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Angelomenos V, Mohaddes M, Kärrholm J, Malchau H, Shareghi B, Itayem R. A prospective randomized study of Refobacin Bone Cement R versus Palacos R + G. Bone Joint J 2024; 106-B:435-441. [PMID: 38688480 DOI: 10.1302/0301-620x.106b5.bjj-2023-0999.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: 05/02/2024]
Abstract
Aims Refobacin Bone Cement R and Palacos R + G bone cement were introduced to replace the original cement Refobacin Palacos R in 2005. Both cements were assumed to behave in a biomechanically similar fashion to the original cement. The primary aim of this study was to compare the migration of a polished triple-tapered femoral stem fixed with either Refobacin Bone Cement R or Palacos R + G bone cement. Repeated radiostereometric analysis was used to measure migration of the femoral head centre. The secondary aims were evaluation of cement mantle, stem positioning, and patient-reported outcome measures. Methods Overall, 75 patients were included in the study and 71 were available at two years postoperatively. Prior to surgery, they were randomized to one of the three combinations studied: Palacos cement with use of the Optivac mixing system, Refobacin with use of the Optivac system, and Refobacin with use of the Optipac system. Cemented MS30 stems and cemented Exceed acetabular components were used in all hips. Postoperative radiographs were used to assess the quality of the cement mantle according to Barrack et al, and the position and migration of the femoral stem. Harris Hip Score, Oxford Hip Score, Forgotten Joint Score, and University of California, Los Angeles Activity Scale were collected. Results Median distal migration (y-axis) at two years for the Refobacin-Optivac system was -0.79 mm (-2.01 to -0.09), for the Refobacin-Optipac system was -0.75 mm (-2.16 to 0.20), and for the Palacos-Optivac system was -1.01 mm (-4.31 to -0.29). No statistically significant differences were found between the groups. Secondary outcomes did not differ statistically between the groups at the two-year follow-up. Conclusion At two years, we found no significant differences in distal migration or clinical outcomes between the three groups. Our data indicate that Refobacin Bone Cement R and Palacos R + G are comparable in terms of stable fixation and early clinical outcomes.
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Affiliation(s)
- Vasileios Angelomenos
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Malchau
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bita Shareghi
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Raed Itayem
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Jørgensen PB, Jakobsen SS, Vainorius D, Homilius M, Hansen TB, Stilling M. Less early subsidence of cemented Exeter short stems compared with cemented Exeter standard stems in Dorr type A femurs. Bone Jt Open 2023; 4:507-515. [PMID: 37407021 DOI: 10.1302/2633-1462.47.bjo-2023-0008.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Aims The Exeter short stem was designed for patients with Dorr type A femora and short-term results are promising. The aim of this study was to evaluate the minimum five-year stem migration pattern of Exeter short stems in comparison with Exeter standard stems. Methods In this case-control study, 25 patients (22 female) at mean age of 78 years (70 to 89) received cemented Exeter short stem (case group). Cases were selected based on Dorr type A femora and matched first by Dorr type A and then age to a control cohort of 21 patients (11 female) at mean age of 74 years (70 to 89) who received with cemented Exeter standard stems (control group). Preoperatively, all patients had primary hip osteoarthritis and no osteoporosis as confirmed by dual X-ray absorptiometry scanning. Patients were followed with radiostereometry for evaluation of stem migration (primary endpoint), evaluation of cement quality, and Oxford Hip Score. Measurements were taken preoperatively, and at three, 12, and 24 months and a minimum five-year follow-up. Results At three months, subsidence of the short stem -0.87 mm (95% confidence interval (CI) -1.07 to -0.67) was lower compared to the standard stem -1.59 mm (95% CI -1.82 to -1.36; p < 0.001). Both stems continued a similar pattern of subsidence until five-year follow-up. At five-year follow-up, the short stem had subsided mean -1.67 mm (95% CI -1.98 to -1.36) compared to mean -2.67 mm (95% CI -3.03 to -2.32) for the standard stem (p < 0.001). Subsidence was not influenced by preoperative bone quality (osteopenia vs normal) or cement mantle thickness. Conclusion The standard Exeter stem had more early subsidence compared with the short Exeter stem in patients with Dorr type A femora, but thereafter a similar migration pattern of subsidence until minimum five years follow-up. Both the standard and the short Exeter stems subside. The standard stem subsides more compared to the short stem in Dorr type A femurs. Subsidence of the Exeter stems was not affected by cement mantle thickness.
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Affiliation(s)
- Peter B Jørgensen
- AutoRSA Reseach Group Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stig S Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dovydas Vainorius
- Department of Orthopaedics, Gødstrup Regional Hospital, Herning, Denmark
| | - Morten Homilius
- Department of Orthopaedics, Gødstrup Regional Hospital, Herning, Denmark
| | - Torben B Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopaedics, Gødstrup Regional Hospital, Herning, Denmark
| | - Maiken Stilling
- AutoRSA Reseach Group Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Fontalis A, Kayani B, Vanhegan I, Tahmassebi J, Haddad IC, Giebaly DE, Rajput V, Hansjee S, Haddad FS. 2-Year Radiostereometric Analysis Evaluation of a Short, Proximally Coated, Triple-Taper Blade Femoral Stem Versus a Quadrangular-Taper Stem With Reinforced Proximal Body: A Randomized Controlled Trial. J Arthroplasty 2023:S0883-5403(23)00242-5. [PMID: 36931355 DOI: 10.1016/j.arth.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Cementless stem designs with proximal metaphyseal fixation aim to achieve better load distribution, reduce stress shielding, and improve primary stability. The purpose of this prospective, randomized controlled trial was to evaluate the 2-year migration and clinical outcomes of two cementless femoral stems. METHODS A total of 60 participants undergoing primary total hip arthroplasty for any cause were randomly allocated to receiving either a proximally coated, short blade stem or a quadrangular-taper stem with a reinforced proximal body. Radiostereometric Analysis (RSA) radiographs were performed post-operatively and at 6 weeks, 6 months, 1- and 2-years. The Harris Hip Score, Oxford Hip Score and the EuroQol five-dimension (EQ5D) were also collected. RESULTS At two years, the median subsidence of the short-blade stem was 0.097 millimeters (mm) [Interquartile range (IQR) -0.67 to 0.08)] versus 0.086 mm(IQR, -0.29 to 0.005, P=0.683); medial translation 0.023 mm (IQR 0.08 to 0.12) versus 0.029 mm(IQR -0.07 to 0.10, P=0.907); anterior translation 0.035 mm (IQR -0.23 to 0.33) versus 0.07 mm (IQR -0.13 to 0.08, P=0.268). At 24 months postoperatively, there were no stem revisions and Patient Reported Outcome Measures (PROMs) were comparable between groups. CONCLUSION Both cementless stems exhibited a predictable migration pattern and achieved initial stability. There was no difference in migration across the three Cartesian axes at any timepoint. Clinical outcomes and PROMs were also comparable. Biological fixation of both implants evidenced by the RSA and excellent PROMs are likely to translate to longer-term stability, which would need to be corroborated by longer-term outcome studies.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Ivor Vanhegan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Jenni Tahmassebi
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Isabella Catrina Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Dia Eldean Giebaly
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Vishal Rajput
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Shanil Hansjee
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom; Division of Surgery and Interventional Science, University College London, Gower Street, London, WC1E 6BT, UK
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Vind TD, Jørgensen PB, Vainorius D, Jakobsen SS, Søballe K, Stilling M. Migration pattern of cemented Exeter short stem in Dorr type A femurs. A prospective radiostereometry study with 2-year follow-up. Arch Orthop Trauma Surg 2023; 143:1071-1080. [PMID: 35113240 DOI: 10.1007/s00402-021-04307-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Exeter short stem (ESS) is 25 mm shorter than the standard length v40 Exeter stem (Stryker) and intended for a narrow femoral diaphysis. The purpose of the study was to evaluate the migration pattern of the cemented ESS. MATERIAL AND METHOD In a prospective single-center cohort study, 23 patients (21 female) mean age 78 (range 70-89) with hip osteoarthritis and Dorr Type A femurs were included. Preoperative DXA was used to group patients into normal (> - 1) and low (< - 1) T-score. Components were the collarless polished double-tapered Exeter short stem type N°1 L125. Patients were followed for 2 years with model-based RSA (stem migration), regular hip radiographs (stem position and cementation quality), Oxford Hip Score (OHS) and VAS pain. RESULTS At 2-year follow-up, the stems subsided 1.48 mm (CI 95% 1.69; 1.26) and retroverted 0.45° (CI 95% 0.01; 0.88). From 12 to 24 months, stem subsidence was 0.18 mm (CI 95% 0.1; 0.25) (p = 0.001) and retroversion was - 0.04° (CI 95% - 0.27; 0.18) (p = 0.70). T-score and stem subsidence correlated (rho = 0.48; p = 0.025) and patients with normal T-score (n = 7) had 0.42 mm (CI 95% - 0.01; 0.85) less subsidence as compared to patients with low T-score (n = 15) (p = 0.054). Stems in varus position (n = 9) subsided 1.7 mm (CI 95% 1.35; 2.05) compared to 1.33 mm (CI 95% 1.05; 1.60) for stems in neutral position (n = 13) (p = 0.07). Postoperative cementation quality did not influence 2-year stem migration. OHS improved to 40.7 (CI 95% 36.8; 44.7) and VAS pain at rest and activity decreased to 5 mm and 10 mm, respectively (p < 0.001). CONCLUSION The 2-year migration pattern of the cemented ESS was similar to reports for the cemented standard length Exeter stem. Low preoperative T-score and varus stem-position showed a tendency for higher stem migration and should be studied as risk factors for failure in larger studies of cemented polished stems.
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Affiliation(s)
- Tobias Dahl Vind
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark.
- Aarhus University, Aarhus, Denmark.
| | - Peter Bo Jørgensen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark
| | - Dovydas Vainorius
- Hospital Unit West, University Clinic for Hand, Hip and Knee Surgery, Lægårdvej 12, 7500, Holstebro, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark
| | - Kjeld Søballe
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark
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Mancino F, Tornberg H, Jones CW, Bucher TA, Malahias MA. The exeter cemented stem provides outstanding long-term fixation and bone load at 15 years follow-up: A systematic review and meta-analysis. J Orthop Surg (Hong Kong) 2023; 31:10225536231153232. [PMID: 36655735 DOI: 10.1177/10225536231153232] [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: 01/20/2023] Open
Abstract
PURPOSE Since its introduction in 1988, the double-tapered polished Exeter cemented stem has been widely adopted in primary total hip arthroplasty (THA). Despite the results coming from the arthroplasty registries have proven great survivorship, the aim of this study was to dig deeper and describe the modes of failure of the Exeter stem at 15 years follow-up while reporting the clinical and radiographic outcomes. METHODS A search of PubMed, MEDLINE, and Embase was performed using the Preferred Reporting Items for Systematic Review and Meta-Analyses since inception of database to January 2022. A meta-analysis was performed on stem's failure rates and clinical outcomes using random effects models. Publication bias was assessed with funnel plots. RESULTS Overall, ten studies met the inclusion criteria with 2167 hips at mean 14.8 ± 4.1 years follow-up. The meta-effect estimate for revision rate for stem-related reasons was 3.8% (CI 95% 2.1-5.6, p < 0.01). The meta-effect for revision rate for stem aseptic loosening (AL) was 0.22% (CI 95% 0-0.4, p = 0.048) and for periprosthetic fracture was 0.6% (CI95% 0.3-0.9, p < 0.001). The meta effect estimate for Oxford Hip Score (OHS) at final follow-up was 32.4 (moderate; CI 95% 23.2-41.6, p <0.001) with and heterogeneity among the studies of I2 0%. Radiolucent lines were reported in 5.5% of cases, with 1.0% of cases (21 hips) reported to be progressive. CONCLUSION Current evidence suggests that the Exeter cemented stem not only has proven long-term outstanding reliability with a revision rate of 3.8%, but also incredibly low revision rates for AL (0.22%) and periprosthetic fracture (0.6%). It is suitable for a variety of indications, and the consistent radiological appearances indicate durable fixation and load transmission while being associated with a remarkably low stem-related complication rate.
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Affiliation(s)
- Fabio Mancino
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), 418838Fiona Stanley Hospital, Perth, WA, Australia
| | - Haley Tornberg
- 363994Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Christopher W Jones
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), 418838Fiona Stanley Hospital, Perth, WA, Australia.,Curtin University, Perth, WA, Australia
| | - Thomas A Bucher
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), 418838Fiona Stanley Hospital, Perth, WA, Australia
| | - Michael-Alexander Malahias
- 3rd Orthopaedic Department, Therapis General Hospital, Athens, Greece.,Stavros Niarchos Foundation Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Sevaldsen K, Schnell Husby O, Lian ØB, Farran KM, Schnell Husby V. Is the French Paradox cementing philosophy superior to the standard cementing? A randomized controlled radiostereometric trial and comparative analysis. Bone Joint J 2022; 104-B:19-26. [PMID: 34969272 PMCID: PMC8779947 DOI: 10.1302/0301-620x.104b1.bjj-2021-0325.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Aims Highly polished stems with force-closed design have shown satisfactory clinical results despite being related to relatively high early migration. It has been suggested that the minimal thickness of cement mantles surrounding the femoral stem should be 2 mm to 4 mm to avoid aseptic loosening. The line-to-line cementing technique of the femoral stem, designed to achieve stem press-fit, challenges this opinion. We compared the migration of a highly polished stem with force-closed design by standard and line-to-line cementing to investigate whether differences in early migration of the stems occur in a clinical study. Methods In this single-blind, randomized controlled, clinical radiostereometric analysis (RSA) study, the migration pattern of the cemented Corail hip stem was compared between line-to-line and standard cementing in 48 arthroplasties. The primary outcome measure was femoral stem migration in terms of rotation and translation around and along with the X-, Y-, and Z- axes measured using model-based RSA at three, 12, and 24 months. A linear mixed-effects model was used for statistical analysis. Results Results from mixed model analyses revealed a lower mean retroversion for line-to-line (0.72° (95% confidence interval (CI) 0.38° to 1.07°; p < 0.001), but no significant differences in subsidence between the techniques (-0.15 mm (95% CI -0.53 to 0.227; p = 0.429) at 24 months. Radiolucent lines measuring < 2 mm wide were found in three and five arthroplasties cemented by the standard and line-to-line method, respectively. Conclusion The cemented Corail stem with a force-closed design seems to settle earlier and better with the line-to-line cementing method, although for subsidence the difference was not significant. However, the lower rate of migration into retroversion may reduce the wear and cement deformation, contributing to good long-term fixation and implant survival. Cite this article: Bone Joint J 2022;104-B(1):19–26.
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Affiliation(s)
- Kirsti Sevaldsen
- Department of Orthopaedic Surgery, Kristiansund Hospital, Kristiansund, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Otto Schnell Husby
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Orthopaedics, Rheumatology and Dermatology, Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway
| | - Øystein Bjerkestrand Lian
- Department of Orthopaedic Surgery, Kristiansund Hospital, Kristiansund, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Vigdis Schnell Husby
- Clinic of Orthopaedics, Rheumatology and Dermatology, Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway.,Department of Health Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Ålesund, Norway
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Mjöberg B. Hip prosthetic loosening: A very personal review. World J Orthop 2021; 12:629-639. [PMID: 34631447 PMCID: PMC8472441 DOI: 10.5312/wjo.v12.i9.629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/03/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Hip prosthetic loosening is often difficult to detect at an early stage, and there has been uncertainty for a long time as to when the loosening occurs and thus to the basic causes. By comparing different diagnostic methods, we found that loosening is best defined as prosthetic migration and measured by radiostereometric analysis. Convincing evidence indicates that poor interlock, poor bone quality, and resorption of a necrotic bone bed may initiate loosening during or shortly after surgery; this forms the basis of the theory of early loosening. Biomechanical factors do affect the subsequent progression of loosening, which may increase subclinically during a long period of time. Eventually, the loosening may be detected on standard radiographs and may be interpreted as late loosening but should to be interpreted as late detection of loosening. The theory of early loosening explains the rapid early migration, the development of periprosthetic osteolysis and granulomas, the causality between wear and loosening, and largely the epidemiology of clinical failure of hip prostheses. Aspects discussed are definition of loosening, the pattern of early migration, the choice of migration threshold, the current understanding of loosening, a less exothermic bone cement, cemented taper-slip stems, a new exciting computed tomography-based technique for simpler implant migration studies, and research suggestions.
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Affiliation(s)
- Bengt Mjöberg
- Department of Orthopedics, Lund University, Lund SE-221 00, Sweden
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8
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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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9
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Richardson CG, Laende EK, Gross M, Dunbar MJ. Prospective clinical study using radiostereometric analysis (RSA) to evaluate fixation of a modular cemented polished femoral stem. Hip Int 2021; 31:191-195. [PMID: 31615281 DOI: 10.1177/1120700019881429] [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
BACKGROUND The long-term clinical success of cemented polished tapered femoral components has been demonstrated in prospective as well as registry studies. This stem design type has also been well studied with radiostereometric analysis (RSA) and provides a standard to evaluate alternative designs of polished tapered cemented femoral components. This prospective study evaluates the subsidence of a polished cemented stem with a modular neck design utilising RSA. METHODS 26 patients were prospectively enrolled in the study and 23 were available for RSA analysis at 2 years. RESULTS The average subsidence of the femoral implant was 1.1 mm (SD 0.4 mm) at 2 years post operation. There were no revisions in this group, specifically no failures of the modular stem-neck design as has been seen with other implants. CONCLUSIONS The RSA subsidence pattern at 2 years of this cemented femoral stem is similar to other successful designs with long-term follow-up. The implications over time of stem neck modularity for cemented polished tapered femoral components requires further evaluation.
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Affiliation(s)
- C Glen Richardson
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Elise K Laende
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Gross
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Michael J Dunbar
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
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10
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Korsnes L, Gottvall A, Buttazzoni C, Mints M. Undersizing the Exeter stem in hip hemiarthroplasty increases the risk of periprosthetic fracture. Hip Int 2020; 30:469-473. [PMID: 31177842 DOI: 10.1177/1120700019855313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Whether under- or oversizing of the femoral component of cemented hip hemiarthroplasties impacts the risk of periprosthetic fractures (PPF) has only been examined experimentally. This study was carried out to add more knowledge about the risks of PPF in cemented polished tapered hemiarthroplasties. METHODS 20 patients with PPF following hip hemiarthroplasty with cemented Exeter V40 stems were compared to 50 controls who never suffered PPF having received the same type of Exeter hemiprosthesis for the same indication. The difference between stem size and post-hoc radiographic ideal templated size was investigated as a predictor of PPF. RESULTS Cases had a median size difference to post-hoc templating of -2, while controls had a median size difference of -1 (p = 0.09). An ROC curve constructed to find an optimal cutoff point in size difference between cases and controls arrived at an area under curve of 63%, with -1.5 as the cutoff. Patients with size differences exceeding -1.5 had a statistically significant increased PPF risk (odds ratio = 3.8, 95% confidence interval, 1.1-13.3, p < 0.05). This group covered 55% of all cases. CONCLUSION An implanted femoral component that is 2 or more sizes smaller than the template that is shown to be appropriate will increase the risk of PPF in Exeter hip hemiarthroplasties.
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Affiliation(s)
- Lars Korsnes
- Department of Orthopaedics, Östersund Hospital, Östersund, Sweden
| | - Andreas Gottvall
- Department of Orthopaedics, Östersund Hospital, Östersund, Sweden
| | | | - Michael Mints
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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11
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Miyamoto S, Iida S, Suzuki C, Kawarai Y, Nakatani T, Nakamura J, Orita S, Ohtori S. Postoperative migration of the anatomical and functional anteversion angle following total hip arthroplasty with a well-fixed cemented femoral component with line-to-line implantation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1067-1074. [PMID: 32314066 DOI: 10.1007/s00590-020-02671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/07/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little is known about the association between well-fixed polished tapered cemented stems (PTCS) implanted by the line-to-line technique and changes of stem migration, or the change of functional anteversion of the femur after total hip arthroplasty (THA). MATERIALS AND METHODS This retrospective study included 422 two-stage bilateral primary THAs performed using PTCS implanted by the line-to-line technique. CT scans were made on both the target side (first postoperative CT) and on the contralateral side (second postoperative CT) 1 week postoperatively. The mean follow-up was 7.8 months. CT data for each scan were transferred to 3D template software (Zed hip, Lexi, Japan). The postoperative changes of anatomical stem anteversion (ASA), functional femoral anteversion (FFA), and stem subsidence were evaluated. RESULTS A total of 20 THAs with CT scans were available on 3D template software. The ASA and the FFA had migrated - 0.68° ± 0.62° and - 5.5° ± 9.7°, respectively, over the follow-up period. A significant positive correlation was observed between the change of subsidence and ASA (r2 = 0.34, p = 0.007), between the FFA on the second postoperative CT and ASA on the first postoperative CT (r2 = 0.26, p = 0.02) and between the FFA on the second postoperative CT and FFA on the first postoperative CT (r2 = 0.52, p = 0.0003). CONCLUSION This study indicates that the change in axial rotation of a PTCS implanted by the line-to-line technique was less than that reported by other studies and the preoperative external rotation contracture was substantially improved after THA.
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Affiliation(s)
- Shuichi Miyamoto
- Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan.
| | - Satoshi Iida
- Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Chiho Suzuki
- Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Yuya Kawarai
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Takushi Nakatani
- Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Junichi Nakamura
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Sumihisa Orita
- Center for Advanced Joint Function and Reconstructive Spine Surgery Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba, 260-8670, Japan
| | - Seiji Ohtori
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
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12
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Abstract
Prosthetic loosening has been debated for decades, both in terms of the timing and nature of the triggering events. Multiple radiostereometric studies of hip prostheses have now shown that early migration poses a risk of future clinical failure, but is this enough to explain late clinical loosening?To answer this question, the progression of loosening from initiation to radiographic detection is described; and the need for explanations other than early prosthetic loosening is analysed, such as stress-shielding, particle disease, and metal sensitivity.Much evidence indicates that prosthetic loosening has already been initiated during or shortly after the surgery, and that the subsequent progression of loosening is affected by biomechanical factors, fluid pressure fluctuations and inflammatory responses to necrotic cells and cell fragments, i.e. the concept of late loosening appears to be a misinterpretation of late-detected loosening.Clinical implications: atraumatic surgery and initial prosthetic stability are crucial in ensuring low risk of prosthetic loosening. Cite this article: EFORT Open Rev 2020;5:113-117. DOI: 10.1302/2058-5241.5.190014.
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Affiliation(s)
- Bengt Mjöberg
- Department of Orthopaedics, Lund University, Lund, Sweden
- Bengt Mjöberg, Västra Vallgatan 29, SE-27135 Ystad, Sweden.
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13
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Prospective, comparative study of cemented, smooth-surfaced titanium stems and polish-surfaced, stainless steel stems at a minimum follow-up of 10 years. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:501-512. [PMID: 31741055 DOI: 10.1007/s00590-019-02597-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Excellent results have been reported with cemented total hip arthroplasty (THA) using both smooth-surfaced and polished-surfaced stems. However, the superiority of polished-surfaced over smooth-surfaced in cemented THA, or vice versa, is still debated. MATERIALS AND METHODS Forty-six smooth-surfaced, triple-tapered, titanium-alloy stem (Group C) and 46 Exeter stems (Group T) have been fixed consecutively at different periods at our institute and prospectively evaluated clinically and radiologically. The area and location demonstrating cortical hypertrophy (CH) was measured in the serial radiograph and compared. RESULTS The mean postoperative follow-up period was 12.4 years for group C and 10.8 years for group T. No significant difference of clinical results was found between both groups. CH was observed in 8 hips (18.6%) of group C and in 7 hips (17.1%) of group T (NS). Among the hips in which distribution of CH was observed at the medial side, a significantly low proportion belonged to group C (adjusted standardized residual = - 2.3) and a significantly high proportion belonged to group T (adjusted standardized residual = 2.3). The largest area of CH found in each group was 166.1 mm2 in group C and 227.6 mm2 in group T (NS). The peak location of CH was 100.4% in group C and 84.3% in group T (p = 0.02). CONCLUSION Medium-term results of both stems were excellent. CH was observed medially and proximally in group T and laterally and distally in group C.
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14
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Koo K, Liddle AD, Pastides PS, Rosenfeld PF. The Salto total ankle arthroplasty - Clinical and radiological outcomes at five years. Foot Ankle Surg 2019; 25:523-528. [PMID: 30321952 DOI: 10.1016/j.fas.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Modern designs of total ankle arthroplasty (TAA) have the potential to treat symptomatic ankle OA without adversely affecting ankle biomechanics. We present the mid-term results of a modern, mobile-bearing TAA design. METHODS TAA was performed in 50 consecutive patients (55 ankles) in an independent, prospective, single-centre series. Implant survival, patient-reported outcome measures (PROMs) and radiographic outcomes are presented at a mean of five years (range 2-10.5years). RESULTS A total of three patients (four ankles) died and two (two ankles) were lost to follow-up. Three TAAs were revised for aseptic loosening (in two cases) or infection. Two further patients underwent reoperations, one for arthroscopic debridement of anterolateral synovitis and one for grafting of an asymptomatic tibial cyst. With all-cause revision as an endpoint, implant survival was 93.3% at five to ten years (95% CI 80.5%-97.8%). If reoperations are included this falls to 90.2% (95% CI 75.6%-96.3%) at five years. No other patient demonstrated radiographic evidence of loosening or subsidence. PROMs and satisfaction were excellent at latest follow-up. CONCLUSION At five years, the outcomes for this design of TAA in this series were excellent, and were similar to those of previously published series from the designer centre.
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Affiliation(s)
- K Koo
- Singapore General Hospital, Outram Road, 169608, Singapore; Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, United Kingdom; Fortius Clinic, 17 Fitzhardinge Street, London W1H 6EQ, United Kingdom.
| | - A D Liddle
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, United Kingdom.
| | - P S Pastides
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, United Kingdom.
| | - P F Rosenfeld
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, United Kingdom; Fortius Clinic, 17 Fitzhardinge Street, London W1H 6EQ, United Kingdom.
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15
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Clement ND, Bardgett M, Merrie K, Furtado S, Bowman R, Langton DJ, Deehan DJ, Holland J. Cemented Exeter total hip arthroplasty with a 32 mm head on highly crosslinked polyethylene: Does age influence functional outcome, satisfaction, activity, stem migration, and periprosthetic bone mineral density? Bone Joint Res 2019; 8:275-287. [PMID: 31346456 PMCID: PMC6609865 DOI: 10.1302/2046-3758.86.bjr-2018-0300.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objectives Our primary aim was to describe migration of the Exeter stem with a 32 mm head on highly crosslinked polyethylene and whether this is influenced by age. Our secondary aims were to assess functional outcome, satisfaction, activity, and bone mineral density (BMD) according to age. Patients and Methods A prospective cohort study was conducted. Patients were recruited into three age groups: less than 65 years (n = 65), 65 to 74 years (n = 68), and 75 years and older (n = 67). There were 200 patients enrolled in the study, of whom 115 were female and 85 were male, with a mean age of 69.9 years (sd 9.5, 42 to 92). They were assessed preoperatively, and at three, 12 and, 24 months postoperatively. Stem migration was assessed using Einzel-Bild-Röntgen-Analyse (EBRA). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), EuroQol-5 domains questionnaire (EQ-5D), short form-36 questionnaire (SF-36,) and patient satisfaction were used to assess outcome. The Lower Extremity Activity Scale (LEAS), Timed Up and Go (TUG) test, and activPAL monitor (energy expelled, time lying/standing/walking and step count) were used to assess activity. The BMD was assessed in Gruen and Charnley zones. Results Mean varus/valgus tilt was -0.77⁰ and axial subsidence was -1.20 mm. No significant difference was observed between age groups (p ⩾ 0.07). There was no difference according to age group for postoperative WOMAC (p ⩾ 0.11), HHS (p ⩾ 0.06), HOOS (p ⩾ 0.46), EQ-5D (p ⩾ 0.38), patient satisfaction (p ⩾ 0.05), or activPAL (p ⩾ 0.06). Patients 75 years and older had a worse SF-36 physical function (p = 0.01) and physical role (p = 0.03), LEAS score (p < 0.001), a shorter TUG (p = 0.01), and a lower BMD in Charnley zone 1 (p = 0.02). Conclusion Exeter stem migration is within normal limits and is not influenced by age group. Functional outcome, patient satisfaction, activity level, and periprosthetic BMD are similar across all age groups. Cite this article: N. D. Clement, M. Bardgett, K. Merrie, S. Furtado, R. Bowman, D. J. Langton, D. J. Deehan, J. Holland. Cemented Exeter total hip arthroplasty with a 32 mm head on highly crosslinked polyethylene: Does age influence functional outcome, satisfaction, activity, stem migration, and periprosthetic bone mineral density? Bone Joint Res 2019;8:275–287. DOI: 10.1302/2046-3758.86.BJR-2018-0300.R1.
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Affiliation(s)
- N D Clement
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne, UK
| | - M Bardgett
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne, UK
| | - K Merrie
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne, UK
| | - S Furtado
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne, UK
| | - R Bowman
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne, UK
| | - D J Langton
- Northern Retrieval Registry, The Biosphere, Newcastle Helix, Newcastle upon Tyne, UK
| | - D J Deehan
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne, UK
| | - J Holland
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne, UK
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16
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Smitham PJ, Carbone TA, Bolam SM, Kim YS, Callary SA, Costi K, Howie DW, Munro JT, Solomon LB. Vancouver B2 Peri-Prosthetic Fractures in Cemented Femoral Implants can be Treated With Open Reduction and Internal Fixation Alone Without Revision. J Arthroplasty 2019; 34:1430-1434. [PMID: 30956048 DOI: 10.1016/j.arth.2019.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study is to assess the outcomes of 52 consecutive Vancouver B2 peri-prosthetic fractures around cemented polished double-tapered stems treated by open reduction and internal fixation in 2 trauma centers in 2 countries. METHODS Outcomes included modified Harris Hip Score (mHHS), Harris Pain Score, and return to pre-injury mobility. Fracture healing was assessed; implant subsidence measured and complications including re-operations reported. RESULTS No patient was lost to follow-up. Median patient age at operation was 82 years (range 43-98); Harris pain scores showed minimal pain (median 42, range 10-44) at latest follow-up. Median total subsidence at 1 year was 1.1 mm (range 0-5.4), the majority of which occurred within the cement mantle. No subsequent femoral stem revision was required (median 2.9 years, 0-10); however, there were 3 re-operations: 1 re-operation for pre-existing recurrent dislocation involving head liner exchange and 2 for repeat fixation due to metal fatigue. Two additional fractures occurred below the new plating, requiring further plating whilst still retaining the original stems. CONCLUSION Anatomical reduction and open reduction and internal fixation of Vancouver B2 peri-prosthetic fractures should be considered as an appropriate treatment solution for frail elderly patients with a peri-prosthetic fracture around cemented polished double-tapered stems.
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Affiliation(s)
- Peter J Smitham
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tania A Carbone
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Scott M Bolam
- Department of Orthopedic Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Young S Kim
- Department of Orthopedic Surgery, Dongguk University Hospital, Gyeongju, Gyeongsangbuk-do, Republic of Korea
| | - Stuart A Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kerry Costi
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Donald W Howie
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jacob T Munro
- Department of Orthopedic Surgery, Dongguk University Hospital, Gyeongju, Gyeongsangbuk-do, Republic of Korea
| | - Lucian B Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
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17
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Jørgensen PB, Lamm M, Søballe K, Stilling M. Equivalent hip stem fixation by Hi-Fatigue G and Palacos R + G bone cement: a randomized radiostereometric controlled trial of 52 patients with 2 years' follow-up. Acta Orthop 2019; 90:237-242. [PMID: 30931663 PMCID: PMC6534245 DOI: 10.1080/17453674.2019.1595390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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 - Long-term fixation of cemented femoral stems relies on several factors including cement adhesion and fatigue. Hi-Fatigue is a newer third-generation bone cement with low-viscosity properties at room temperature, good mechanical strength, and stable bone-cement interface in a laboratory testing environment. Palacos bone cement has excellent 10-year survival and is considered gold standard. We compared stem subsidence after fixation with Hi-Fatigue and Palacos bone cements using radiostereometry. Patients and methods - In a patient-blinded randomized controlled trial, 52 patients (30 women) at mean age 76 years (71-87) with osteoarthrosis and no osteoporosis received Hi-Fatigue G or Palacos R + G cement fixation of collarless, polished, double-tapered stems (CPT). Tantalum beads were inserted in the periprosthetic bone. Supine stereoradiographs were obtained postoperatively, 3 months, 6 months, 1 year, and 2 years after surgery. Oxford Hip Score (OHS) and VAS pain were recorded preoperatively and 1 and 2 years after surgery. Cement working times and properties were registered. Results - At 2 years, mean stem subsidence of 1.12 mm (95% CI 0.96-1.29) for Hi-Fatigue and 1.19 mm (CI 1.03-1.34) for Palacos was similar. Likewise, stem version was comparable between cement groups. Mean OHS and VAS pain were similar between cement groups. Cement working times were similar between cement groups, but the mean curing time was longer for Hi-Fatigue (13.7 min) than for Palacos (11.6 min). Interpretation - We found similar and generally low migration of CPT femoral stems inserted with Hi-Fatigue and Palacos bone cement until 2 years' follow-up, which indicates a good long-term survival of polished taper femoral stems inserted with both cement types.
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Affiliation(s)
- Peter B Jørgensen
- Department of Orthopedic Surgery, Aarhus University Hospital;; ,Department of Clinical Medicine, Aarhus University, Denmark,Correspondence:
| | - Martin Lamm
- Department of Orthopedic Surgery, Aarhus University Hospital;;
| | - Kjeld Søballe
- Department of Orthopedic Surgery, Aarhus University Hospital;; ,Department of Clinical Medicine, Aarhus University, Denmark
| | - Maiken Stilling
- Department of Orthopedic Surgery, Aarhus University Hospital;; ,Department of Clinical Medicine, Aarhus University, Denmark
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18
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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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19
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Chatziagorou G, Lindahl H, Kärrholm J. The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems. Acta Orthop 2019; 90:135-142. [PMID: 30739553 PMCID: PMC6461110 DOI: 10.1080/17453674.2019.1574387] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - In total hip replacements, stem design may affect the occurrence of periprosthetic femoral fracture. We studied risk factors for fractures around and distal to the 2 most used cemented femoral stems in Sweden. Patients and methods - This is a register study including all standard primary Lubinus SPII and Exeter Polished stems operated in Sweden between 2001 and 2009. The outcome was any kind of reoperation due to fracture around (Vancouver type B) or distal to the stem (Vancouver type C), with use of age, sex, diagnosis at primary THR, and year of index operation as covariates in a Cox regression analysis. A separate analysis of the primary osteoarthritis patient group was done in order to evaluate eventual influence of the surgical approach (lateral versus posterior) on the risk for Vancouver type B fractures. Results - The Exeter stem had a 10-times (95% CI 7-13) higher risk for type B fractures, compared with the Lubinus, while no statistically significant difference was noticed for type C fractures. The elderly, and patients with hip fracture or idiopathic femoral head necrosis, had a higher risk for both fracture types. Inflammatory arthritis was a risk factor only for type C fractures. Type B fractures were more common in men, and type C in women. A lateral approach was associated with decreased risk for Type B fracture. Interpretation - Stem design influenced the risk for type B, but not for type C fracture. The influence of surgical approach on the risk for periprosthetic femoral fracture should be studied further.
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Affiliation(s)
- Georgios Chatziagorou
- The Swedish Hip Arthroplasty Register, Gothenburg; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; ,Correspondence:
| | - Hans Lindahl
- The Swedish Hip Arthroplasty Register, Gothenburg; ,Department of Orthopaedics, Lidköping Hospital, Sweden
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Gothenburg; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg;
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20
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Teeter MG, McCalden RW, Yuan X, MacDonald SJ, Naudie DD. Predictive accuracy of RSA migration thresholds for cemented total hip arthroplasty stem designs. Hip Int 2018; 28:363-368. [PMID: 29781291 DOI: 10.1177/1120700018762179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Radiostereometric analysis (RSA) migration thresholds for cemented total hip stems have been established beyond which an unacceptably high risk of revision is likely to occur. These thresholds are subsidence >0.23 mm or >1.2 mm after 2 years. The purpose of this study was to retrospectively examine after long-term follow-up the predictive accuracy of the two thresholds. METHODS Data from two previous prospective RSA trials with 2 year follow-up for which minimum 10 year survivorship data was available were used. Thirty-six patients received a Spectron stem, 17 patients received an Exeter stem, and 17 patients received a CPCS stem. Subsidence after 2 years was compared to the migration thresholds, and long-term survivorship and clinical outcome scores were obtained. RESULTS At 2 years, the Spectron stem subsided 0.046 ± 0.160 mm, the Exeter stem subsided 1.218 ± 0.320 mm, and the CPCS stem subsided 0.681 ± 0.246 mm ( p < 0.0001). The Spectron stem passed both thresholds, the Exeter stem failed both thresholds, and the CPCS stem passed 1 and failed 1 threshold. At 10 years, survivorship exceeded 90% for all stems. CONCLUSION All stems demonstrated strong 10 year survivorship and equivalent clinical outcome scores, but this success would not have been equally predicted across RSA migration thresholds. Although RSA is a useful predictive tool, care should be taken in applying migration thresholds only to those stem designs they are indicated for, with the threshold of 1.2 mm of subsidence at 2 years being most broadly applicable.
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Affiliation(s)
- Matthew G Teeter
- 1 Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada.,4 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Richard W McCalden
- 1 Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
| | - Xunhua Yuan
- 4 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Steven J MacDonald
- 1 Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
| | - Douglas D Naudie
- 1 Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada.,2 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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21
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Excellent mid-term results of a new polished tapered modular cemented stem: a study of 113 hip replacements with minimum 5-year follow-up. Hip Int 2017; 27:455-459. [PMID: 28222212 PMCID: PMC6380089 DOI: 10.5301/hipint.5000486] [Citation(s) in RCA: 5] [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] [Accepted: 11/11/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND This prospective cohort study reports the medium-term clinical and radiographic results of 113 hips treated with a hybrid total hip replacement (THR) with a new cemented tapered cobalt-chrome (Co-Cr) stem with a titanium (Ti) modular neck (ProfemurXm®). METHOD Between October 2008 and December 2010 we performed 115 consecutive hybrid THR with the ProfemurXm® in 105 patients. RESULTS Survivorship of the implant (stem and modular neck) at a mean of 6.5 years (min 5-max 8) was 100% with the endpoint revision for any reason. No implant was at risk for revision or showed signs of loosening. The mean Harris Hip Score was 89/100, mean Oxford Hip Score was 43/48, mean WOMAC was 91/100. No patient had thigh pain, no patient reported squeaking. There were no dislocations in this cohort. No implant showed development of radiolucent lines (RLL), either at the stem-cement or cement-bone interface. No hip showed osteolysis or calcar resorption. The mean femoral subsidence of the stem within the cement mantel was 0.31 mm (range 0-0.6 mm) after 6.5 years. With the use of this modular stem, 93% of hips showed no measurable leg length difference after THR, and leg length could be restored within a 5-mm limit in 99% of hips. CONCLUSIONS The mid-term results of this new polished stem were excellent, without adverse effects from the use of modularity.
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Schmitz MWJL, Bronsema E, de Kam DCJ, Gardeniers JWM, Veth RPH, Schreurs BW. Results of the cemented Exeter femoral component in patients under the age of 40 : an update at ten to 20 years' follow-up. Bone Joint J 2017; 99-B:192-198. [PMID: 28148660 DOI: 10.1302/0301-620x.99b2.38045] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 10/03/2016] [Indexed: 11/05/2022]
Abstract
AIMS We carried out a further study of the long-term results of the cemented Exeter femoral component in patients under the age of 40 with a mean follow-up of 13.6 years (10 to 20). PATIENTS AND METHODS We reviewed our original cohort of 104 cemented Exeter stems in 78 consecutive patients with a mean age of 31 years (16 to 39). Only one patient was lost to radiological follow-up. RESULTS A total of six patients (eight hips) had died for reasons unrelated to their surgery. There had been one further periprosthetic fracture from a fall and one fractured femoral stem. No revisions for aseptic loosening were undertaken during the whole study period. Overall, 11 hips had progressive radiolucent lines in one or more zones. The Kaplan Meier survival percentages at ten and 17 years were 97.1% (95% confidence interval (CI) 91.3 to 99.1) and 92.1% (95% CI 74.1 to 97.8) with revision for any reason as the endpoint, and 100% at both ten and 17 years with aseptic loosening (95% CI 83.8 to 100) as the endpoint. No additional hips were classified as radiologically loose. CONCLUSION The Exeter femoral component continues to function satisfactorily in young patients for up to 17 years after surgery. Cite this article: Bone Joint J 2017;99-B:192-8.
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Affiliation(s)
- M W J L Schmitz
- Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - E Bronsema
- Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - D C J de Kam
- Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - J W M Gardeniers
- Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - R P H Veth
- Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - B W Schreurs
- Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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23
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Siepen W, Zwicky L, Stoffel KK, Ilchmann T, Clauss M. Prospective two-year subsidence analysis of 100 cemented polished straight stems - a short-term clinical and radiological observation. BMC Musculoskelet Disord 2016; 17:395. [PMID: 27640188 PMCID: PMC5027091 DOI: 10.1186/s12891-016-1247-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 09/09/2016] [Indexed: 01/14/2023] Open
Abstract
Background Cemented stems show good long-term results and the survival of new implants can be predicted by their early subsidence. With EBRA-FCA (Femoral Component Analysis using Einzel-Bild-Röntgen-Analyse) early subsidence as an early indicator for later aseptic loosening can be analysed. For the cemented TwinSys stem mid- and long-term data is only avalible from the New Zeeland Arthroplasty register, thus close monitoring of this implant system is still mandatory. Methods We conducted a 2 year follow up of 100 consecutive hybrid THA (Total hip arthroplasty) of a series of 285 primary THA operated between Jan 2009 und Oct 2010. These 100 received a polished, cemented collarless straight stem (twinSys®, Mathys AG® Bettlach, Switzerland) with an uncemented monobloc pressfit cup (RM pressfit®, Mathys AG® Bettlach, Switzerland). The other patients were treated with the uncemented version of this stem and the same cup. Clinical (Harris Hip Score) and radiological (ap and axial x-rays, cementing quality according to Barrack, alignment) outcomes besides an EBRA-FCA subsidence analysis were performed. Results Median age at operation was 78 (68 to 93) years. 5 patients died in the course of follow-up unrelated to surgery. The KM (Kaplan-Meier) survival at 2 years for the endpoint reoperation for any reason was 94.9 (95 % confidence interval 90.6–100 %). Survival for the endpoint aseptic loosening at 2 years was 100 %. The HHS (Harris Hip Score) improved from 56 (14–86) preoperatively to 95 (60–100) 2 years after the operation. Cementing results were judged 47 % Grade A, 45 % Grade B and 7 % Grade C. Osteolysis was found in 2 stems without clinical symptoms or correlation to subsidence or cementing quality. The EBRA-FCA analysis showed an average subsidence of -0.30 mm (95 % CI -0.5 mm to -0.1 mm). 11 patients showed a subsidence of more than 1 mm. In this group one patient showed a subsidence of 1.5 mm and one of 3.1 mm without further radiological changes. Conclusions The twinSys stem showed excellent clinical and radiologic short term results at 2 years follow-up and seems to be a reliable implant.
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Affiliation(s)
- Wolf Siepen
- Department for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, CH-4410, Liestal, Switzerland.
| | - Lukas Zwicky
- Department for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, CH-4410, Liestal, Switzerland
| | - Karl Kilian Stoffel
- Department for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, CH-4410, Liestal, Switzerland
| | - Thomas Ilchmann
- LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Martin Clauss
- Department for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, CH-4410, Liestal, Switzerland
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Streit MR, Haeussler D, Bruckner T, Proctor T, Innmann MM, Merle C, Gotterbarm T, Weiss S. Early Migration Predicts Aseptic Loosening of Cementless Femoral Stems: A Long-term Study. Clin Orthop Relat Res 2016; 474:1697-706. [PMID: 27130649 PMCID: PMC4887381 DOI: 10.1007/s11999-016-4857-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 04/19/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Excessive early migration of cemented stems and cups after THA has been associated with poor long-term survival and allows predictable evaluation of implant performance. However, there are few data regarding the relationship between early migration and aseptic loosening of cementless femoral components, and whether early migration might predict late failure has not been evaluated, to our knowledge. Einzel-Bild-Röntgen-Analyse-femoral component analysis (EBRA-FCA) is a validated technique to accurately measure axial femoral stem migration without the need for tantalum markers, can be performed retrospectively, and may be a suitable tool to identify poor performing implants before their widespread use. QUESTIONS/PURPOSES We asked: (1) Is axial migration within the first 24 months as assessed by EBRA-FCA greater among cementless stems that develop aseptic loosening than those that remain well fixed through the second decade; (2) what is the diagnostic performance of implant migration at 24 months postoperatively to predict later aseptic loosening of these components; and (3) how does long-term stem survivorship compare between groups with high and low early migration? METHODS We evaluated early axial stem migration in 158 cementless THAs using EBRA-FCA. The EBRA-FCA measurements were performed during the first week postoperatively (baseline measurement) and at regular followups of 3, 6, and 12 months postoperatively and annually thereafter. The mean duration of followup was 21 years (range, 18-24 years). The stems studied represented 45% (158 of 354) of the cementless THAs performed during that time, and cementless THAs represented 34% (354 of 1038) of the THA practice during that period. No patient enrolled in this study was lost to followup. Multivariate survivorship analysis using Cox's regression model was performed with an endpoint of aseptic loosening of the femoral component. Loosening was defined according to the criteria described by Engh et al. and assessed by two independent observers. Patients with a diagnosis of prosthetic joint infection were excluded. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance of axial stem migration 1, 2, 3, and 4 years postoperatively as a predictor of aseptic loosening. Survivorship of hips with high (≥ 2.7 mm) and low (< 2.7 mm) migration was compared using a competing-events analysis. RESULTS Femoral components that had aseptic loosening develop showed greater mean distal migration at 24 months postoperatively than did components that remained well fixed throughout the surveillance period (4.2 mm ± 3.1 mm vs 0.8 mm ± 0.9 mm; mean difference, 3.4 mm, 95% CI, 2.5-4.4; p ≤ 0.001). Distal migration at 24 months postoperatively was a strong risk factor for aseptic loosening (hazard ratio, 1.98; 95% CI, 1.51-2.57; p < 0.001). The associated overall diagnostic performance of 2-year distal migration for predicting aseptic loosening was good (area under the ROC curve, 0.86; 95% CI, 0.72-1.00; p < 0.001). Sensitivity of early migration measurement was high for the prediction of aseptic loosening during the first decade after surgery but decreased markedly thereafter. Stems with large amounts of early migration (≥ 2.7 mm) had lower 18-year survivorship than did stems with little early migration (29% [95% CI, 0%-62%] versus 95% [95% CI, 90%-100%] p < 0.001). CONCLUSIONS Early migration, as measured by EBRA-FCA at 2 years postoperatively, has good diagnostic capabilities for detection of uncemented femoral components at risk for aseptic loosening during the first and early second decades after surgery. However, there was no relationship between early migration patterns and aseptic loosening during the late second and third decades. EBRA-FCA can be used as a research tool to evaluate new cementless stems or in clinical practice to evaluate migration patterns in patients with painful femoral components. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Marcus R. Streit
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Daniel Haeussler
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Tanja Proctor
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Moritz M. Innmann
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Christian Merle
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Tobias Gotterbarm
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Stefan Weiss
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany ,Department of Joint Replacement Surgery, ARCUS Kliniken Pforzheim, Pforzheim, Germany
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Ka-Bon K, Jason FCH, Bobby NKW. The Polished MS-30 Stem with a Solid Centralizer: A Minimum 10-year Review of Radiological and Clinical Outcomes. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2015. [DOI: 10.1016/j.jotr.2014.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background/Purpose MS-30 is a triple tapered cemented femoral stem. Before 2005, it was used together with a solid centralizer. We wanted to investigate its effect on the migration behaviour and survivorship of polished stem with a minimum of 10 years. Methods Twenty-seven hips in 26 patients were available for follow-up. The mean length of follow-up was 12.1 years. Clinical outcomes were documented with the Harris Hip Score. Radiographs were examined for evidence of aseptic loosening. Results The average Harris Hip Score was 74.8. No stem was revised for aseptic loosening. Two stems (7.4%) developed radiolucent lines of more than 2 mm width with osteolysis. The mean subsidence was 0.77 mm. The survival rate at the 10th postoperative year, with aseptic loosening as the end point, was 100%. Conclusion The polished MS-30 stem with a solid centralizer has a satisfactory long-term outcome. Its mean subsidence was less than that of other polished tapered stems reported in the literature.
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Affiliation(s)
- Kwok Ka-Bon
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Fan Chi-Ho Jason
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Ng Kin-Wan Bobby
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Rajakulendran K, Strambi F, Ruggeri R, Field RE. A Cannulated Tri-Tapered Femoral Stem for Total Hip Arthroplasty: Clinical and Radiological Results at Ten Years. J Arthroplasty 2015; 30:1772-6. [PMID: 25956523 DOI: 10.1016/j.arth.2015.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 02/23/2015] [Accepted: 04/18/2015] [Indexed: 02/01/2023] Open
Abstract
We report the ten-year clinical and radiological outcomes of a novel cannulated, tri-tapered femoral stem, used in primary total hip arthroplasty (110 stems in 98 patients). At ten years, two Tri-taper stems had been revised for infection and dislocation. The mean Oxford Hip Score improved from 13.46 pre-operatively, to 37.04. Radiological analysis revealed radiolucent lines in 57 cases, but none exceeded 2 mm thickness. Stem subsidence was identified in 63 cases, with mean distal tip migration of 3.8 mm. Survivorship with revision for aseptic loosening as the end point was 100% at 10 years. Stem survival with revision for any cause was 98.2% (95% CI, 92.9% to 99.5%). The ten-year results of the Tri-taper stem are comparable to other polished, tapered femoral stems.
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Affiliation(s)
- Karthig Rajakulendran
- The Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom; The Elective Orthopaedic Centre, Epsom, Surrey, United Kingdom
| | | | | | - Richard E Field
- The Elective Orthopaedic Centre, Epsom, Surrey, United Kingdom; St George's, University of London, Cranmer Terrace, London, United Kingdom
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Flatøy B, Röhrl SM, Rydinge J, Dahl J, Diep LM, Nordsletten L. Triple taper stem design shows promising fixation and bone remodelling characteristics: radiostereometric analysis in a randomised controlled trial. Bone Joint J 2015; 97-B:755-61. [PMID: 26033054 DOI: 10.1302/0301-620x.97b6.34736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cemented femoral stems with force closed fixation designs have shown good clinical results despite high early subsidence. A new triple-tapered stem in this category (C-stem AMT) was introduced in 2005. This study compares this new stem with an established stem of similar design (Exeter) in terms of migration (as measured using radiostereometric analysis), peri-prosthetic bone remodelling (measured using dual energy x-ray densitometry, DXA), Oxford Hip Score, and plain radiographs. A total of 70 patients (70 hips) with a mean age of 66 years (53 to 78) were followed for two years. Owing to missing data of miscellaneous reasons, the final analysis represents data from 51 (RSA) and 65 (DXA) patients. Both stems showed a typical pattern of migration: Subsidence and retroversion that primarily occurred during the first three months. C-stem AMT subsided less during the first three months (p = 0.01), before stabilising at a subsidence rate similar to the Exeter stem from years one to two. The rate of migration into retroversion was slightly higher for C-stem AMT during the second year (p = 0.03). Whilst there were slight differences in movement patterns between the stems, the C-stem AMT exhibits good early clinical outcomes and displays a pattern of migration and bone remodelling that predicts good clinical performance.
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Affiliation(s)
- B Flatøy
- Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - S M Röhrl
- Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - J Rydinge
- Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - J Dahl
- Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - L M Diep
- Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - L Nordsletten
- Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
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von Schewelov T, Carlsson A, Sanzén L, Besjakov J. Continuous distal migration and internal rotation of the C-stem prosthesis without any adverse clinical effects: an RSA study of 33 primary total hip arthroplasties followed for up to ten years. Bone Joint J 2014; 96-B:604-8. [PMID: 24788493 DOI: 10.1302/0301-620x.96b5.33580] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2005, we demonstrated that the polished triple-tapered C-stem at two years had migrated distally and rotated internally. From that series, 33 patients have now been followed radiologically, clinically and by radiostereometric analysis (RSA) for up to ten years. The distal migration within the cement mantle had continued and reached a mean of 2 mm (0.5 to 4.0) at ten years. Internal rotation, also within the cement mantle, was a mean 3.8° (external 1.6° to internal 6.6°) The cement mantle did not show any sign of migration or loosening in relation to the femoral bone. There were no clinical or radiological signs indicating that the migration or rotation within the cement mantle had had any adverse effects for the patients.
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Affiliation(s)
- T von Schewelov
- Skane University Hospital, Department of Orthopaedics, S-205 02 Malmö, Sweden
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29
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deVos MJ, Verdonschot N, Luites JWH, Anderson PG, Eygendaal D. Stable fixation of the IBP humeral component implanted without cement in total elbow replacement: a radiostereometric analysis study of 16 elbows at two-year follow-up. Bone Joint J 2014; 96-B:229-36. [PMID: 24493189 DOI: 10.1302/0301-620x.96b2.29050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We determined the short-term clinical outcome and migration within the bone of the humeral cementless component of the Instrumented Bone Preserving (IBP) total elbow replacement in a series of 16 patients. There were four men and 12 women with a mean age at operation of 63 years (40 to 81). Migration was calculated using radiostereometric analysis. There were no intra-operative complications and no revisions. At two-year follow-up, all patients showed a significant reduction in pain and functional improvement of the elbow (both p < 0.001). Although ten components (63%) showed movement or micromovement during the first six weeks, 14 (88%) were stable at one year post-operatively. Translation was primarily found in the proximal direction (median 0.3 mm (interquartile range (IQR) -0.09 to 0.8); the major rotational movement was an anterior tilt (median 0.7° (IQR 0.4° to 1.6°)). One malaligned component continued to migrate during the second year, and one component could not be followed beyond three months because migration had caused the markers to break off the prosthesis. This study shows promising early results for the cementless humeral component of the IBP total elbow replacement. All patients had a good clinical outcome, and most components stabilised within six months of the operation.
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Affiliation(s)
- M J deVos
- Ter Gooi Hospital, Department of Orthopaedics, P. O. Box 10016, 1201DA, Hilversum, the Netherlands
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30
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Haddad FS. The breadth of orthopaedics. Bone Joint J 2014; 96-B:145-6. [DOI: 10.1302/0301-620x.96b2.33788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- F. S. Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET, UK
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Abstract
There is a North Atlantic divide, with cementless femoral stems being used more frequently in the USA and cemented stems being used more frequently in many countries in Europe. This is primarily because different cemented stems have been used on different sides of the Atlantic and the results of the cemented stems in the US have often been poor, whereas the results of the stems used in Europe have been good. In the National registers in Europe, cemented stems have tended to achieve better results than cementless. Cite this article: Bone Joint J 2013;95-B, Supple A:51–2.
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Affiliation(s)
- D. W. Murray
- Nuffield Orthopaedic Centre, Botnar
Research Centre, Headington, Oxford
OX3 7LD, UK
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