1
|
Migliorini F, Maffulli N, Pilone M, Velaj E, Hofmann UK, Bell A. Demographic characteristics influencing the stem subsidence in total hip arthroplasty: an imaging study. Arch Orthop Trauma Surg 2024; 144:887-894. [PMID: 37770626 PMCID: PMC10822810 DOI: 10.1007/s00402-023-05054-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/02/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION The present study evaluated whether patient demographic characteristics influence the subsidence of the stem in total hip arthroplasty (THA). The following characteristics were evaluated: age, height, weight, and sex. The association between the time elapsed from the THA implantation and the amount of stem subsidence was also investigated. METHODS The records of patients who underwent THA in the period between 2016 and 2023 were accessed. All patients underwent two-staged bilateral THA using cementless DePuy collarless Corail (DePuy Synthes, Raynham, MA, USA) stems. The following parameters were measured and compared to assess stem subsidence: distance from the proximal femur at the stem bone interface and the medial apex of the regular triangle built within the trochanter minor (point A); distance from the medial apex of the regular triangle built within the trochanter minor and the distal portion of the femoral stem (point B). RESULTS Overall, 294 patients were included. 62% (182 of 294 patients) were women. 45% (134 of 296 THAs) were on the right side. The mean age was 64.9 ± 10.4 years. The mean BMI was 28.3 ± 5.1 kg/m2. The mean length of the follow-up was 14.4 ± 11.0 months. The mean subsidence in point A was 2.1 mm (P < 0.0001), and that in point B was 3.1 mm (P < 0.0001). There was evidence of a weak positive association between patient weight (P < 0.0001), age (P = 0.03), follow-up (P = 0.002) and the amount of stem subsidence. Patient height did not demonstrate any association with the amount of stem subsidence (P = 0.07). There was no difference in stem subsidence between women and men (P = 0.9). CONCLUSION Stem subsidence in THA using cementless DePuy collarless Corail implants is approximately 2.6 mm after 14.4 months. Greater patient weight, age, and longer time elapsed from THA implantation were associated with greater stem subsidence. Patient height and sex did not demonstrate any influence on the amount of stem subsidence. These results must be considered in light of the limitations of the present study.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Clinic Aachen, RWTH Aachen University Medical Centre, Pauwelsstraße 30, 52064, Aachen, Germany.
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bolzano, Italy.
| | - Nicola Maffulli
- Department of Orthopaedic and Trauma Surgery, Hospital Sant'Andrea, University of Rome La Sapienza, Rome, Italy
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke On Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England
| | - Marco Pilone
- Department of Orthopaedic and Trauma Surgery, Hospital Sant'Andrea, University of Rome La Sapienza, Rome, Italy
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Erlis Velaj
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Clinic Aachen, RWTH Aachen University Medical Centre, Pauwelsstraße 30, 52064, Aachen, Germany
| | - Ulf Krister Hofmann
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Clinic Aachen, RWTH Aachen University Medical Centre, Pauwelsstraße 30, 52064, Aachen, Germany
| | - Andreas Bell
- Department of Orthopedics, Eifelklinik St. Brigida, 52152, Simmerath, Germany
| |
Collapse
|
2
|
Li M, Zeng Y, Nie Y, Liao K, Pei F, Yang J, Xie H, Shen B. A high risk of postoperative periprosthetic femoral fracture in Dorr type C femurs: a retrospective cohort study with 10-year follow-up data and a preliminary monochromatic image analysis. Int J Surg 2024; 110:296-305. [PMID: 37830949 PMCID: PMC10793812 DOI: 10.1097/js9.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The authors applied Anatomique Benoist Girard II (ABG II) stems for total hip arthroplasty in some Dorr type C femurs as early attempts. Here, the authors compared the long-term follow-up results between ABG II stems and the 'well-performing' Corail stems and their monochromatic images. METHODS Among 3214 primary total hip arthroplasty records, 43 short ABG II stems and 67 standard-length Corail stems implanted in Dorr type C femurs were eligible and enrolled in this retrospective cohort study, with a mean follow-up of 10.3 years. Revision rates, Harris hip scores, and radiologic signs were compared. Spectral CT scans from a representative sample were obtained, and monochromatic images were reconstructed. A quantitative method was developed to measure the volume of the gap around stems. Patient-specific finite element analysis was conducted to investigate the strains. RESULTS The revision rate of ABG II stems was significantly higher than that of Corail stems (21 vs. 3%, P <0.05). In the monochromatic images, fewer spot-weld signs (2.2 vs. 3.4, P <0.05) and wider gaps around stems (1.64 cm 3 vs. 0.13 cm 3 , P <0.05) were observed on average in the ABG II group. The mean maximum principal strains of the proximal femurs in the ABG II group were close to the yield strains and significantly larger than those in the Corail group (0.0052 vs. 0.0011, P <0.05). CONCLUSIONS There was a high risk of postoperative periprosthetic femoral fracture for ABG II stems in Dorr type C femurs. Monochromatic images provided some insight into the failure mechanism. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Mingyang Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital
| | - Yi Zeng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital
| | - Yong Nie
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital
| | - Kai Liao
- Department of Radiology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Fuxing Pei
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital
| | - Jing Yang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital
| | - Huiqi Xie
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital
| | - Bin Shen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital
| |
Collapse
|
3
|
Kropivšek L, Antolič V, Mavčič B. Surgeon-Stratified Periprosthetic Fracture Risk in a Single-Hospital Cohort of 1531 Uncemented ABG-II Femoral Stems at Primary Total Hip Arthroplasty. Indian J Orthop 2023; 57:1850-1857. [PMID: 37881273 PMCID: PMC10593654 DOI: 10.1007/s43465-023-00996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 09/04/2023] [Indexed: 10/27/2023]
Abstract
Purpose Late periprosthetic fracture risk with uncemented ABG-II femoral stems at primary total hip arthroplasty (THA) has been reported before, but single-hospital surgeon-stratified reports of this implant have never been published. We asked whether periprosthetic fracture rates of ABG-II femoral stems implanted at a single tertiary hospital depended on patients' age, gender and the operating surgeon. Methods The study included 1531 consecutive primary ABG-II femoral stems implanted at a single tertiary hospital between January 1, 2012 and December 31, 2018. The Kaplan-Meier and Cox regression analyses were performed after 3.6-10.6 years of follow-up. Results In the cohort, we recorded 8 intraoperative, 22 early postoperative (within 90 days of implantation) and 26 late periprosthetic fractures (over 90 days postoperatively). The revision rate of ABG-II femoral stems was 5.1/100 component-years for early and 0.3/100 component-years for late periprosthetic fractures. The Kaplan-Meier cumulative probability of periprosthetic fracture was 2.1% at one, 2.3% at 2, 3.2% at 5, and 6.5% at 10 years after the implantation. Higher patient's age at operation was an independent risk factor of subsequent periprosthetic fracture (hazard ratio 1.07, 95% confidence interval 1.03-1.10; p < 0.01), regardless of the operating surgeon. Most of the fractured femora were Dorr type C (stovepipe). Conclusion The study presents the largest published ABG-II femoral stem cohort from a single hospital so far with 9291 component-years of observation. Periprosthetic fracture risk of ABG-II increased with patients' age, had no variability between different surgeons, and was considerably higher from other uncemented femoral stems used at the same hospital. Level of Evidence III.
Collapse
Affiliation(s)
- Luka Kropivšek
- Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia
| | - Vane Antolič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia
| | - Blaž Mavčič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia
| |
Collapse
|
4
|
Mjöberg B. Hip prosthetic loosening and periprosthetic osteolysis: A commentary. World J Orthop 2022; 13:574-577. [PMID: 35949708 PMCID: PMC9244959 DOI: 10.5312/wjo.v13.i6.574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/02/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023] Open
Abstract
Prosthetic loosening and periprosthetic osteolysis have been debated for decades, both in terms of the timing and nature of the triggering events. The hypothesis of wear-particle-induced loosening states that wear particles cause a foreign-body response leading to periprosthetic osteolysis and ultimately to late prosthetic loosening, i.e., that the osteolysis precedes the loosening. The theory of early loosening, on the other hand, postulates that the loosening is already initiated during or shortly after surgery, i.e., that the osteolysis is secondary to the loosening. This commentary focuses on the causal relationship between prosthetic loosening and periprosthetic osteolysis.
Collapse
Affiliation(s)
- Bengt Mjöberg
- Department of Orthopedics, Lund University, Lund SE-221 00, Sweden
| |
Collapse
|
5
|
Mjöberg B. Hip prosthetic loosening: A very personal review. World J Orthop 2021; 12:629-639. [PMID: 34631447 PMCID: PMC8472441 DOI: 10.5312/wjo.v12.i9.629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/03/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Hip prosthetic loosening is often difficult to detect at an early stage, and there has been uncertainty for a long time as to when the loosening occurs and thus to the basic causes. By comparing different diagnostic methods, we found that loosening is best defined as prosthetic migration and measured by radiostereometric analysis. Convincing evidence indicates that poor interlock, poor bone quality, and resorption of a necrotic bone bed may initiate loosening during or shortly after surgery; this forms the basis of the theory of early loosening. Biomechanical factors do affect the subsequent progression of loosening, which may increase subclinically during a long period of time. Eventually, the loosening may be detected on standard radiographs and may be interpreted as late loosening but should to be interpreted as late detection of loosening. The theory of early loosening explains the rapid early migration, the development of periprosthetic osteolysis and granulomas, the causality between wear and loosening, and largely the epidemiology of clinical failure of hip prostheses. Aspects discussed are definition of loosening, the pattern of early migration, the choice of migration threshold, the current understanding of loosening, a less exothermic bone cement, cemented taper-slip stems, a new exciting computed tomography-based technique for simpler implant migration studies, and research suggestions.
Collapse
Affiliation(s)
- Bengt Mjöberg
- Department of Orthopedics, Lund University, Lund SE-221 00, Sweden
| |
Collapse
|
6
|
Aro HT, Engelke K, Mattila K, Löyttyniemi E. Volumetric Bone Mineral Density in Cementless Total Hip Arthroplasty in Postmenopausal Women: Effects on Primary Femoral Stem Stability and Clinical Recovery. J Bone Joint Surg Am 2021; 103:1072-1082. [PMID: 33750747 DOI: 10.2106/jbjs.20.01614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In cementless total hip arthroplasty, femoral stems should preferably not migrate at all postoperatively. This goal is difficult to achieve in postmenopausal women with impaired bone quality. Here, we explored the clinical importance of initial stem migration, measured by radiostereometric analysis (RSA), in women who underwent quantitative computed tomography (CT) of the involved hip preoperatively. METHODS A prospective cohort of 65 postmenopausal women (mean age, 69 years) with hip osteoarthritis and Dorr type-A or B femoral anatomy underwent total hip arthroplasty with implantation of a tapered, single-wedge femoral stem. Volumetric bone mineral density (BMD) was measured using quantitative CT. Femoral stem translation and rotation were measured using model-based RSA within 3 days after the surgical procedure and were repeated at 3, 5, and 11 months. Postoperative recovery parameters included walking speed, walking activity, and patient-reported outcome measures. Subjects were categorized into 2 groups according to the magnitude of initial 5-month stem subsidence (<2 mm or ≥2 mm); RSA outliers (n = 7) were analyzed separately. RESULTS Subjects with stem subsidence of ≥2 mm (mean, 3.09 mm [95% confidence interval (CI), 2.70 to 3.47 mm]) had lower intertrochanteric volumetric BMD (p = 0.008). Subjects with subsidence of <2 mm (mean, 0.80 mm [95% CI, 0.51 to 1.09 mm]) had faster improvement of patient-reported outcome measures and exhibited faster walking speed (p = 0.007) and greater walking activity (p = 0.010) at 11 months as well as better Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (p = 0.002) and RAND 36-Item Health Survey mental component scores (p = 0.006) at 2 years. All cohort stems were osseointegrated at 2 years. CONCLUSIONS Femoral stem stability and resistance to subsidence were sensitive to adequate intertrochanteric volumetric BMD. Low intertrochanteric volumetric BMD was associated with greater stem migration. With initial migration, clinical recovery was slower and patient-reported outcome measures were less satisfactory. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Hannu T Aro
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Klaus Engelke
- Institute of Medical Physics, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Kimmo Mattila
- Department of Diagnostic Imaging, Turku University Hospital and University of Turku, Turku, Finland
| | - Eliisa Löyttyniemi
- Unit of Biostatistics, Department of Clinical Medicine, University of Turku, Turku, Finland
| |
Collapse
|
7
|
Vertesich K, Sosa BR, Niu Y, Ji G, Suhardi V, Turajane K, Mun S, Xu R, Windhager R, Park-Min KH, Greenblatt MB, Bostrom MP, Yang X. Alendronate enhances osseointegration in a murine implant model. J Orthop Res 2021; 39:719-726. [PMID: 32915488 PMCID: PMC8672942 DOI: 10.1002/jor.24853] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 02/04/2023]
Abstract
Administration of bisphosphonates following total joint arthroplasty might be beneficial to reduce aseptic loosening. However, their effects on peri-implant bone formation and bone-implant interface strength have not been investigated yet. We used a physiologically loaded mouse implant model to investigate the short-term effects of postoperative systemic alendronate on osseointegration. A titanium implant with a rough surface was inserted in the proximal tibiae of 17-week-old female C57BL/6 mice (n = 44). Postimplantation mice were given alendronate (73 μg/kg/days, n = 22) or vehicle (n = 22) 5 days/week. At 7- and 14-day postimplantation, histology and histomorphometry were conducted. At 28 days, microcomputed tomography and biomechanical testing were performed (n = 10/group). Postoperative alendronate treatment enhanced osseointegration, increasing maximum pullout load by 45% (p < .001) from 19.1 ± 4.5 N in the control mice to 27.6 ± 4.9 N in the treated mice, at day 28 postimplantation. Alendronate treatment increased the bone volume fraction by 139% (p < .001) in the region distal to the implant and 60% (p < .05) in the peri-implant region. At 14-day postimplantation, alendronate treatment decreased the number of osteoclasts per bone perimeter (p < .05) and increased bone volume fraction (p < .01) when compared with the control group. Postimplantation, short-term alendronate treatment enhanced osseointegration as demonstrated by increased bone mass, trabecular bone thickness, and maximum pullout load. Alendronate decreased peri-implant osteoclasts while preserving peri-implant osteoblasts and endothelial cells, in turn, increasing bone volume fraction. This data supports the postoperative clinical use of bisphosphonates, especially in patients with high risks of aseptic loosening.
Collapse
Affiliation(s)
- Klemens Vertesich
- Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, New York, USA,Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Branden R. Sosa
- Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, New York, USA
| | - Yingzhen Niu
- Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, New York, USA,Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Gang Ji
- Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, New York, USA,Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Vincentius Suhardi
- Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, New York, USA
| | - Kathleen Turajane
- Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, New York, USA
| | - Sehwan Mun
- Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, New York, USA
| | - Ren Xu
- Regulation of Bone Mass Laboratory, Weill Cornell Medicine, New York, New York, USA
| | - Reinhard Windhager
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Kyung Hyun Park-Min
- Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, New York, USA,Regulation of Bone Mass Laboratory, Weill Cornell Medicine, New York, New York, USA
| | | | - Mathias P. Bostrom
- Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, New York, USA,Regulation of Bone Mass Laboratory, Weill Cornell Medicine, New York, New York, USA
| | - Xu Yang
- Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
8
|
Coffey SP, Sorial RM, Sharma R, Field JR. Two-year migration characteristics of a novel cementless femoral stem: a radiostereometric analysis and clinical outcomes study. ANZ J Surg 2021; 91:398-403. [PMID: 33522681 DOI: 10.1111/ans.16616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Radiostereometric analysis (RSA) is an established high precision tool enabling us to detect early implant migration in total hip arthroplasty. The aim of this study is to present the RSA and clinical results of a new cementless hip stem and to compare those with established benchmarks. METHODS A total of 45 patients (46 hips) undergoing total hip arthroplasty were available for full radiographic and clinical assessment at 2 years post-operatively. Mean patient age was 69 (range 43-85) years and mean body mass index was 29 (range 21-38) kg/m2 . RSA was undertaken at day 1, 6 weeks, 6 months and 1 and 2 years post-operatively. Oxford hip score and EQ-5D-5L scores were recorded preoperatively and at the same other time points. Results were compared to published data of established implants. RESULTS At 2 years, mean subsidence and retroversion were 0.61 mm (standard deviation 0.7 mm, range -0.19 to 3.06 mm) and 0.44° (standard deviation 0.81°, range 0.98 to 3.29°), respectively. Stem migration occurred primarily in the first 6 weeks with no detectable subsidence or rotation at 6 months or 2 years. Mean Oxford hip score and EQ-5D-5L improved from 18.6 to 44.7, and 69 to 86, respectively. There was one cup-only revision and no revisions for stem loosening. CONCLUSION RSA serves as an accurate measure of femoral stem stability early in the post-operative period. Our data confirm that stability occurs as early as 6 weeks and is sustained at 2 years. The Paragon stem demonstrates stability parameters at 2 years that exceed other established benchmark implants.
Collapse
Affiliation(s)
- Simon P Coffey
- Department of Orthopaedics, Nepean Hospital, Penrith, New South Wales, Australia
| | - Rami M Sorial
- Department of Orthopaedics, Nepean Hospital, Penrith, New South Wales, Australia
| | - Rahul Sharma
- Department of Orthopaedics, Nepean Private Hospital, Penrith, New South Wales, Australia
| | - John R Field
- Department of Orthopaedic Surgery, Nepean Private Hospital, Penrith, New South Wales, Australia
| |
Collapse
|
9
|
Nazari-Farsani S, Vuopio M, Löyttyniemi E, Aro HT. Contributing factors to the initial femoral stem migration in cementless total hip arthroplasty of postmenopausal women. J Biomech 2021; 117:110262. [PMID: 33508723 DOI: 10.1016/j.jbiomech.2021.110262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 01/01/2021] [Accepted: 01/10/2021] [Indexed: 02/06/2023]
Abstract
In cementless total hip arthroplasty (THA), femoral stems rely on the initial press-fit fixation against cortical bone to achieve osseointegration. Decreased bone mineral density (BMD) in postmenopausal women poses natural difficulties in achieving axial and rotational femoral stem stability. The present study examined contributing demographic, surgery-related and postoperative factors in determining the magnitude of early stem migration prior to osseointegration. A prospective cohort of 65 postmenopausal women with hip osteoarthritis (Dorr type A or B femur anatomy) underwent THA with implantation of an uncemented parallel-sided femoral component. Postoperative femoral stem translation and rotation were measured using model-based radiostereometric analysis. Based on analysis of covariance, which controlled for outliers and randomized antiresorptive treatment with denosumab or placebo, none of the analyzed demographics (including BMI) and surgery-related variables (including the stem-to-canal fil ratio) was associated with stem subsidence. Stem subsidence (mean 1.8 mm, 95% CI 1.2 to 2.4) occurred even in women with normal hip BMD. Total hip BMD and postoperative walking activity (measured three months after surgery) were significantly associated with stem rotation, and height acted as a confounding factor. The effect of walking activity on stem rotation was significant at 5 months (p = 0.0083) and at 11 months (p = 0.0117). This observation confirms the previous results of instrumented hip prostheses on torsional moments affecting stems during daily activities. High-resolution imaging modalities of local bone quality are needed to explore reasons for RSA-measurable stem subsidence even in women with normal hip BMD.
Collapse
Affiliation(s)
- Sanaz Nazari-Farsani
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Mia Vuopio
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Eliisa Löyttyniemi
- Unit of Biostatistics, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Hannu T Aro
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku, Finland.
| |
Collapse
|
10
|
Sandberg O, Tholén S, Carlsson S, Wretenberg P. The anatomical SP-CL stem demonstrates a non-progressing migration pattern in the first year: a low dose CT-based migration study in 20 patients. Acta Orthop 2020; 91:654-659. [PMID: 33063555 PMCID: PMC8023890 DOI: 10.1080/17453674.2020.1832294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - RSA is the gold standard for evaluation of early implant migration. We report the results of a new CT-based method Sectra CT micromotion analysis (CTMA) applied to assess the migration pattern in 20 patients in the 1st year after surgery, both with and without the use of tantalum beads in the bone. The patients had an SP-CL anatomical stem that uses an S-shape, designed to better fit the curvature of the femur. Patients and methods - 20 THA patients (mean age 61 years, 10 female) received SP-CL stems, tantalum markers in the femur, and low-dose CT scans at 1 day, 3 months and 12 months postoperatively. In addition, precision as well as inter- and intra-observer variability of the 12-month migration was measured. Results - The 3-month subsidence was median 0.5 mm (95% CI 0.3-1.0) and the internal rotation 1.8° (CI 0.9-2.6). At 12 months the corresponding values were 0.6 (CI 0.3-1.6) mm and 1.9° (CI 0.8-2.4). Precision was 0.1 to 0.3 mm and 0.1° to 0.4° at 3 and 12 months. Intra- and inter- observer variability yielded R-values averaging 0.96 and 0.98. Interpretation - The migration mainly took place during the 1st 3 months, in line with other uncemented stems. The number of patients with subsidence over 2 mm in the first year (5) might be due to the design of the prosthesis with an anatomical shape. Alternatively, our results might indicate a challenge when choosing the correct size for these new anatomical stems. CTMA provided precise and highly repeatable measurements of migration without the need for tantalum markers.
Collapse
Affiliation(s)
| | - Simon Tholén
- Department of Radiology, Lindesberg Hospital, Örebro University Hospital
| | - Sofia Carlsson
- Department of Radiology, Lindesberg Hospital, Örebro University Hospital
| | - Per Wretenberg
- Department of Medical Sciences, Section of Orthopaedics, Örebro University Hospital, Sweden
| |
Collapse
|
11
|
Kheir MM, Drayer NJ, Chen AF. An Update on Cementless Femoral Fixation in Total Hip Arthroplasty. J Bone Joint Surg Am 2020; 102:1646-1661. [PMID: 32740265 DOI: 10.2106/jbjs.19.01397] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael M Kheir
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nicholas J Drayer
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
12
|
Pre-operative bone mineral density is a predictive factor for excellent early patient-reported outcome measures in cementless total hip arthroplasty using a proximally fixed anatomic stem. A prospective study at two year minimum follow-up. INTERNATIONAL ORTHOPAEDICS 2020; 44:2253-2259. [PMID: 32594225 DOI: 10.1007/s00264-020-04683-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The goal of the study was to analyze the impact of the pre-operative bone mineral density on the patients' reported outcomes at two year minimum follow-up of cementless THA using a proximally fixed anatomic stem. METHODS A prospective study included all patients who underwent a cementless THA using a specific proximally fixed anatomic stem and a 3D preoperative CT scan-based planning. The bone mineral density (BMD) of the metaphyseal cancellous bone was computed in a volume (of 1 mm thick and of 1 cm2 surface) at the level of the calcar 10 mm above the top of the lesser trochanter. Patients were assessed at two year follow-up using self-administered auto-questionnaires corresponding to the modified Harris (mHHS), the Oxford (OHS), and the Forgotten Hip (FHS) scores. A multiple linear regression statistical analysis was performed to assess the link between the mHHS, the age, body mass index (BMI), BMD, gender, and ASA grade. RESULTS Fifty patients were included (29 men, 21 women), with an average age of 62 ± 12 years and an average BMI of 27 ± 5 kg/m2. At two year follow-up, on multivariate analysis, excellent mHHS (≥ 90%) was significantly associated with only two parameters: a BMI ≤ 25 kg /m2 with an odd ratio OR = 10 (CI95% [2.1-48.3], p = 0.004) and a BMD ≥ 72 mg/cm3 with an odd ratio OR = 4.87 (CI95% [1.2-18.6], p = 0.02). CONCLUSION The short-term PROMs after cementless THA are impacted by pre-operative cancellous bone density. However, the BMI remains the most influential parameter on the clinical outcomes.
Collapse
|
13
|
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: 12] [Impact Index Per Article: 3.0] [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.
Collapse
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
| |
Collapse
|
14
|
Critchley O, Callary S, Mercer G, Campbell D, Wilson C. Long-term migration characteristics of the Corail hydroxyapatite-coated femoral stem: a 14-year radiostereometric analysis follow-up study. Arch Orthop Trauma Surg 2020; 140:121-127. [PMID: 31655879 DOI: 10.1007/s00402-019-03291-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND The magnitude and pattern of acceptable long-term migration of cementless femoral stems are not well understood. The Corail hydroxyapatite-coated cementless stem is a clinically successful and commonly used femoral stem with a long-term migration pattern not previously described in the literature. The aim of this study was to assess the long-term migration of the Corail hydroxyapatite-coated cementless stem using radiostereometric analysis (RSA) at 14-year follow-up, thereby establishing a benchmark acceptable long-term migration pattern for hydroxyapatite-coated cementless prostheses. MATERIALS AND METHODS A prospective cohort of 29 patients (30 hips) undergoing primary total hip arthroplasty for primary hip osteoarthritis were enrolled into a study to characterise the migration of the Corail cementless stem. A total of 13 patients (4 males, 9 females) with mean age 82 (range 68-92) underwent repeat RSA radiographs at minimum 10 years post-operation (mean 13.9 years, range 13.3-14.4). Subsidence of the stem was measured and compared to prior measurements taken at 6 months and 1, 2, and 6 years. RESULTS None of the 13 patients have been revised. The migration at 6 months, 1 year, 2 years, and 6 years has been previously recorded. At mean 14-year follow-up, the cohort mean subsidence of the cementless stem was 0.70 mm (range - 0.06 to 3.61 mm). For each stem followed up at 6 months and 14 years, the mean subsidence over this period was 0.05 mm (range - 0.14 to 0.57 mm). There is no significant difference in mean subsidence at 6 months and 14 years (p = 0.43). CONCLUSIONS The long-term pattern of the subsidence of the Corail femoral stem has not previously been described. Subsidence occurs within the first 6 months, after which there is persistent stabilisation of the implant to 14 years. This study provides a description of a long-term acceptable migration pattern to which new hydroxyapatite-coated cementless prostheses may be compared. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Owain Critchley
- Department of Orthopaedics and Trauma Surgery, Flinders University, Adelaide, SA, Australia.,Department of Orthopaedics and Trauma, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia
| | - Stuart Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia.,Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, SA, Australia
| | - Graham Mercer
- Department of Orthopaedics, Repatriation General Hospital, Adelaide, SA, Australia
| | - David Campbell
- Wakefield Orthopaedic Clinic, 270 Wakefield Street, Adelaide, SA, Australia
| | - Christopher Wilson
- Department of Orthopaedics and Trauma Surgery, Flinders University, Adelaide, SA, Australia. .,Department of Orthopaedics and Trauma, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
| |
Collapse
|
15
|
Klasan A, Bäumlein M, Bliemel C, Putnis SE, Neri T, Schofer MD, Heyse TJ. Cementing of the hip arthroplasty stem increases load-to-failure force: a cadaveric study. Acta Orthop 2019; 90:445-449. [PMID: 31282247 PMCID: PMC6746255 DOI: 10.1080/17453674.2019.1634331] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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 - To date, there is not a single clinical or mechanical study directly comparing a cemented and a cementless version of the same stem. We investigated the load-to-failure force of a cementless and a cemented version of a double tapered stem. Material and methods - 10 femurs from 5 human cadaveric specimens, mean age 74 years (68-79) were extracted. Bone mineral density (BMD) was measured using peripheral quantitative computed tomography. None of the specimens had a compromised quality (average T value 0.0, -1.0 to 1.4). Each specimen from a pair randomly received a cemented or a cementless version of the same stem. A material testing machine was used for lateral load-to-failure test of up to a maximal load of 5.0 kN. Results - Average load-to-failure of the cemented stem was 2.8 kN (2.3-3.2) and 2.2 kN (1.8-2.8) for the cementless stem (p = 0.002). The cemented version of the stem sustained a higher load than its cementless counterpart in all cases. Failure force was not statistically significantly correlated to BMD (p = 0.07). Interpretation - Implanting a cemented version of the stem increases the load-to-failure force by 25%.
Collapse
Affiliation(s)
- Antonio Klasan
- University Hospital Marburg, Center for Orthopedics and Traumatology, Marburg, Germany; ,Correspondence:
| | - Martin Bäumlein
- University Hospital Marburg, Center for Orthopedics and Traumatology, Marburg, Germany;
| | - Christopher Bliemel
- University Hospital Marburg, Center for Orthopedics and Traumatology, Marburg, Germany;
| | | | - Thomas Neri
- University Hospital St. Etienne, Department of Orthopaedic Surgery, Saint-Priest-en-Jatez, France;
| | | | | |
Collapse
|
16
|
Aro HT, Nazari-Farsani S, Vuopio M, Löyttyniemi E, Mattila K. Effect of Denosumab on Femoral Periprosthetic BMD and Early Femoral Stem Subsidence in Postmenopausal Women Undergoing Cementless Total Hip Arthroplasty. JBMR Plus 2019; 3:e10217. [PMID: 31687650 PMCID: PMC6820573 DOI: 10.1002/jbm4.10217] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 12/11/2022] Open
Abstract
Antiresorptive denosumab is known to improve the quality and strength of cortical bone in the proximal femurs of osteoporotic women, but its efficacy in preventing periprosthetic bone loss and reducing femoral stem migration has not been studied in women undergoing cementless total hip arthroplasty. We conducted a single-center, randomized, double-blinded, placebo-controlled trial of 65 postmenopausal women with primary hip osteoarthritis and Dorr type A or B proximal femur anatomy. The patients randomly received subcutaneous injections of denosumab 60 mg or placebo once every 6 months for 12 months, starting 1 month before surgery. The primary endpoint was the change in bone mineral density (BMD) of the proximal femur (Gruen zone 7) at week 48, and the secondary endpoint was stem subsidence measured by radiostereometric analysis (RSA) at week 48. Exploratory endpoints included changes in BMDs of the contralateral hip, lumbar spine and distal radius, serum levels of bone turnover markers, walking speed, walking activity, patient-reported outcome measures, and radiographic assessment of stem osseointegration. The participants underwent vertebral-fracture assessment in an extension safety study at 3 years. Denosumab significantly decreased bone loss in the medial femoral neck (zone 7) and increased periprosthetic BMD in the greater trochanteric region (zone 1) and lesser trochanteric region (zone 6). Denosumab did not reduce temporary femoral stem migration. The migration occurred mainly during the settling period (0 to 12 weeks) after implantation of the prosthesis. All of the stems osseointegrated, as evaluated by RSA and radiographs. There were no intergroup differences in functional recovery. Discontinuation of denosumab did not lead to any adverse events. In conclusion, denosumab increased periprosthetic BMD in the clinically relevant regions of the proximal femur, but the treatment response was not associated with any reduction of initial stem migration. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Hannu T Aro
- Departments of Orthopaedic Surgery and Traumatology Turku University Hospital and University of Turku Turku Finland
| | - Sanaz Nazari-Farsani
- Departments of Orthopaedic Surgery and Traumatology Turku University Hospital and University of Turku Turku Finland
| | - Mia Vuopio
- Departments of Orthopaedic Surgery and Traumatology Turku University Hospital and University of Turku Turku Finland
| | - Eliisa Löyttyniemi
- Unit of Biostatistics, Department of Clinical Medicine University of Turku Turku Finland
| | - Kimmo Mattila
- Department of Diagnostic Imaging Turku University Hospital Turku Finland
| |
Collapse
|