Periprosthetic femoral fractures around the original cemented polished triple-tapered C-stem femoral implant: a consecutive series of 500 primary total hip arthroplasties with an average follow-up of 15 years

The short-term outcomes of cementless collared triple-tapered stem for primary total hip arthroplasty in patients ≥70-years old

Background

Periprosthetic fractures and mechanical failure following total hip arthroplasty (THA) are not uncommon occurrences in elderly patients, especially with the use of cementless implants. The utilization of collared, triple-tapered femoral stems has demonstrated good clinical outcomes and results comparable to other femoral stems. There remains a paucity of literature on the use of these stems in older patients. In this study, we evaluated post-operative outcomes following primary THA in patients ≥70-years old using a collared, triple-tapered femoral stem.

Methods

Retrospective study including 91 primary THAs in patients ≥70-years old using a triple-tapered femoral stem, between September 2017 and July 2024. Primary outcomes included intraoperative or post-operative periprosthetic fractures and subsidence of the femoral stem. Subsidence was measured on x-rays as the distance between the most proximal aspect of the greater trochanter and the shoulder of the femoral stem.

Results

A total of 91 patients were included, with no periprosthetic fractures observed intraoperatively or post-operatively. The average femoral stem subsidence at 6-weeks post-operative was 1.1 mm (std dev, 0.9) compared to baseline post-operative imaging. At that time point three patients had subsidence ≥3 mm, with no clinically significant symptoms. There was one prosthetic joint infection requiring revision and three superficial surgical site infections. The overall average follow-up time was 12.5 months (std dev, 12.7).

Conclusion

In this study, we found low rates of subsidence and no periprosthetic fractures following primary THA with triple-taper stems in patients ≥70-years old. Of note, no revision surgeries were performed for mechanical failure.

Multi-center study of use of the Exeter stem in Japan: a 10-year follow-up report

PURPOSE

Since the introduction of the Exeter stem for clinical use in Japan in 1996, the number of stems used has continued to rise owing to its favorable results. We investigated the outcomes of patients who had previously undergone total hip arthroplasty with the Exeter stem in Japan with a 10-year + follow-up period.

METHODS

This retrospective cohort study used clinical and radiographic data of 682 cases of primary total hip arthroplasty performed using the Exeter stem.

RESULTS

The mean postoperative follow-up period was 13.3 years. Femoral-side revision was required in 14 hips, with no cases of aseptic stem loosening-associated revision observed. Kaplan-Meier survival analysis predicted 97.3% 15-year survival when revision for any reason was used as the endpoint.

CONCLUSION

The obtained findings suggested the excellent long-term stability of the Exeter stem for primary total hip arthroplasty in Japan.

Experience of an anatomic femoral stem in a UK orthopaedic centre beyond 20 years of follow-up

INTRODUCTION

Increasing interest in the use of anatomical stems has developed as the prevalence of periprosthetic fractures (PPFs) continues to increase. The primary aim of this study was to determine the long-term survivorship and PPF rate of an anatomical femoral stem in a single UK centre.

PATIENTS AND METHODS

Between 2000 and 2002, 94 consecutive THAs were performed using the 170 mm Lubinus SP II anatomical femoral stem in our institution. Patient demographics, operative details and clinical outcomes were collected prospectively in an arthroplasty database. Patient records and national radiographic archives were reviewed finally at a mean of 21.5 years (SD 0.7) following surgery to identify occurrence of subsequent revision surgery, dislocation or periprosthetic fracture.

RESULTS

Mean patient age at surgery was 65.8 years (SD 12.5, 34-88 years). There were 48 women (51%). Osteoarthritis was the operative indication in 88 patients (94%). Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (95% confidence interval [CI], 98.0-99.3%) at 10 years and 96.7% (94.5-98.9%) at 21 years. The 20-year stem survival for aseptic loosening was 100% with no cases of significant lysis found (lucent line > 2 mm) and no stems required revision. Patient demographics did not appear to influence risk of revision (p > 0.05). There were 2 revisions in total (2 for acetabular loosening with original stems retained). There were no PPFs identified at mean 21.5 year follow-up and 5 dislocations (5%).

CONCLUSIONS

The Lubinus SP II 170 mm stem demonstrated excellent survivorship and negligible PPF rates over 20 years following primary THA.

Low rate of periprosthetic femoral fracture with the Hueter anterior approach using stems cemented according to the 'French paradox'

Aims

The aim of this retrospective study was to assess the incidence of early periprosthetic femoral fracture (PFF) associated with Charnley-Kerboull (CK) femoral components cemented according to the 'French paradox' principles through the Hueter anterior approach (HAA) in patients older than 70 years.

Methods

From a prospectively collected database, all short CK femoral components implanted consecutively from January 2018 to May 2022 through the HAA in patients older than 70 years were included. Exclusion criteria were age below 70 years, use of cementless femoral component, and approaches other than the HAA. A total of 416 short CK prostheses used by 25 surgeons with various levels of experience were included. All patients had a minimum of one-year follow-up, with a mean of 2.6 years (SD 1.1). The mean age was 77.4 years (70 to 95) and the mean BMI was 25.3 kg/m2 (18.4 to 43). Femoral anatomy was classified according to Dorr. The measured parameters included canal flare index, morphological cortical index, canal-calcar ratio, ilium-ischial ratio, and anterior superior iliac spine to greater trochanter (GT) distance.

Results

Among the 416 THAs, two PFFs (0.48% (95% confidence interval 0.13 to 1.74)) were observed, including one Vancouver type B2 fracture 24 days postoperatively and one intraoperative Vancouver type B1 fracture. Valgus malalignment and higher canal bone ratio were found to be associated with PFF.

Conclusion

This study demonstrated that short CK femoral components cemented according to the French paradox were associated with a low rate of early PFF (0.48%) in patients aged over 70 years. Longer follow-up is warranted to further evaluate the rate of fracture that may occur during the bone remodelling process and with time.

Exploring Individualized Approaches to Managing Vancouver B Periprosthetic Femoral Fractures: Insights from a Comprehensive Case Series Analysis

The increasing prevalence of periprosthetic femoral fractures, specifically in the vicinity of the hip, has emerged as a significant issue in recent times. Consequently, there is a need for a thorough examination to enhance the effectiveness of management and treatment approaches. The findings of this study emphasize a significant disparity in the occurrence and characteristics of these fractures, and the multiple cases have highlighted the efficacy of various treatment strategies, such as open reduction and internal fixation, as well as the utilization of cortical strut allografts. Furthermore, the study has identified potential risk factors that have an impact on the characteristics of fractures, providing valuable insights that could be crucial in the development of preventive strategies. This study provides a thorough examination of periprosthetic femoral fractures, highlighting the importance of a cohesive treatment algorithm to improve the handling of such fractures. Moreover, it promotes the need for a collaborative endeavor in conducting research in this field, cultivating a more profound comprehension that has the potential to drive progress in therapeutic approaches, ultimately enhancing patient results over an extended period of time. It is crucial that forthcoming research endeavors persist in expanding upon these discoveries, striving towards a unified methodology in tackling this substantial clinical obstacle.