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Perez Alamino L, Garabano G, Rodriguez J, Lopreite F, Pesciallo C. Total hip arthroplasty in patients under 50 years old: Does cementless fixation have better results? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00079-1. [PMID: 38643855 DOI: 10.1016/j.recot.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/20/2024] [Accepted: 04/14/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Cementless fixation for hip arthroplasties has increased in the last decades, particularly in younger patients. The purpose of this study was to compare the long-term results three different types of fixations in patients under 50years old. METHODS Cemented, hybrid and cementless fixations were assessed in patients under 50years old with a minimum follow-up of 8years. Loosening, demarcation, complications, and prosthesis survival were assessed. Functional analysis was performed with the modified Harris Hip Score and Visual analogue scale was collected. RESULTS Final series consisted in 222 patients. Significant improvement was observed regarding mHHS and VAS score in each group. We observed statistically significant difference regarding demarcation between the groups (P<.001). The higher rate of acetabular and femoral stem loosening was observed in the cemented (20.0%) and hybrid (18.9%) group. The lowest prosthesis survival rate after 16 years was observed in hybrid group (P<.001). CONCLUSION Total hip replacement has good long-term clinical and functional outcomes. The lowest rate of prosthesis survival was observed in hybrid group with 84.2% after 16years.
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Affiliation(s)
- L Perez Alamino
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
| | - G Garabano
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - J Rodriguez
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - F Lopreite
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - C Pesciallo
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
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Hoskins W, Corfield S, Peng Y, Graves SE, Bingham R. A comparison of cemented femoral fixation via anterior versus posterior approach total hip arthroplasty: an analysis of 60,739 total hip arthroplasties. Hip Int 2024:11207000241239914. [PMID: 38529902 DOI: 10.1177/11207000241239914] [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] [Indexed: 03/27/2024]
Abstract
BACKGROUND Anterior approach total hip arthroplasty (THA) decreases the rate of dislocation but increases femoral-sided complications in the way of periprosthetic fractures and component loosening. A cemented prosthesis may reduce femoral-sided complications and improve the risk:benefit profile of anterior approach THA. METHODS Data from the Australian National Joint Replacement Registry were analysed for patients undergoing primary THA via the anterior or posterior approach using a cemented polished femoral stem from January 2015 to December 2021. The primary outcome measure was the cumulative percent revision (CPR) for all causes and CPR for femoral component loosening and fracture. The CPR for the primary outcome measures were compared between the anterior and posterior approach and adjusted for age, sex, ASA score, BMI and femoral head size. RESULTS The study included 60,739 THAs with cemented stems (10,742 anterior, 49,997 posterior). The rate of revision of the anterior versus the posterior approach did not significantly differ (HR 0.87 (95% CI, 0.74-1.03), p = 0.100). Anterior approach THA had a significantly higher rate of revision for femoral component loosening (HR 5.06 [95% CI, 3.08-8.30], p < 0.001); and a decreased rate of revision for infection (HR 0.59 [95% CI, 0.43-0.81], p = 0.001) and dislocation/instability (HR 0-3 months 0.48 [95% CI, 0.27-0.83], p = 0.008; HR >3 months 0.30 [95% CI, 0.15-0.61], p < 0.001). There was no difference in the rate of revision surgery for fracture between the 2 approaches (HR 1.01 [95% CI, 0.71-1.43]), p = 0.975). CONCLUSIONS There is no significant difference in overall revision rates with cemented femoral fixation performed with an anterior or posterior approach. Cemented fixation performed with the anterior approach partly mitigates femoral complications with no difference in the revision rate for fracture but an increased rate of femoral component loosening.
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Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Traumaplasty. Melbourne, East Melbourne, VIC, Australia
| | - Sophie Corfield
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Yi Peng
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Roger Bingham
- Traumaplasty. Melbourne, East Melbourne, VIC, Australia
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Shichman I, Oakley CT, Beaton G, Davidovitch RI, Schwarzkopf R, Rozell JC. Are we getting better at cementing femoral stems in total hip arthroplasty? A 5-year institutional trend. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04751-4. [PMID: 36593365 DOI: 10.1007/s00402-022-04751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Femoral stem cementation provides excellent implant longevity with a low periprosthetic fracture rate among patients with compromised bone quality or abnormal anatomy. We radiologically evaluated the quality of the femoral cement mantle in patients undergoing THA to examine whether cementation quality improved with increased institutional experience. METHODS A retrospective study of 542 primary elective THAs performed using cemented stems from 2016 to 2021 at a high-volume orthopedic specialty center was conducted. Immediate post-operative anterior-posterior (AP) and lateral radiographs were evaluated to assess cement mantle quality based on the Barrack classification. Cement mantles were deemed satisfactory (Barrack A and B) or unsatisfactory (Barrack C and D). Regression was performed to identify predictors of unsatisfactory cementation quality. RESULTS The annual cemented primary THA volume increased throughout the study period from 14 cases in 2016 to 201 cases in 2021. Overall, the majority of cement mantles were deemed satisfactory; 91.7% on AP radiographs and 91.0% on lateral radiographs. Satisfactory cementation on AP radiograph achievement rates improved during the study period, which coincided with greater annual volume (p < 0.001). No association was found between posterior and direct anterior surgical approaches and satisfactory cementation quality on both AP and lateral radiographs. CONCLUSION Majority of femoral stems had satisfactory cementation quality. Higher institutional annual cemented THA volume was associated with improved cementation quality. Residency and fellowship training programs should place greater emphasis on the importance of femoral stem cementation for appropriately indicated patients. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Ittai Shichman
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY, USA.,Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Christian T Oakley
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY, USA
| | - Geidily Beaton
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY, USA
| | - Roy I Davidovitch
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY, USA
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY, USA.
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Pomeroy E, McGoldrick NP, Moody PW, Vasarhelyi EM, McCalden RW, Lanting BA. Cement Mantle Quality and Stem Alignment in Cemented Collarless Polished Tapered Stems Implanted via the Direct Anterior and Direct Lateral Approaches: A Single Institution Experience. J Arthroplasty 2022; 37:2208-2213. [PMID: 35580767 DOI: 10.1016/j.arth.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study was to compare the stem alignment and the quality of cement mantle of collarless polished tapered cemented stems inserted through the direct anterior approach (DAA) and the direct lateral approach (DLA). METHODS A comparative retrospective study of 232 hybrid total hip arthroplasties using a cemented collarless polished tapered stem through either the DAA (n = 147) or DLA (n = 85) was performed. Radiographic evaluation included stem alignment, cement mantle quality, and cement mantle thickness. RESULTS On anteroposterior radiographs, stems implanted through the DLA were more likely to be in neutral alignment, than those implanted through the DAA (83.5%[n = 71] versus 71.4% [n = 105]; P = <.001). No difference between approaches was noted for stem alignment on lateral radiographs or cement mantle quality. Multivariate analysis revealed factors associated with suboptimal cement mantle and included Dorr type B or C femur as well as male gender. A mean cement mantle thickness ≥2mm was achieved in all Gruen zones for both approaches. CONCLUSION In our series, the DAA was associated with a higher incidence of coronal plane stem malalignment compared to the DLA when using cemented tapered polished femoral components for total hip arthroplasty. No difference in lateral stem alignment or cement mantle quality was found.
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Affiliation(s)
- Eoghan Pomeroy
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | | | - Patrick W Moody
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | | | - Richard W McCalden
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Brent A Lanting
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
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Clinical Outcomes and Survivorship of Hybrid Total Hip Arthroplasty Performed Through the Anterior Approach. J Arthroplasty 2022; 37:S556-S559. [PMID: 35660198 DOI: 10.1016/j.arth.2021.12.031] [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: 08/30/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION There is growing evidence that cemented femoral stems have lower complication rates in the elderly due to lower rates of periprosthetic fracture. The main objective of this study was to analyze the survival rate of a hybrid total hip arthroplasty (THA) construct utilizing a taper-slip femoral stem implanted through the anterior approach (AA). Secondary outcome measures were the complication rate, the rate of aseptic loosening, coronal plane alignment of the stem, and the grade of the cement mantle. METHODS Patients who underwent AA hybrid THA from 2013 to 2020 were included. Indications for a cemented stem were age over 70 or patients with poor bone quality. Descriptive statistics were calculated for patient characteristics. Serial radiographs were reviewed for component alignment and for evidence of implant loosening. The survival of the femoral stem was recorded, with failure defined as femoral stem revision for any reason or radiographic evidence of implant loosening. RESULTS A total of 473 hybrid THA in 426 patients were identified, with a mean age of 76 years. Mean follow-up was 38 months. Femoral stem survival was 99.2%. There were no cases of aseptic loosening of the femoral component. Mean coronal stem alignment was 0.2 degrees varus, and all were within 5 degrees of neutral. Cement mantle grade was either A or B in 94% of cases. CONCLUSION AA hybrid THA is an excellent option in elderly patients, or patients with poor bone quality, with a femoral stem survival rate of 99.2% and a 0% rate of aseptic loosening.
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McGoldrick NP, Fischman D, Nicol GM, Kreviazuk C, Grammatopoulos G, Beaulé PE. Cementing a collarless polished tapered femoral stem through the anterior approach : evaluation of cement mantle quality and component alignment. Bone Joint J 2021; 103-B:46-52. [PMID: 34192917 DOI: 10.1302/0301-620x.103b7.bjj-2020-2394.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to radiologically evaluate the quality of cement mantle and alignment achieved with a polished tapered cemented femoral stem inserted through the anterior approach and compared with the posterior approach. METHODS A comparative retrospective study of 115 consecutive hybrid total hip arthroplasties or cemented hemiarthroplasties in 110 patients, performed through anterior (n = 58) or posterior approach (n = 57) using a collarless polished taper-slip femoral stem, was conducted. Cement mantle quality and thickness were assessed in both planes. Radiological outcomes were compared between groups. RESULTS No significant differences were identified between groups in Barrack grade on the anteroposterior (AP) (p = 0.640) or lateral views (p = 0.306), or for alignment on the AP (p = 0.603) or lateral views (p = 0.254). An adequate cement mantle (Barrack A or B) was achieved in 77.6% (anterior group, n = 45) and in 86% (posterior group, n = 49), respectively. Multivariate analysis revealed factors associated with unsatisfactory cement mantle (Barrack C or D) included higher BMI, left side, and Dorr Type C morphology. A mean cement mantle thickness of ≥ 2 mm was achieved in all Gruen zones for both approaches. The mean cement mantle was thicker in zone 7 (p < 0.001) and thinner in zone 9 for the anterior approach (p = 0.032). Incidence of cement mantle defects between groups was similar (6.9% (n = 4) vs 8.8% (n = 5), respectively; p = 0.489). CONCLUSION An adequate cement mantle and good alignment can be achieved using a collarless polished tapered femoral component inserted through the anterior approach. Cite this article: Bone Joint J 2021;103-B(7 Supple B):46-52.
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Affiliation(s)
| | - Daniel Fischman
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Graeme M Nicol
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Cheryl Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | | | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada.,University of Ottawa, Ottawa, Canada
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