require high bone stock and quality should, being indicated for young patients with high bone quality.
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Affiliation(s)
- Sergio Gabarre
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragón Institute for Engineering Research, Zaragoza, Spain
| | - Antonio Herrera
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
- * E-mail:
| | - Elena Ibarz
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragón Institute for Engineering Research, Zaragoza, Spain
| | - Jesús Mateo
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Jorge Gil-Albarova
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis Gracia
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragón Institute for Engineering Research, Zaragoza, Spain
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