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Hegde V, Harris AB, Springer BD, Khanuja HS. Cemented Stem Design in Total Hip Arthroplasty: Fixation Philosophies, Biomechanics, and an Updated Classification System. J Am Acad Orthop Surg 2024; 32:525-534. [PMID: 38626413 DOI: 10.5435/jaaos-d-23-00914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/20/2024] [Indexed: 04/18/2024] Open
Abstract
There is renewed interest in cemented femoral fixation in total hip arthroplasty in the United States, and to fully appreciate the evolution of cemented femoral stem designs, an understanding of their history and design rationale is essential. To adequately study the outcomes of modern-day designs, a comprehensive classification system is also necessary. The biomechanical principles, failure mechanisms, and clinical outcomes associated with various cemented femoral stems are described in this comprehensive review. In addition, an updated version of an existing classification system is described that incorporates the primary design characteristics which differentiate implants currently in use. In this classification, implants are categorized as taper-slip (Type I), which are subdivided by Anatomic (IA), Double-Taper (IB), and Triple-Taper (IC) with subclassification for Traditional and Line-to-Line implants. Composite beam (Type II) implants are similarly divided into Anatomic (IIA), Straight (IIB), and Wedge (IIC) with subclassification for Polished, Satin, or Roughened finish. This classification system provides a basis for comparing cemented femoral stems, thereby improving our understanding of the effect of design characteristics on survivorship to guide future advancements and improve clinical outcomes.
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Affiliation(s)
- Vishal Hegde
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Dr. Hegde, Dr. Harris, Dr. Khanuja), and the OrthoCarolina Hip and Knee Center and Atrium Musculoskeletal Institute, Charlotte, NC (Dr. Springer)
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Sasaki K, Fujita H, Iwase T, Sakurai T, Oura H, Morishima T, Nishisaka F, Shibanuma N, Katayama N, Ishii M, Otsuka H. Four stem fractures in a 12-year follow-up study of 9,135 patients with Exeter hip stems at seven teaching facilities in Japan. J Orthop Sci 2024:S0949-2658(24)00099-X. [PMID: 38871632 DOI: 10.1016/j.jos.2024.05.005] [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: 03/08/2024] [Revised: 05/16/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Although excellent long-term results have been reported for the Exeter stem, stem fracture is recognized as a rare complication. However, there have been no reports on the incidence and risk factors for stem fractures based on detailed population information. This study aimed to clarify the incidence of Exeter hip stem fracture based on detailed population information from seven Exeter stem teaching centers in Japan and to examine the risk factors for stem fracture. METHODS A total of 8,499 primary total hip arthroplasties (THA) and 636 revision hip arthroplasties (revisions) performed at seven Exeter teaching hospitals between 1999 and 2021 were included and retrospectively investigated based on medical records. RESULTS Stem fractures were identified in two primary THA (fracture rate: 0.02%) and two revision THA (fracture rate: 0.21%) cases. The stem length was ≤125 mm in three out of these four cases. Revision and 30 stem were the risk factors for stem fractures. Weight and body mass index (BMI) were not significantly associated with the occurrence of stem fractures. CONCLUSIONS In Western countries, the incidence of Exeter stem fractures is reportedly 0.017-0.15% for primary THA and 0.99-1.21% for revision THA. In this study, the incidence of primary THA was 0.02%, which is similar to the lowest reported rate, whereas the incidence of revision THA was 0.21%, which is lower than that reported in previous studies. Revision surgery had the same risk factors as those reported in the West-namely, stem length ≤125 mm (except for the 30 stem) and BMI, which were not risk factors in Japanese patients.
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Affiliation(s)
- Kan Sasaki
- Department of Orthopedic Surgery, Yamagata Saisei Hospital, Yamagata, 990-8545, Japan.
| | - Hiroshi Fujita
- Center for Hip Arthroplasty, Senshunkai Hospital, Nagaokakyo, Kyoto, 617-0826, Japan
| | - Toshiki Iwase
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, 432-8580, Japan
| | - Tatsuro Sakurai
- Department of Orthopedic Surgery, Nagareyama Central Hospital, Nagareyama, Chiba, 270-0114, Japan
| | - Hisanori Oura
- Department of Orthopedic Surgery, Hokkaido Orthopedic Memorial Hospital, Sapporo, Hokkaido, 062-0937, Japan
| | - Takkan Morishima
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
| | - Fumiaki Nishisaka
- Department of Orthopedic Surgery, Osaka Rehabilitation Hospital, Hannan, Osaka, 599-0212, Japan
| | - Nao Shibanuma
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, Nada-ku, Kobe, 657-0068, Japan
| | - Naoyuki Katayama
- Department of Orthopedic Surgery, Hokkaido Orthopedic Memorial Hospital, Sapporo, Hokkaido, 062-0937, Japan
| | - Masaji Ishii
- Department of Orthopedic Surgery, Yamagata Saisei Hospital, Yamagata, 990-8545, Japan
| | - Hiromi Otsuka
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
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Sakurai T, Fujita H, Iwase T, Sasaki K, Katayama N, Otsuka H. Multi-center study of use of the Exeter stem in Japan: a 10-year follow-up report. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04001-w. [PMID: 38822154 DOI: 10.1007/s00590-024-04001-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/09/2024] [Indexed: 06/02/2024]
Abstract
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.
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Affiliation(s)
- Tatsuro Sakurai
- Department of Orthopedic Surgery, Nagareyama Central Hospital, 2-243-3 Higashihatsuishi, Nagareyama-shi, Chiba, 270-0114, Japan.
| | - Hiroshi Fujita
- Center for Hip Arthroplasty, Senshunkai Hospital, Nagaokakyo-shi, Kyoto, 617-0826, Japan
| | - Toshiki Iwase
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, 432-8580, Japan
| | - Kan Sasaki
- Department of Orthopedic Surgery, Yamagata Saisei Hospital, Okimachi, Yamagata, 990-8545, Japan
| | - Naoyuki Katayama
- Department of Orthopedic Surgery, Hokkaido Orthopedic Memorial Hospital, Sapporo, Hokkaido, 062-0937, Japan
| | - Hiromi Otsuka
- Department of Orthopedic Surgery, School of Medicine, Aichi Medical University, Nagakute-shi, Aichi, 480-1195, Japan
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Wakama H, Okamoto Y, Okayoshi T, Ikeda K, Matsuyama J, Otsuki S, Neo M. Unfavorable cortical hypertrophy potentially predisposes to periprosthetic "axe splitter" fracture in a collarless polished curved triple-tapered cemented stem: The time-dependent radiographic change in five SC-stem cases. J Orthop Sci 2024; 29:439-444. [PMID: 36182639 DOI: 10.1016/j.jos.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/20/2022] [Accepted: 09/02/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The periprosthetic fracture of cemented polished tapered stems is occasionally called a "unique" or "axe splitter" fracture. However, there has been insufficient evidence regarding the association between the radiographic findings prior to incidence and this cumbersome fracture. To determine if there are any radiographic interpretations associated with this fracture pattern, we report the five SC-stem cases with total hip arthroplasty. METHODS We investigate the patient characteristics and serial radiographs of five fracture cases and evaluate the time-dependent specific radiographical changes around the stem between pre-arthroplasty and fracture. RESULTS Fractures developed at 3.5-6.4 years after surgery with low-grade injury or with no particular incentive. Femoral cortical hypertrophy at the distal medial side around the stem was observed in all cases before the development of fractures, at 2-6 years after primary surgery. The duration between cortical hypertrophy appearance to the development of fracture was 0.4-3.1 years. CONCLUSIONS The appearance of this zone-specific cortical hypertrophy might play a key role in the occurrence of periprosthetic fractures. Further studies with larger sample sizes should be conducted to elucidate this eccentric periprosthetic fracture.
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Affiliation(s)
- Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan.
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki Osaka, Japan
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Iwase T, Otsuka H, Katayama N, Fujita H. Impaction bone grafting for femoral revision hip arthroplasty with Exeter stem in Japan: An extended 10- to 15-year stem survival analysis of the previously reported series. J Orthop Sci 2024; 29:151-156. [PMID: 36610839 DOI: 10.1016/j.jos.2022.12.009] [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: 09/07/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Femoral impaction bone grafting (IBG) was introduced in the late 1990s in Japan and has gradually become recognized as a useful option for femoral revision. The aim of the present study was to retrospectively analyze 10 to 15 years of clinical results of femoral revision arthroplasties of IBG using Exeter stem performed by experienced Japanese surgeons. METHODS We investigated radiographic and clinical records more than 2 years after surgery in 99 hips of 93 patients. The average age was 66.3 years (36-84 years) and the average follow-up period was 11 years (2-23 years and 8 months). Merle d'Aubigné and Postel hip score was used for clinical assessment, and re-operations for any reason were recorded. The survival curve was estimated using Kaplan-Meier method. RESULTS The mean Merle d'Aubigné and Postel hip score improved from 9.0 points to 14.5 points at the final follow-up. Re-operations were undertaken in 15 hips of 14 patients for aseptic acetabular component loosening (n = 1 hip), recurrent dislocation (n = 2 hips), infection (n = 4 hips), and periprosthetic femoral fracture (n = 8 hips). The survival rates at 10 and 15 years after operation were 87.1% and 81.1% with any type of re-operation as the endpoint, 92.2% and 92.2% with stem removal or exchange as the endpoint, 94.9% and 88.1% with re-operation for periprosthetic femoral fracture as the endpoint, and 99.0% and 99.0% with re-operation for aseptic stem loosening as the endpoint, respectively. CONCLUSIONS The present study showed encouraging results of femoral IBG over 10 years by experienced surgeons in Japan. Although femoral IBG is recognized as a technically complex procedure, survivorship of the stem is excellent, with a 15-year stem survival rate of 99.0% at the end point of aseptic loosening.
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Affiliation(s)
- Toshiki Iwase
- Department of Orthopedic Surgery, Hamamatsu Medical Center, 328 Tomitsuka-cho, Naka-ku, Hamamatsu, Shizuoka 432-8580, Japan.
| | - Hiromi Otsuka
- Department of Orthopedic Surgery, School of Medicine Aichi Medical University, Aichi, Japan
| | - Naoyuki Katayama
- Department of Orthopedic Surgery, Hokkaido Orthopedic Memorial Hospital, Sapporo, Japan
| | - Hiroshi Fujita
- Center for Hip Arthroplasty, Senshunkai Hospital, Kyoto, Japan
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Mabrouk A, Feathers JR, Mahmood A, West R, Pandit H, Lamb JN. Systematic Review and Meta-Analysis of Studies Comparing the Rate of Post-operative Periprosthetic Fracture Following Hip Arthroplasty With a Polished Taper Slip versus Composite Beam Stem. J Arthroplasty 2024; 39:269-275. [PMID: 37343648 DOI: 10.1016/j.arth.2023.06.014] [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: 02/06/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND We compared the incidence of postoperative periprosthetic femoral fractures (POPFF) following hip arthroplasty with either a cemented polished taper slip (PTS) stem or a cemented composite beam (CB) stem in comparative studies. METHODS A systematic review of comparative studies, written in English and published in peer-reviewed journals since the year 2000, was conducted. Study quality was assessed using the Newcastle-Ottawa scale.The overall study qualities were good. There were 913,021 patients from 18 cohorts included in the meta-analysis. There were 294,540 patients who received a CB stem and 618,481 received a PTS stem. Cohorts were classified as high- or low-risk for POPFF based on patient risk factors. A metanalysis was performed using a random effects model, and the relative incidence with 95% confidence intervals (CIs) was reported. RESULTS The patients at low risk of POPFF had an incidence rate ratio of 3.14 (CI: 2.48, 3.98) for the PTS group versus the CB group. Whereas, the patients at high risk of POPFF had an incidence rate ratio of 9.87 (CI: 3.63, 26.80) for the PTS group versus the CB group. CONCLUSIONS The risk of POPFF is lower when hip arthroplasty was performed using a CB stem versus a PTS stem. This protective effect was greatest in patients who had a higher risk of POPFF. Surgeons should consider the effect of cemented stem choice on the risk of subsequent periprosthetic femur fracture, particularly in frail or elderly patients who are at a higher risk of postoperative periprosthetic femoral fracture.
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Affiliation(s)
- Ahmed Mabrouk
- Leeds Teaching Hospitals NHS Trust, Leeds; Mid Yorkshire Hospital NHS Trust, Wakefield
| | | | - Ansar Mahmood
- University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Robert West
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of medicine, University of Leeds, Chapel Allerton Hospital, Leeds
| | - Jonathan N Lamb
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of medicine, University of Leeds, Chapel Allerton Hospital, Leeds
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Thomsen M, van Uden M, Kretzer JP. [Current design and cement mantle thickness in hip arthroplasty : Theory and analysis of register data]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:1-10. [PMID: 37978051 DOI: 10.1007/s00132-023-04454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND In this article, an overview and comparison of the most commonly used cemented hip stems, grouped into different stem types and cement mantle thickness, is given to see which combination performs well. METHODOLOGY Revision rates of cemented stem types were categorized from the Endoprosthesis Register-Germany, and 3‑ and 5‑year revision rates were reported and analyzed. For the research, the focus was on the Exeter, C‑Stem, MS-30, Excia, Bicontact, Charnley, Müller straight stem, Twinsys, Corail, Avenir, Quadra, and the Lubinus SP II stems. An important aspect was which stem is preferred to be implanted and which cementing technique is used with regard to the planned cement mantle thickness. In order to identify a trend in cemented hip arthroplasty, data from the Danish, Swedish, Norwegian, Swiss, New Zealand, English and Australian arthroplasty registers were also compared. RESULTS AND CONCLUSION Most countries use cemented prostheses according to the taper slip principle (Exeter, MS30, C‑Stem etc) or the composite beam (Charnley, Excia, Bicontact), which are implanted with a cement mantle thickness of 2-4 mm. However, a trend has emerged in Germany and Switzerland towards the line-to-line technique, with a planned cement mantle thickness of 1 mm (Twinsys, Corail, Avenir, Quadra), following the principle of the Müller straight stem prosthesis and the Kerboul-Charnley prosthesis, even though these are postulated to be "French paradoxes" in themselves. In the EPRD 5‑year results, the newer line-to-line prostheses seem to perform slightly worse. The best results are achieved by the "MS 30" in Germany and the "Exeter" in England. These are polished straight stems with centralizer and subsidence space at the apex with a 2-4 mm cement mantle in good cementing technique.
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Affiliation(s)
- M Thomsen
- Klinik für Orthopädie und Unfallchirurgie, Balger Str. 50, 76532, Baden-Baden, Deutschland.
| | - M van Uden
- Biomechanik, Hochschule Offenburg of applied science, Offenburg, Deutschland
| | - J P Kretzer
- Labor für Biomechanik und Implantatforschung, Orthopädische Universitätsklinik Heidelberg, Heidelberg, Deutschland
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Jain S, Lamb JN, Pandit H. Cemented femoral stem design and postoperative periprosthetic fracture risk following total hip arthroplasty. Bone Joint J 2024; 106-B:11-15. [PMID: 38160687 DOI: 10.1302/0301-620x.106b1.bjj-2023-0587.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Polished taper-slip (PTS) cemented stems have an excellent clinical track record and are the most common stem type used in primary total hip arthroplasty (THA) in the UK. Due to low rates of aseptic loosening, they have largely replaced more traditional composite beam (CB) cemented stems. However, there is now emerging evidence from multiple joint registries that PTS stems are associated with higher rates of postoperative periprosthetic femoral fracture (PFF) compared to their CB stem counterparts. The risk of both intraoperative and postoperative PFF remains greater with uncemented stems compared to either of these cemented stem subtypes. PFF continues to be a devastating complication following primary THA and is associated with high complication and mortality rates. Recent efforts have focused on identifying implant-related risk factors for PFF in order to guide preventative strategies, and therefore the purpose of this article is to present the current evidence on the effect of cemented femoral stem design on the risk of PFF.
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Affiliation(s)
- Sameer Jain
- Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Hemant Pandit
- Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Heijnens LJ, Heyligers IC, Boonen B, Spekenbrink-Spooren A, van Haaren EH, Schotanus MG. Survival rates of anatomically shaped and tapered slip cemented femoral implants: an analysis of 76,281 femoral implants of the Dutch arthroplasty register (LROI). Hip Int 2023; 33:1035-1042. [PMID: 36536533 DOI: 10.1177/11207000221145150] [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] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In cemented total hip arthroplasty (THA) various shapes and geometries of femoral implants are in use. Collarless, polished, and tapered (CPT) implants, and anatomically shaped (AS) implants are most commonly used. Due to their different design features, this might lead to different survival outcomes. In this register-based study, overall implant survival and short-term complications of CPT and AS cemented implants were evaluated. METHODS Data of the Dutch Arthroplasty Register (LROI) were used. Cemented femoral implants, which could be classified as CPT or AS were included in this study. Implants were excluded when no classification could be made or if implanted <100 times. Survival analyses were performed using Kaplan-Meier survival analysis and multivariable Cox-proportional hazard analysis. RESULTS 76,281 cemented THAs were included. At a mean of 5.1 years follow-up (SD 3.1, range 0-12 years), the overall survival of the AS implants was higher compared with the CPT implants, with a survival, of 99.2% and 99.0% respectively (log-rank; p < 0.001). Multivariable regression analysis revealed a higher rate for revision because of loosening of the AS implants (HR 2; CI, 1.4-3.1). AS implants had a lower rate for periprosthetic fractures compared with the CPT implants (HR 0.13; CI, 0.07-0.23). CONCLUSIONS Both designs show excellent overall survival rates at short-term follow-up. There is a higher overall survival of AS implants when compared with CPT implants. Revision for implant loosening, however, was statistically significantly higher in AS implants when compared with the CPT implants.
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Affiliation(s)
- Luc Jm Heijnens
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, The Netherlands
| | - Ide C Heyligers
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, The Netherlands
- School of Health Profession Education, Faculty of Health, Medicine and Life Science, Maastricht University, The Netherlands
| | - Bert Boonen
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, The Netherlands
| | - Anneke Spekenbrink-Spooren
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), 's-Hertogenbosch, The Netherlands
| | - Emil H van Haaren
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, The Netherlands
| | - Martijn Gm Schotanus
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, The Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Science, Maastricht University, The Netherlands
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Tyas B, Marsh M, de Steiger R, Lorimer M, Petheram TG, Inman DS, Reed MR, Jameson SS. Long-term implant survival following hemiarthroplasty for fractured neck of femur. Bone Joint J 2023; 105-B:864-871. [PMID: 37524341 DOI: 10.1302/0301-620x.105b8.bjj-2022-1150.r3] [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: 08/02/2023]
Abstract
Aims Several different designs of hemiarthroplasty are used to treat intracapsular fractures of the proximal femur, with large variations in costs. No clinical benefit of modular over monoblock designs has been reported in the literature. Long-term data are lacking. The aim of this study was to report the ten-year implant survival of commonly used designs of hemiarthroplasty. Methods Patients recorded by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) between 1 September 1999 and 31 December 2020 who underwent hemiarthroplasty for the treatment of a hip fracture with the following implants were included: a cemented monoblock Exeter Trauma Stem (ETS), cemented Exeter V40 with a bipolar head, a monoblock Thompsons prosthesis (Cobalt/Chromium or Titanium), and an Exeter V40 with a Unitrax head. Overall and age-defined cumulative revision rates were compared over the ten years following surgery. Results A total of 41,949 hemiarthroplasties were included. Exeter V40 with a Unitrax head was the most commonly used (n = 20,707, 49.4%). The overall rate of revision was small. A total of 28,201 patients (67.2%) were aged > 80 years. There were no significant differences in revision rates across all designs of hemiarthroplasty in patients of this age at any time. The revision rates for all designs were < 3.5%, three years postoperatively. At subsequent times the ETS and Exeter V40 with a bipolar head performed well in all age groups. The unadjusted ten-year mortality rate for the whole cohort was 82.2%. Conclusion There was no difference in implant survival between all the designs of hemiarthroplasty in the first three years following surgery, supporting the selection of a cost-effective design of hemiarthroplasty for most patients with an intracapsular fracture of the hip, as determined by local availability and costs. Beyond this, the ETS and Exeter bipolar designs performed well in all age groups.
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Affiliation(s)
- Ben Tyas
- Health Education North East, Newcastle upon Tyne, UK
| | - Martin Marsh
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Richard de Steiger
- Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Dominic S Inman
- Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Mike R Reed
- Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Simon S Jameson
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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Madanipour S, Singh P, Patel A, Beg R, Sha M, Grewal IS, Iranpour F, Subramanian P. Subsidence in Centraliser Sign: A Novel Tool to Help Predict Early Subsidence in Periprosthetic Femoral Fractures Around Polished Tapered Stems Treated With Internal Fixation. Cureus 2023; 15:e42742. [PMID: 37654957 PMCID: PMC10467608 DOI: 10.7759/cureus.42742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
Background When treating periprosthetic femoral fractures (PPF) around polished taper slip stems (PTS), determining which patients can be successfully treated with internal fixation can be challenging. We have described the subsidence-in-centraliser (SINC) sign as a radiographic feature of PPF around PTS stems. We hypothesise that a positive SINC sign can help predict a poorer outcome for the fixation of these fractures. Patients and methods Retrospective identification of PPFs around cemented PTS with an appreciable centraliser on radiographs was conducted at a single centre. A positive SINC sign was defined as a post-injury radiograph demonstrating >50% reduction in the radiographic lucency representing the stem centraliser when compared to pre-injury films or complete obliteration of distal lucency when no pre-injury film was available. The primary outcome was the rate of subsequent stem subsidence on follow-up radiographs comparing SINC-positive and SINC-negative fractures, which were managed with open reduction and internal fixation (ORIF). Results Fifty-four patients were included in the analysis. The mean age was 76.8 years, and the mean follow-up for all patients was 12.7 months. Thirty-five fractures were deemed SINC-positive, and 19 were SINC-negative. 17/17 (100%) SINC-positive fractures managed with fixation underwent further subsidence (mean 5.4 mm, SD 2.8). A positive SINC sign demonstrated a sensitivity of 90.5% and specificity of 100% for subsequent stem subsidence in fractures treated without revision. SINC positive fractures underwent significantly more subsidence compared with SINC negative fractures when fixed (5.4 mm vs. 0.28 mm, U = 6.50, p<0.001) at a mean follow-up of 12.7 months. The SINC sign demonstrated strong inter- (k=0.96) and intra-rater (k=0.86) reliability. Conclusion The SINC sign can serve as a useful adjunct in the decision to fix or revise PPF around PTS. A positive SINC sign may represent a cement mantle that cannot be reconstituted anatomically, leading to subsidence after treatment with ORIF.
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Affiliation(s)
| | - Prashant Singh
- Trauma and Orthopaedics, Royal Free London NHS Trust, London, GBR
| | - Arpit Patel
- Trauma and Orthopaedics, Royal Free London NHS Trust, London, GBR
| | - Ruqqayyah Beg
- Trauma and Orthopaedics, University College London Medical School, London, GBR
| | - Menazir Sha
- Trauma and Orthopaedics, University College London Medical School, London, GBR
| | - Ishvinder S Grewal
- Orthopaedic Surgery, University of Texas (UT) Southwestern Medical Center, Dallas, USA
| | - Farhad Iranpour
- Trauma and Orthopaedics, Royal Free London NHS Trust, London, GBR
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12
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Baryeh K, Sochart DH. Post-operative peri-prosthetic fracture rates following the use of cemented polished taper-slip stems for primary total hip arthroplasty: a systematic review. Arch Orthop Trauma Surg 2022; 142:4075-4085. [PMID: 35048171 DOI: 10.1007/s00402-021-04302-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/04/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Peri-prosthetic fractures (PPFs) are a serious complication of total hip arthroplasty (THA) associated with significant morbidity, mortality and re-operation similar to the rates seen following femoral neck fractures. When exploring the PPF rates around cemented stems, many studies combine the results of composite beam and taper-slip stems despite their different philosophies. This review looks specifically at PPFs with the use of cemented stems of the taper-slip philosophy to evaluate the demographics, PPF rate and fracture patterns in this patient cohort. MATERIALS AND METHODS A systematic search of Embase, Medline and CINAHL databases was performed to seek studies involving the use of cemented, polished, taper-slip stems, reporting on a rate of post-operative PPF and not involving patient cohorts that were exclusively hip fracture or revision arthroplasty. RESULTS 27 studies reported on 505 PPFs with an average time from primary operation to PPF of 71.2 months (2-301 months). The average age of patients who sustained PPFs was 70.6 years (53.5-82 years) and the majority were female (64.2%). The Vancouver B2 fracture type was most common (39.5%). Open reduction and internal fixation represented the management of choice in 61.2% of PPFs. There was a re-operation rate of 11.4%. CONCLUSION This review suggests an association with being older and female, and a greater risk of PPFs secondary to low energy falls in cemented polished taper-slip stems.
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Affiliation(s)
- Kwaku Baryeh
- Education Centre, West Middlesex University Hospital, Twickenham Road, Middlesex, TW7 6AF, UK.
| | - David H Sochart
- The Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK
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13
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Baryeh K, Wang C, Sochart DH. 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. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04712-x. [PMID: 36447057 PMCID: PMC9708125 DOI: 10.1007/s00402-022-04712-x] [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: 10/16/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The true incidence of periprosthetic femoral fracture (PFF) around cemented polished taper-slip implants remains largely unknown. Registries usually only capture PFFs that result in revision, missing those managed non-operatively or treated by open reduction and internal fixation (ORIF). This study reports the long-term rate of PFF with the original triple-tapered C-stem femoral implant. MATERIALS AND METHODS A prospective review of a consecutive series of 500 primary total hip arthroplasties (THAs) performed at a single centre between March 2000 and December 2005, with average follow-up of 15 years (12-19 years). RESULTS There were 500 consecutive THAs in 455 patients. Seven PFFs (1.4%) occurred in seven patients at an average of 7.9 years (range 2-11.5) from the primary arthroplasty. Five PFFs were managed by ORIF, one Vancouver B3 fracture was revised for a loose implant and one patient was treated non-operatively. Average age at primary operation was 74 years (67-87) and BMI averaged 27.3 (22-31). There was no typical fracture pattern and no statistically significant associations with patient demographics (age, gender, BMI, diagnosis) or prosthetic details (size, offset, alignment, cement mantle, subsidence). Survivorship to the occurrence of PFF was 99% (97.3-99.6%) at 10 years and 97.8% (95.5-99.0%) at 15. CONCLUSION A PFF rate of 1.4% at an average follow-up of 15 years represents the true incidence of PFF with the use of the original triple-tapered C-Stem femoral implant, similar to that of published Exeter series (1.85%) but lower than the CPT (3.3%).
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Affiliation(s)
- Kwaku Baryeh
- Postgraduate Medical Education, West Middlesex University Hospital, Twickenham Road, Islewoth, TW7 6AF Middlesex UK
| | - Chao Wang
- Department of Statistics, Kingston University, River House, 53-57 High Street, Kingston upon Thames, KT1 1LQ Surrey UK
| | - David H. Sochart
- The Academic Unit, South West London Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG UK ,The School of Health and Society, University of Salford, Prestwood Road, Salford, M50 2EQ Manchester UK
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14
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Khan SK, Tyas B, Shenfine A, Jameson SS, Inman DS, Muller SD, Reed MR. Reoperation and revision rates at ten years after 1,312 cemented Thompson’s hemiarthroplasties. Bone Jt Open 2022; 3:710-715. [PMID: 36062890 PMCID: PMC9533242 DOI: 10.1302/2633-1462.39.bjo-2022-0084] [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: 11/25/2022] Open
Abstract
Aims Despite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson’s hemiarthroplasties over a ten-year period, recording all accessible patient and implant outcomes. Methods Patient identifiers for a consecutive cohort treated between 1 January 2003 and 31 December 2011 were linked to radiographs, surgical notes, clinic letters, and mortality data from a national dataset. This allowed charting of their postoperative course, complications, readmissions, returns to theatre, revisions, and deaths. We also identified all postoperative attendances at the Emergency and Outpatient Departments, and recorded any subsequent skeletal injuries. Results In total, 1,312 Thompson’s hemiarthroplasties were analyzed (mean age at surgery 82.8 years); 125 complications were recorded, necessitating 82 returns to theatre. These included 14 patients undergoing aspiration or manipulation under anaesthesia, 68 reoperations (5.2%) for debridement and implant retention (n = 12), haematoma evacuation (n = 2), open reduction for dislocation (n = 1), fixation of periprosthetic fracture (n = 5), and 48 revised stems (3.7%), for infection (n = 13), dislocation (n = 12), aseptic loosening (n = 9), persistent pain (n = 6), periprosthetic fracture (n = 4), acetabular erosion (n = 3), and metastatic bone disease (n = 1). Their status at ten years is summarized as follows: 1,180 (89.9%) dead without revision, 34 (2.6%) dead having had revision, 84 (6.6%) alive with the stem unrevised, and 14 (1.1%) alive having had revision. Cumulative implant survivorship was 90.3% at ten years; patient survivorship was 7.4%. Conclusion The Thompson’s stem demonstrates very low rates of complications requiring reoperation and revision, up to ten years after the index procedure. Fewer than one in ten patients live for ten years after fracture. This study supports the use of a cemented Thompson’s implant as a cost-effective option for frail hip fracture patients. Cite this article: Bone Jt Open 2022;3(9):710–715.
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Affiliation(s)
- Sameer K. Khan
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, UK
| | - Ben Tyas
- Health Education North East, Newcastle Upon Tyne, UK
| | | | - Simon S. Jameson
- South Tees Hospitals NHS Foundation Trust, The James Cook University Hospital, Middlesbrough, UK
| | - Dominic S. Inman
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, UK
| | - Scott D. Muller
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, UK
| | - Mike R. Reed
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, UK
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15
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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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16
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Rames RD, Smartt AA, Abdel MP, Mabry TM, Berry DJ, Sierra RJ. Collarless Taper Slip and Collared Composite Beam Stems Differ in Failure Modes and Reoperation Rates. J Arthroplasty 2022; 37:S598-S603. [PMID: 35279340 DOI: 10.1016/j.arth.2022.02.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cemented femoral components are used in older patients based on lower risk of periprosthetic fracture and implant loosening. This study reports the survivorship free of periprosthetic femoral fracture (PPFX), femoral loosening, all-cause revision, and reoperation between 2 philosophies of cemented stems. METHODS In total, 1,306 primary hybrid total hip arthroplasties were performed for osteoarthritis between 2000 and 2018 in a retrospective single center study. Cemented stems included 798 EON composite beam (CB) and 508 Exeter collarless taper slip (CTS) stems. Mean age was 77 years. An inverse treated probability weighted model was utilized to control for risk factors including age, gender, body mass index, year, and surgeon. RESULTS There was no difference in risk of PPFX at 10 years (CTS 9% vs CB 5%; hazard ratio [HR] 1.4, P = .47). There was an increased risk of intraoperative fractures requiring fixation in the CB cohort (7/798 [5 calcar, 2 greater trochanter] vs 0/508, P < .001), while there was an increased risk of Vancouver B2 PPFX in the CTS cohort (7/508 vs 0/798; P < 001). There was a higher risk of femoral loosening in the CB cohort (6/798 vs 0/508; P < .0001). Higher survivorship free of revision (98% vs 91%; HR 4, P = .001) and free of reoperation (96% vs 88%; HR 2.5, P = .002) was seen at 10 years in the CB cohort. CONCLUSION The risk of PPFX requiring implant revision was increased in the CTS cohort, while there was an increased risk of femoral component loosening and intraoperative fractures seen in the CB cohort. Surgeons should be aware of the different failure modes when choosing implant design for their patient.
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Affiliation(s)
- Richard D Rames
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Anne A Smartt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Tad M Mabry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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17
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The influence of calcar collar and surface finish in the cemented femoral component on the incidence of postoperative periprosthetic femoral fracture at a minimum of five years after primary total hip arthroplasty. Injury 2022; 53:2247-2258. [PMID: 35292157 DOI: 10.1016/j.injury.2022.03.011] [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: 07/20/2021] [Revised: 01/13/2022] [Accepted: 03/05/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Cemented femoral component design including its mechanical behavior in total hip arthroplasty (THA) has influenced the occurrence of postoperative periprosthetic femoral fracture (PPFF). The main aim of this study was to investigate the influence of the calcar collar and surface finish in the cemented femoral component on the risk of PPFF. MATERIALS AND METHODS This retrospective review was undertaken of 1082 primary THAs in 912 patients using cemented femoral components followed for a minimum of five years (mean, 9.4 years; range, 5-24 years). The incidence of PPFF, patients' demographics and surgical details were evaluated. Kaplan-Meier survivorship analysis was performed for four different outcomes: any PPFF, revision of the femoral component for PPFF, aseptic loosening, and for any reason. RESULTS The overall incidence of PPFFs was 1.0% (n = 11): 1.4% (n = 10) in the collarless polished (CLP) group, none in the collared polished (CP) group and 0.6% (n = 1) in the collared non-polished (CNP) group (p > 0.05). Kaplan-Meier survival analysis for the femoral component at 12 years with PPFF as the end point was 97.4% (95% confidence interval [CI], 94.9 to 99.8) in the collarless group and 99.7% (95% CI, 99.1 to 100) in the collared group (p = 0.048). With revision of the femoral component for aseptic loosening as the end point, survivorship was 100.0% in the CLP and CP groups, and 98.1% (95% CI, 95.9 to 100) in the CNP group (CLP vs CP, p > 0.999; CLP vs CNP, p = 0.001; CP vs CNP, p = 0.112). CONCLUSION This study demonstrated that the calcar collar in the cemented femoral component could play an important role to reduce the incidence of PPFF. The surface finish in the cemented femoral components influenced the incidence of femoral component revision for aseptic loosening over 5-12 years. Surgeons should consider not only the geometry and the mechanical function of the femoral components based on different design philosophies, but also potential complications associated with different designs that may require revision arthroplasty.
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18
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Khanuja HS, Mekkawy KL, MacMahon A, McDaniel CM, Allen DA, Moskal JT. Revisiting Cemented Femoral Fixation in Hip Arthroplasty. J Bone Joint Surg Am 2022; 104:1024-1033. [PMID: 35298444 PMCID: PMC9969348 DOI: 10.2106/jbjs.21.00853] [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: 02/01/2023]
Abstract
➤ The primary means of femoral fixation in North America is cementless, and its use is increasing worldwide, despite registry data and recent studies showing a higher risk of periprosthetic fracture and early revision in elderly patients managed with such fixation than in those who have cemented femoral fixation. ➤ Cemented femoral stems have excellent long-term outcomes and a continued role, particularly in elderly patients. ➤ Contrary to historical concerns, recent studies have not shown an increased risk of death with cemented femoral fixation. ➤ The choice of femoral fixation method should be determined by the patient's age, comorbidities, and bone quality. ➤ We recommend considering cemented femoral fixation in patients who are >70 years old (particularly women), in those with Dorr type-C bone or a history of osteoporosis or fragility fractures, or when intraoperative broach stability cannot be obtained.
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Affiliation(s)
- Harpal S. Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Kevin L. Mekkawy
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Aoife MacMahon
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Claire M. McDaniel
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Donald A. Allen
- Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia
| | - Joseph T. Moskal
- Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia
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19
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Formica M, Mosconi L, Cavagnaro L, Chiarlone F, Quarto E, Lontaro-Baracchini M, Zanirato A. A 24-year single-centre experience with Collum Femoris Preserving stem: clinical and radiological results in young and elderly population. Hip Int 2022:11207000221093248. [PMID: 35465751 DOI: 10.1177/11207000221093248] [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: 02/04/2023]
Abstract
OBJECTIVE The primary aim was to evaluate the long-term follow-up of Collum Femoris Preserving (CFP) stem, specifically focusing on stem survivorship, complications, as well as on clinical and radiological results. The secondary study objective is an age-based sub-analysis (<65 years vs. ⩾65 years) of long-term results. MATERIALS AND METHODS We performed a retrospective analysis of patients who underwent CFP implantation between 1997 and 2009. A total of 311 patients (342 hips) were included with a mean follow-up of 15.8 ± 2.2 (range 11-24) years. 2 age groups were analysed: Group-Y (age <65) and Group-E (age ⩾65). Group-Y included 182 hips (mean follow-up 16.3 ± 4.2 years), whereas Group-E included 160 hips (mean follow-up 15.5 ± 3.7 years). Clinical (HHS, OHS and VAS) and radiological data were obtained at final follow-up. Any complications, reoperations, prosthetic components revisions and stem revisions were analysed. RESULTS According to HSS score, 95% of patients reported excellent/good results (95.6% Group-Y vs. 94.4% Group-E) with an overall stem survival rate of 93.3% (94% Group-Y vs. 92.5% Group-E; p = 0.37). Overall, 87% of stem revisions were performed with primary stems. The rate of prosthetic components revision was 9.9 % (9.9% in Group-Y vs. 10% in Group-E; p = 1). The reoperation rate was 10.8% (11.5% in Group-Y vs. 10.0% in Group-E; p = 0.73). CONCLUSIONS The CFP stem provides good clinical and radiological long-term results with low rate of complications in both young and elderly patients. No significant difference in stem revision and reoperation rates was observed between the 2 groups. Both in elderly and young patients, CFP stem allows revisions to be performed with primary stems.
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Affiliation(s)
- Matteo Formica
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy.,DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
| | - Lorenzo Mosconi
- Joint Replacement Unit - Orthopaedics and Traumatology 2, Hospital Santa Corona, Pietra Ligure, Italy
| | - Luca Cavagnaro
- Joint Replacement Unit - Orthopaedics and Traumatology 2, Hospital Santa Corona, Pietra Ligure, Italy
| | - Francesco Chiarlone
- Joint Replacement Unit - Orthopaedics and Traumatology 2, Hospital Santa Corona, Pietra Ligure, Italy
| | - Emanuele Quarto
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy.,DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
| | - Maddalena Lontaro-Baracchini
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy.,DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
| | - Andrea Zanirato
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy.,DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
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20
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Gausden EB, Abdel MP, Mabry TM, Berry DJ, Trousdale RT, Sierra RJ. Midterm Results of Primary Exeter Cemented Stem in a Select Patient Population. J Bone Joint Surg Am 2021; 103:1826-1833. [PMID: 33974592 DOI: 10.2106/jbjs.20.01829] [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 Most North American surgeons predominantly use uncemented stems in primary total hip arthroplasties (THAs) and reserve cemented stems for selected older patients and those with poor bone quality. However, data on this "selective use" strategy for cemented stems in the population at risk for periprosthetic fracture and implant loosening are limited. The purpose of this study was to describe implant survivorship, complications, and radiographic results of a specific collarless, polished, tapered cemented stem (Exeter; Stryker) used selectively in a predominantly elderly population undergoing primary THA. METHODS We identified 386 patients who underwent a total of 423 primary THAs with selectively utilized Exeter stems for the treatment of osteoarthritis between 2006 and 2017. In the same time period, 11,010 primary THAs were performed with uncemented stems and 961 with non-Exeter cemented stems. The mean patient age was 77 years, 71% were female, and the mean body mass index was 29 kg/m2. Competing risk analysis accounting for death was utilized to determine cumulative incidences of revision and reoperation. The mean follow-up was 5 years (range, 2 to 12 years). RESULTS The 10-year cumulative incidence of any femoral component revision in this patient cohort was 4%, with 10 stems revised at the time of the latest follow-up. There were no intraoperative femoral fractures. The indications for revision were postoperative periprosthetic femoral fracture (n = 6), dislocation (n = 3), and infection (n = 1). There were no revisions for femoral loosening. The 10-year cumulative incidence of reoperation was 10%. The 10-year cumulative incidence of Vancouver B periprosthetic femoral fracture was 2%. Radiographically, there were no cases of aseptic loosening or osteolysis. There was a significant improvement in median Harris hip score, from 53 preoperatively to 92 at a mean follow-up of 5 years (p < 0.001). CONCLUSIONS The strategy of selectively utilizing a collarless, polished, tapered cemented stem produced a low (4%) cumulative incidence of stem revision at 10 years postoperatively and resulted in no cases of aseptic loosening. The use of the Exeter stem did not eliminate postoperative femoral fractures in this predominantly elderly, female patient population. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Tad M Mabry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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21
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Kennedy JW, Ng NYB, Young D, Kane N, Marsh AG, Meek RMD. Cement-in-cement femoral component revision : a comparison of two different taper-slip designs with medium-term follow up. Bone Joint J 2021; 103-B:1215-1221. [PMID: 34192939 DOI: 10.1302/0301-620x.103b7.bjj-2020-1953.r2] [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: 11/05/2022]
Abstract
AIMS Cement-in-cement revision of the femoral component represents a widely practised technique for a variety of indications in revision total hip arthroplasty. In this study, we compare the clinical and radiological outcomes of two polished tapered femoral components. METHODS From our prospectively collated database, we identified all patients undergoing cement-in-cement revision from January 2005 to January 2013 who had a minimum of two years' follow-up. All cases were performed by the senior author using either an Exeter short revision stem or the C-Stem AMT high offset No. 1 prosthesis. Patients were followed-up annually with clinical and radiological assessment. RESULTS A total of 97 patients matched the inclusion criteria (50 Exeter and 47 C-Stem AMT components). There were no significant differences between the patient demographic data in either group. Mean follow-up was 9.7 years. A significant improvement in Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item Short-Form Survey (SF-12) scores was observed in both cohorts. Leg lengths were significantly shorter in the Exeter group, with a mean of -4 mm in this cohort compared with 0 mm in the C-Stem AMT group. One patient in the Exeter group had early evidence of radiological loosening. In total, 16 patients (15%) underwent further revision of the femoral component (seven in the C-Stem AMT group and nine in the Exeter group). No femoral components were revised for aseptic loosening. There were two cases of femoral component fracture in the Exeter group. CONCLUSION Our series shows promising mid-term outcomes for the cement-in-cement revision technique using either the Exeter or C-Stem AMT components. These results demonstrate that cement-in-cement revision using a double or triple taper-slip design is a safe and reliable technique when used for the correct indications. Cite this article: Bone Joint J 2021;103-B(7):1215-1221.
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Affiliation(s)
| | - Nigel Y B Ng
- Queen Elizabeth University Hospital, Glasgow, UK
| | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
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22
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Murphy EP, Fenelon C, Cassar-Gheiti A, O'Loughlin P, Curtin W, Murphy CG. Does Proximal Femoral Morphology Impact Morbidity and Mortality? A Cohort Study of Uncemented Hemiarthroplasties in the Treatment of Femoral Neck Fractures. Arthroplast Today 2021; 10:57-62. [PMID: 34307812 PMCID: PMC8283011 DOI: 10.1016/j.artd.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background To assess outcomes after uncemented hemiarthroplasty stems in the treatment of intracapsular femoral neck fractures over an 11-year period. Mortality rates were assessed, and whether proximal femoral geometry and stem alignment were factors in intraoperative or postoperative periprosthetic fracture (PPF) needs to be identified. Materials and Methods A retrospective single-center observational study was conducted of all patients who underwent intracapsular femoral neck fracture treatment using an uncemented prosthesis between January 2008 and December 2018. Primary endpoints included mortality rate, Dorr classification, prosthesis alignment, intraoperative fracture, and reoperation rate for any reason. Subanalysis on collared and uncollared implants was also conducted. Multivariate logistic regression was performed based on Dorr classification for stem alignment, fracture incidence, reoperation rate, implant sizing, and patient mortality. Results A total of 536 patients received an uncemented hemiarthroplasty in the study period. The mean patients age was 80.4 years, of which 71% were female. The 30-day mortality rate was 5.2%, with no deaths on day zero or day one. Twenty patients (3.7%) sustained an intraoperative calcar fracture, and 14 patients a PPF (2.6%) at a mean of 1.3 years from surgery. Dorr C type femurs were more likely to develop a PPF (P = .001), while valgus stem alignment was associated with PPF (P = .049). Conclusions This implant has low reoperation rates, low early postoperative mortality, and low 30-day mortality. This large single-center study provides up-to-date information using a contemporary stem in patients with multiple comorbidities. Dorr C femoral morphology and valgus stem malalignment were risk factors for postoperative fractures.
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Affiliation(s)
- Evelyn P Murphy
- Department of Trauma and Orthopaedics, Galway University Hospitals, Saolta Hospital Group, Galway, Ireland
| | - Christopher Fenelon
- Department of Science and Engineering, University of Limerick, Limerick, Co, Limerick, Ireland
| | - Adrian Cassar-Gheiti
- Department of Trauma and Orthopaedics, Galway University Hospitals, Saolta Hospital Group, Galway, Ireland
| | | | - William Curtin
- Department of Trauma and Orthopaedics, Galway University Hospitals, Saolta Hospital Group, Galway, Ireland
| | - Colin G Murphy
- Department of Trauma and Orthopaedics, Galway University Hospitals, Saolta Hospital Group, Galway, Ireland
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Ohashi H, Iida S, Minato I. Minimum ten-year outcome of a triple-tapered femoral stem implanted with line-to-line cementing technique. BMC Musculoskelet Disord 2021; 22:601. [PMID: 34193115 PMCID: PMC8246659 DOI: 10.1186/s12891-021-04484-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background A triple-tapered polished femoral stem was implanted with line-to-line cementing technique. The purpose of this study was to determine the survivorship, loosening rate, stem subsidence, radiologic changes and clinical outcomes in the minimum 10-year follow-up. Methods This was a retrospective study done in three institutes. Finally, 118 hips in 97 patients could be followed-up at the mean follow-up period of 126.3 months. The survivorship, radiological and clinical outcomes were investigated. Results Radiologically, 107 hips (90.7%) were categorized to Barrack cementing grade A, and 108 stems (91.5%) were inserted in neutral position. All hips were not loose and were not revised due to any reason. Survival with revision for any reason as the endpoint was 100% after 10 years. At the last follow-up, the mean subsidence was 0.43 mm, and the subsidence was less than 1 mm in 110 hips (93.2%). JOA hip score improved from 42.7 ± 8.9 points preoperatively to 92.8 ± 6.8 points at the last follow-up. No patient complained thigh pain. Conclusions Line-to-line cementing technique with use of a triple-tapered polished stem was effective to achieve good cementation quality and centralization of the stem. The subsidence was small, and the minimum 10-year results were excellent without any failures related to the stem. Trial registration Retrospectively registered.
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Affiliation(s)
- Hirotsugu Ohashi
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-ku, Osaka, 530-0012, Japan.
| | - Satoshi Iida
- Department of Orthopaedic Surgery, Matsudo City General Hospital, 933-1 Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Izumi Minato
- Department of Orthopaedic Surgery, Niigata Rinko Hospital, 1-114-3 Momoyama-cho, higashi-ku, Niigata, 950-8725, Japan
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24
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Thompson JW, Corbett J, Bye D, Jones A, Tissingh EK, Nolan J. Analysis of the Exeter V40 femoral stem prosthesis fracture : systematic review and single centre case series. Bone Jt Open 2021; 2:443-456. [PMID: 34176335 PMCID: PMC8244800 DOI: 10.1302/2633-1462.26.bjo-2021-0025.r1] [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] [Indexed: 11/23/2022] Open
Abstract
Aims The Exeter V40 cemented polished tapered stem system has demonstrated excellent long-term outcomes. This paper presents a systematic review of the existing literature and reports on a large case series comparing implant fractures between the Exeter V40 series; 125 mm and conventional length stem systems. Methods A systematic literature search was performed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. In parallel, we performed a retrospective single centre study of Exeter V40 femoral stem prosthetic fractures between April 2003 and June 2020. Results There are 25 reported cases of such prosthetic fractures confined to small case series and case reports within the literature. We report an additional 19 cases to the literature (mean age 66.3 years (SD 11.7); 12 (63%) females; BMI 32.9 kg/m2 (SD 5.9)). The mean time from index procedure to fracture was 7.8 years (SD 3.6; 2.5 to 16.3). Exeter V40 stem fracture incidence was 0.15% and 1.21% for primary and revision arthroplasty, respectively. Incidence was significantly higher in revision arthroplasty (p < 0.001) and 125 mm length stems compared to ≥ 150 mm length stems (1.25% vs 0.13%, respectively; p < 0.001). When comparing different stem length cohorts, 125 mm short-stems were associated with stem-body fractures (92% vs 29%; p = 0.0095), earlier time to fracture (6.2 years vs 11.0 years; p = 0.0018), younger patient age at time of fracture (62.7 years vs 72.6 years; p = 0.037), and female sex (75% vs 43%; p = 0.326). Conclusion This complication remains rare, although we report a significantly higher incidence at up to 17 years follow-up than in the literature. Short 125 mm length Exeter V40 stems undoubtedly have a role in restoring anatomy and biomechanics in smaller femoral geometries, although the surgeon has to appreciate the higher risk of stem fracture and the associated predisposing factors which may necessitate particular attention to surgical technique and planning. Cite this article: Bone Jt Open 2021;2(6):443–456.
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Affiliation(s)
- Joshua W Thompson
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - James Corbett
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - Daniel Bye
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - Adrian Jones
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - Elizabeth K Tissingh
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - John Nolan
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
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25
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Baryeh K, Mendis J, Sochart DH. Temporal subsidence patterns of cemented polished taper-slip stems: a systematic review. EFORT Open Rev 2021; 6:331-342. [PMID: 34150327 PMCID: PMC8183154 DOI: 10.1302/2058-5241.6.200086] [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] [Indexed: 11/21/2022] Open
Abstract
The literature was reviewed to establish the levels of stem subsidence for both double and triple-tapered implants in order to determine whether there were any differences in subsidence levels with regard to the methods of measurement, the magnitude and rate of subsidence and clinical outcomes. All studies reporting subsidence of polished taper-slip stems were identified. Patient demographics, implant design, radiological findings, details of surgical technique, methods of measurement and levels of subsidence were collected to investigate which factors were related to increased subsidence. Following application of inclusion and exclusion criteria, 28 papers of relevance were identified. The studies initially recruited 3090 hips with 2099 being available for radiological analysis at final follow-up. Patient age averaged 68 years (42–70), 60.4% were female and the average body mass index (BMI) was 27.4 kg/m2 (24.1–29.2). Mean subsidence at one, two, five and 10 years was 0.97 mm, 1.07 mm, 1.47 mm and 1.61 mm respectively. Although double-tapered stems subsided more than triple-tapered stems at all time points this was not statistically significant (p > 0.05), nor was the method of measurement used (p > 0.05). We report the levels of subsidence at which clinical outcomes and survivorship remain excellent, but based on the literature it was not possible to determine a threshold of subsidence beyond which failure was more likely. There were relatively few studies of triple-tapered stems, but given that there were no statistically significant differences, the levels presented in this review can be applied to both double and triple-tapered designs.
Cite this article: EFORT Open Rev 2021;6:331-342. DOI: 10.1302/2058-5241.6.200086
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Affiliation(s)
- Kwaku Baryeh
- The Academic Surgical Unit, South West London Elective Orthopaedic Centre, UK
| | | | - David H Sochart
- The Academic Surgical Unit, South West London Elective Orthopaedic Centre, UK
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26
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Emara AK, Ng M, Krebs VE, Bloomfield M, Molloy RM, Piuzzi NS. Femoral Stem Cementation in Hip Arthroplasty: The Know-How of a "Lost" Art. Curr Rev Musculoskelet Med 2021; 14:47-59. [PMID: 33453016 PMCID: PMC7930165 DOI: 10.1007/s12178-020-09681-5] [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] [Accepted: 12/17/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW To describe the (1) indications, (2) preoperative precautions, and (3) stepwise technical details of modern femoral stem cemented fixation. RECENT FINDINGS Femoral stem cementation provides excellent implant longevity with a low periprosthetic fracture rate among patients with compromised bone quality or aberrant anatomy. Unfamiliarity with the details of modern cementation techniques among trainees who may lack frequent exposure to cementing femoral stems may preclude them from offering this viable option to suitable patients in later stages of their careers. As such, maximizing benefit from cemented femoral stem fixation among suitable candidates is contingent upon the meticulous use of modern cementation techniques. In addition to proper patient selection, modern cementation techniques emphasize the use of (1) pulsatile lavage of the femoral canal, (2) utilization of epinephrine-soaked swabs, (3) vacuum cement mixing, (4) retrograde cement introduction, (5) cement pressurization, and (6) the use of stem centralizers. Furthermore, identifying and optimizing the preoperative status of at-risk patients with pre-existing cardiopulmonary compromise, in addition to intraoperative vigilance, are essential for mitigating the risk of developing bone cement implantation syndrome. Further research is required to assess the utility of cemented femoral stem fixation among younger patients.
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Affiliation(s)
- Ahmed K Emara
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | - Mitchell Ng
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | - Viktor E Krebs
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | | | - Robert M Molloy
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA.
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27
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Kruse M, Mohammed J, Sayed-Noor A, Wolf O, Holmgren G, Nordström R, Crnalic S, Sköldenberg O, Mukka S. Peri-implant femoral fractures in hip fracture patients treated with osteosynthesis: a retrospective cohort study of 1965 patients. Eur J Trauma Emerg Surg 2021; 48:293-298. [PMID: 33484277 DOI: 10.1007/s00068-020-01596-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE There are few studies on incidence rates, treatment and outcomes for peri-implant femoral fractures (PIFF) in the proximity of osteosynthesis. The purpose of this study was to investigate the incidence of PIFF following osteosynthesis of proximal femoral fractures. PATIENTS AND METHODS This retrospective cohort study comprised a consecutive series of hip fracture patients aged 50 years or older and operated with osteosynthesis between 2003 and 2015. Patients were followed-up until 2018, removal of implants or death, for a mean of 4 years (range 0-15). Data on age, sex, housing, hip complications, and reoperations were recorded. The risk of PIFFs was assessed using Cox proportional hazards regression analysis. In patients with two fractures during the study period, only the first fracture was included. RESULTS A total of 1965 osteosynthesis procedures were performed, of which 382 were cephalomedullary nails (CMN), 933 sliding hip devices (SHD) and 650 pins. Mean age was 80 years (range 50-104), 65% of patients were women. A total of 41 PIFFs occurred during the study period. The cumulative incidence of peri-implant fractures was 0.8% for CMN, 2.7% (HR 2.995% CI, 0.87-9.6, p = 0.08) for SHD and 2.0% (HR 2.3 95% CI, 0.6-8.1, p = 0.2) for pins. PIFFs occurred after a mean of 27 months (range 0-143). The 1-year mortality was 34% following PIFF. The majority was treated surgically (66%, 27/41) and the reoperation rate was 15% (4/27). CONCLUSION In this retrospective cohort study, in contrast to previous reports, we found a tendency to a higher cumulative incidence of PIFFs for SHD compared to modern CMN. Our results show cumulative incidences of PIFFs comparable to those described for periprosthetic femur fractures after hip arthroplasty for femoral neck fracture.
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Affiliation(s)
- Mark Kruse
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
| | - Jabbar Mohammed
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Arkan Sayed-Noor
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Solna, Sweden
| | - Olof Wolf
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Gunnar Holmgren
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Robin Nordström
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Solna, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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28
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Mahon J, McCarthy CJ, Sheridan GA, Cashman JP, O'Byrne JM, Kenny P. Outcomes of the Exeter V40 cemented femoral stem at a minimum of ten years in a non-designer centre. Bone Jt Open 2020; 1:743-748. [PMID: 33367281 PMCID: PMC7750737 DOI: 10.1302/2633-1462.112.bjo-2020-0163.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims The Exeter V40 cemented femoral stem was first introduced in 2000. The largest single-centre analysis of this implant to date was published in 2018 by Westerman et al. Excellent results were reported at a minimum of ten years for the first 540 cases performed at the designer centre in the Exeter NHS Trust, with stem survivorship of 96.8%. The aim of this current study is to report long-term outcomes and survivorship for the Exeter V40 stem in a non-designer centre. Methods All patients undergoing primary total hip arthroplasty using the Exeter V40 femoral stem between 1 January 2005 and 31 January 2010 were eligible for inclusion. Data were collected prospectively, with routine follow-up at six to 12 months, two years, five years, and ten years. Functional outcomes were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Outcome measures included data on all components in situ beyond ten years, death occurring within ten years with components in situ, and all-cause revision surgery. Results A total of 829 stems in 745 patients were included in the dataset; 155 patients (20.8%) died within ten years, and of the remaining 664 stems, 648 stems (97.6%) remained in situ beyond ten years. For the 21 patients (2.5%) undergoing revision surgery, 16 femoral stems (1.9%) were revised and 18 acetabular components (2.2%) were revised. Indications for revision in order of decreasing frequency were infection (n = 6), pain (n = 6), aseptic component loosening (n = 3), periprosthetic fracture (n = 3), recurrent dislocation (n = 2), and noise production (ceramic-on-ceramic squeak) (n = 1). One patient was revised for aseptic stem loosening. The mean preoperative WOMAC score was 61 (SD 15.9) with a mean postoperative score of 20.4 (SD 19.3) (n = 732; 88.3%). Conclusion The Exeter V40 cemented femoral stem demonstrates excellent functional outcomes and survival when used in a high volume non-designer centre. Outcomes are comparable to those of its serially validated predecessor, the Exeter Universal stem. Cite this article: Bone Jt Open 2020;1-12:743–748.
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Affiliation(s)
- John Mahon
- Cappagh National Orthopaedic Hospital, Dublin, Ireland
| | | | | | - James P Cashman
- Cappagh National Orthopaedic Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - John M O'Byrne
- Cappagh National Orthopaedic Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paddy Kenny
- Cappagh National Orthopaedic Hospital, Dublin, Ireland.,Connolly Hospital Blanchardstown, Dublin, Ireland
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29
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Lamb JN, Jain S, King SW, West RM, Pandit HG. Risk Factors for Revision of Polished Taper-Slip Cemented Stems for Periprosthetic Femoral Fracture After Primary Total Hip Replacement: A Registry-Based Cohort Study from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. J Bone Joint Surg Am 2020; 102:1600-1608. [PMID: 32604382 DOI: 10.2106/jbjs.19.01242] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip replacement (THR) with a cemented polished taper-slip (PTS) femoral stem has excellent long-term results but is associated with a higher postoperative periprosthetic femoral fracture (PFF) risk compared with composite beam stems. This study aimed to identify risk factors associated with PFF revision following THR with PTS stems. METHODS In a retrospective cohort study, 299,019 primary THRs using PTS stems from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) were included, with a median follow-up of 5.2 years (interquartile range [IQR], 3.1 to 8.2 years). The adjusted hazard ratio (HR) of PFF revision was estimated for each variable using multivariable Cox survival regression analysis. RESULTS Of 299,019 THR cases, 1,055 underwent revision for PFF at a median time of 3.1 years (IQR, 1.0 to 6.1 years). The mean age (and standard deviation) was 72 ± 9.7 years, 64.3% (192,365 patients) were female, and 82.6% (247,126 patients) had an American Society of Anesthesiologists (ASA) class of 1 or 2. Variables associated with increased PFF were increasing age (HR, 1.02 per year), intraoperative fracture (HR, 2.57 [95% confidence interval (CI), 1.42 to 4.66]), ovaloid (HR, 1.96 [95% CI, 1.22 to 3.16]) and round cross-sectional shapes (HR, 9.58 [95% CI, 2.29 to 40.12]), increasing stem offset (HR, 1.07 per millimeter), increasing head size (HR, 1.04 per millimeter), THR performed from 2012 to 2016 (HR, 1.45 [95% CI, 1.18 to 1.78]), cobalt-chromium stem material (HR, 6.7 [95% CI, 3.0 to 15.4]), and cobalt-chromium stems with low-viscosity cement (HR, 22.88 [95% CI, 9.90 to 52.85]). Variables associated with a decreased risk of PFF revision were female sex (HR, 0.52 [95% CI, 0.45 to 0.59]), increasing stem length (HR, 0.97 per millimeter), and a ceramic-on-polyethylene bearing (HR, 0.55 [95% CI, 0.36 to 0.85]). CONCLUSIONS Increased risk of PFF revision was associated with PTS stems that are short, have high offset, are used with large femoral heads, are made of cobalt-chromium, or have ovaloid or round cross-sectional shapes. Large increases in PFF risk were associated with cobalt-chromium stems used with low-viscosity cement. Further study is required to confirm causation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- J N Lamb
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom
| | - S Jain
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - S W King
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom
| | - R M West
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - H G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom.,Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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30
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Blankstein M, Lentine B, Nelms NJ. The Use of Cement in Hip Arthroplasty: A Contemporary Perspective. J Am Acad Orthop Surg 2020; 28:e586-e594. [PMID: 32692094 DOI: 10.5435/jaaos-d-19-00604] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Notable advances in hip arthroplasty implants and techniques over the past 60 years have yielded excellent survivorship of fully cemented, hybrid, and reverse hybrid total hip replacements as demonstrated in joint registries worldwide. Major advances in noncemented implants have reduced the use of cement, particularly in North America. Noncemented implants predominate today based on procedural efficiency, concern related to thromboembolic risk, and a historic belief that cement was the primary cause of osteolysis and implant loosening. With the decline of cemented techniques, press-fit fixation has become common even in osteoporotic elderly patients. Unfortunately, there is a troubling rise in intraoperative, as well as early and late postoperative periprosthetic fractures associated with the use of noncemented implants. Despite the success of noncemented fixation, an understanding of modern cement techniques and cemented implant designs is useful to mitigate the risk of periprosthetic fractures. Cemented acetabular components can be considered in elderly patients with osteoporotic or pathologic bone. Cemented stems should be considered with abnormal proximal femoral morphology, conversion of failed hip fixation, inflammatory arthritis, patient age over 75 (especially women), osteoporotic bone (Dorr C), and in the treatment of femoral neck fractures.
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Affiliation(s)
- Michael Blankstein
- From the The University of Vermont Medical Center, Orthopedics and Rehabilitation Center (Dr. Blankstein and Dr. Nelms), and the Department of Orthopaedics and Rehabilitation (Dr. Lentine), The Robert Larner, M.D., College of Medicine at The University of Vermont, Burlington, VT
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31
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Increased risk for postoperative periprosthetic fracture in hip fracture patients with the Exeter stem than the anatomic SP2 Lubinus stem. Eur J Trauma Emerg Surg 2019; 47:803-809. [PMID: 31740996 PMCID: PMC8187181 DOI: 10.1007/s00068-019-01263-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/11/2019] [Indexed: 11/08/2022]
Abstract
Background The purpose of this study was to compare the cumulative incidence of postoperative periprosthetic fracture (PPF) in a cohort of femoral neck fracture (FNF) patients treated with two commonly used cemented stems: either a collarless, polished, tapered Exeter stem or the anatomic Lubinus SP2 stem. Methods In this retrospective multicenter cohort study of a consecutive series of patients, we included 2528 patients of age 60 years and above with an FNF who were treated with either hemiarthroplasty or total hip arthroplasty using either a polished tapered Exeter stem or an anatomic Lubinus SP2 stem. The incidence of PPF was assessed at a minimum of 2 years postoperatively. Results The incidence of PPF was assessed at a median follow-up of 47 months postoperatively. Thirty nine patients (1.5%) sustained a PPF at a median of 27 months (range 0–96 months) postoperatively. Two of the operatively treated fractures were Vancouver A (5%), 7 were Vancouver B1 (18%), 10 were Vancouver B2 (26%), 7 were Vancouver B3 (18%), and 13 were Vancouver C (32%). The cumulative incidence of PPF was 2.3% in the Exeter group compared with 0.7% in the SP2 group (p < 0.001). The HR was 5.4 (95% CI 2.4–12.5, p < 0.001), using the SP2 group as the denominator. Conclusions The Exeter stem was associated with a higher risk for PPF than the Lubinus SP2 stem. We suggest that the tapered Exeter stem should be used with caution in the treatment of FNF. Trial registration The study was registered at clinicaltrials.gov (identifier: NCT03326271).
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32
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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%.
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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;
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33
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Madörin K, Siepen W, Manzoni I, Stoffel KK, Ilchmann T, Clauss M. Five-year prospective subsidence analysis of 100 cemented polished straight stems: A concise clinical and radiological follow-up observation. Orthop Rev (Pavia) 2019; 11:7984. [PMID: 31210913 PMCID: PMC6551455 DOI: 10.4081/or.2019.7984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/02/2019] [Indexed: 12/31/2022] Open
Abstract
Early subsidence (>1.5mm) has been shown to be an indicator for later aseptic loosening of cemented hip stems. For the cemented twinSys® stem we published excellent short-term results at 2 years. Midterm data for this stem are available from national registers (NZL, NL), however in all of these sources, clinical and radiological results are missing. Aim of our study was to analyse mid-term survival and radiological changes around the cemented twinSys® stem with special emphasis on subsidence using EBRA-FCA. We conducted a prospective clinical and radiological 5- year follow-up study of 100 consecutive hybrid total hip arthroplasties (THA) using a polished, cemented collarless straight stem (twinSys®, Mathys AG® Bettlach, Switzerland) with a cementless monobloc pressfit cup (RM pressfit®, Mathys AG® Bettlach, Switzerland). Median age at surgery was 79 (69 to 93) years. No patient was lost to follow-up. Survival rates were calculated using the Kaplan-Meier method. Clinical (Harris Hip Score [HHS]) and radiological (cementing quality, alignment, osteolysis, debonding and cortical atrophy) outcomes and an in-depth subsidence analysis using EBRA-FCA were performed. 22 patients died in the course of follow-up unrelated to surgery, 21 stems had an incomplete radiological follow-up. 2 stems were revised, both due to an infection. The survival rate for the stem at 5 years was 98.0% (95% CI 95.3-100%). The survival rate of the stem for revision due to aseptic loosening at 5 years was 100%. The HHS improved from 53 (14-86) points preoperatively to 90 (49-100) points 5 years after surgery. Osteolysis was found in 2 stems without clinical symptoms. In 49 out of 55 patients with a complete radiological follow- up, the EBRA-FCA analysis was possible and showed an average subsidence of 0.66 (95% CI 0.46 to 0.86) mm 5 years after surgery. 10 patients showed a subsidence >1 mm, 5 of which bigger than 1.5 mm. Subsidence was independent from radiological changes and cementing quality. The cemented twinSys® stem showed excellent clinical and radiological mid-term results at five years' follow-up and seems to be a reliable implant.
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Affiliation(s)
- Kevin Madörin
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland
| | - Wolf Siepen
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland
| | - Isabella Manzoni
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland
| | | | | | - Martin Clauss
- Department of Orthopedics and Trauma Surgery, Kantonsspital Baselland
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