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Høl PJ, Hallan G, Furnes O, Fenstad AM, Indrekvam K, Kadar T. Similarly low blood metal ion levels at 10-years follow-up of total hip arthroplasties with Oxinium, CoCrMo, and stainless steel femoral heads. Data from a randomized clinical trial. J Biomed Mater Res B Appl Biomater 2023; 111:821-828. [PMID: 36356214 PMCID: PMC10099800 DOI: 10.1002/jbm.b.35193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/21/2022] [Accepted: 10/29/2022] [Indexed: 11/12/2022]
Abstract
The use of inert head materials such as ceramic heads has been proposed as a method of reducing wear and corrosion products from the articulating surfaces in total hip arthroplasty, as well as from the stem-head taper connection. The aim of the present study was to compare the blood metal ion levels in patients with Oxinium and CoCrMo modular femoral heads, as well as monoblock stainless steel Charnley prostheses at 10 years postoperatively. The 150 patients with osteoarthritis of the hip joint included in a randomized clinical trial were grouped according to femoral head material. One group (n = 30) had received the Charnley monoblock stainless steel stem (DePuy, UK). The other patients (n = 120) received a Spectron EF CoCrMo stem with either a 28 mm CoCrMo or Oxinium modular head (Smith & Nephew, USA). After 10 years, 38 patients had withdrawn, 19 deceased, 7 revised due to aseptic loosening and 5 revised due to infection. The 81 patients with median age of 79 years (70-91) were available for whole blood metal ion analysis. The levels of Co, Cr, Ni and Zr in the blood were generally low with all the head materials (medians <0.3 micrograms/L) and no statistical difference between the groups were found (p = .2-.8). Based on the low blood metal ion values in our study groups, no indication of severe trunnion corrosion in patients with CoCrMo heads was observed, neither was there any beneficial reduction in metal ion exposure with the Oxinium femoral heads.
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Affiliation(s)
- Paul Johan Høl
- Biomatlab, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Geir Hallan
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,The Coastal Hospital at Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kari Indrekvam
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Coastal Hospital at Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Thomas Kadar
- Physical Medicine and Rehabilitation, Clinic of Habilitation and Rehabilitation, Haukeland University Hospital, Bergen, Norway
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ITAYEM R, ROLFSON O, MOHADDES M, KÄRRHOLM J. Influence of implant variations on survival of the Lubinus SP II stem: evaluation of 76,530 hips in the Swedish Arthroplasty Register, 2000-2018. Acta Orthop 2022; 93:37-42. [PMID: 34633905 PMCID: PMC8815278 DOI: 10.1080/17453674.2021.1984669] [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] [Received: 03/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Almost all prosthetic implant brands include several variations. Most studies on implant performance investigate an implant system without sub-analysis of implant attributes. We studied the influence of design variations during the last 2 decades on implant survival of the most frequently used cemented femoral stem, the Lubinus SPII, reported to the Swedish Arthroplasty Register (SHAR). Patients and methods - Between 2000 and 2018, 100,032 cemented Lubinus SP II stems had been reported to SHAR. Patients with primary osteoarthritis operated on with stem length 150 mm together with a cemented cup from the same manufacturer (n = 76,530) were included in this analysis. Primary study outcome was non-infectious stem revision. Cox regression with adjustment for age, sex, surgical approach, and year of surgery was used. Hazard rates (HR) are presented with 95% confidence intervals (CI). Results - Average follow-up was 7.6 years (SD 4.2). At 18 years the overall stem survival was 99.1 (CI 98.9-99.3). Increased revision rate was observed for stems with extra offset, when a long or an extra-long head length had been used. Smaller stem sizes, in particular the smallest stem size (01), substantially increased the rate of mechanical failure as reflected by an almost 10 times increased rate of revision compared with the standard size (2). Interpretation - In this study with larger sample size and longer follow-up than previously presented from the same register, we observed more pronounced effects of previously documented design variations. Based on our results, surgeons using the Lubinus SPII stems are advised to consider an alternative solution if a Lubinus stem size 01, Lubinus extra offset, or an extra-long head seems to be the most suitable choice at the preoperative planning.
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Affiliation(s)
- Raed ITAYEM
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg Gothenburg,The Swedish Arthroplasty Register, Gothenburg,Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Ola ROLFSON
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg Gothenburg,The Swedish Arthroplasty Register, Gothenburg,Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Maziar MOHADDES
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg Gothenburg,The Swedish Arthroplasty Register, Gothenburg,Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Johan KÄRRHOLM
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg Gothenburg,The Swedish Arthroplasty Register, Gothenburg,Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Batailler C, Shatrov J, Schmidt A, Servien E, Puch JM, Lustig S. Similar stress repartition for a standard uncemented collared femoral stem versus a shortened collared femoral stem. SICOT J 2021; 7:58. [PMID: 34797213 PMCID: PMC8603923 DOI: 10.1051/sicotj/2021061] [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: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction: The design of uncemented femoral stems for use in total hip arthroplasty has evolved. Several uncemented short stems have been developed with different bone fixations, shapes, or stem lengths. The literature analyzing the biomechanical performance of short to standard stem lengths is limited. The aim was to compare the stress repartition on a standard uncemented stem and a shortened uncemented femoral stem with the same design features. Material and methods: This finite element analysis assessed the stress repartition on two femoral components with the same design (uncemented, collared, proximal trapezoidal cross-section, and a tapered quadrangular distal stem) but with two different lengths. The shortened stem was shorter by 40 mm compared to the standard stem. The stress repartition was analysed according to the Von Mises criterion. Results: The stress repartition was similar for the standard and shorter stem without significant difference (p = 0.94). The mean Von Mises stress was 58.1 MPa [0.2; 154.1] for the standard stem and 57.2 MPa [0.03; 160.2] for the short stem. The distal part of the standard stem, which was removed in the short stem, had mean stress of 3.7 MPa [0.2; 7.0]. Conclusion: The finite element analysis found similar stress repartitions between a standard uncemented collared stem and a short, collared stem with the same design. A clinical study assessing the clinical outcomes and the bone remodelling with a collared short stem would be interesting to confirm these first promising results.
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Affiliation(s)
- Cécile Batailler
- Department of Orthopaedic surgery and Sports Medicine, Croix-Rousse Hospital, Lyon University Hospital, 103 grande rue de la Croix Rousse, 69004, Lyon, France - Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Jobe Shatrov
- Department of Orthopaedic surgery and Sports Medicine, Croix-Rousse Hospital, Lyon University Hospital, 103 grande rue de la Croix Rousse, 69004, Lyon, France - Sydney Orthopaedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, NSW 2067, Sydney, Australia
| | - Axel Schmidt
- Department of Orthopaedic surgery and Sports Medicine, Croix-Rousse Hospital, Lyon University Hospital, 103 grande rue de la Croix Rousse, 69004, Lyon, France
| | - Elvire Servien
- Department of Orthopaedic surgery and Sports Medicine, Croix-Rousse Hospital, Lyon University Hospital, 103 grande rue de la Croix Rousse, 69004, Lyon, France - LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 69003 Lyon, France
| | - Jean Marc Puch
- Department of Orthopaedic Surgery, Clinique Saint-Georges, 2 Av. de Rimiez, 06105 Nice, France
| | - Sébastien Lustig
- Department of Orthopaedic surgery and Sports Medicine, Croix-Rousse Hospital, Lyon University Hospital, 103 grande rue de la Croix Rousse, 69004, Lyon, France - Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
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Flatøy B, Dahl J, Röhrl SM, Nordsletten L. Does radiopaque cement conceal periprosthetic bone loss around femoral stems? Hip Int 2020; 30:731-738. [PMID: 31359800 DOI: 10.1177/1120700019863352] [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 Periprosthetic bone remodelling may increase fracture risk and deplete bone stock around hip implants. These changes are in part caused by implant design, advocating an early evaluation of bone remodelling properties of new implants. This can be done by repeated dual-energy x-ray absorptiometry (DXA) measurements. We know that radiopaque cement falsely elevates bone mineral density (BMD) in single measurements, however, its impact on repeated measurements, i.e. BMD changes is unexplored. We have therefore investigated whether the presence of radiopaque cement affect repeated BMD measurements. METHODS 33 patients eligible for total hip replacement were randomly assigned to either radiopaque or radiolucent cement. BMD changes up to 12 months were measured by DXA, in addition to Harris Hip Score, plain radiographs and radiostereometric analysis (RSA). RESULTS Periprosthetic BMD declined during the first 3-6 months in all zones in both groups. The greatest reduction (14%) was seen in the proximal Gruen zones (1 and 7). We found a significant difference in Gruen zones 1 and 2, where the measured bone loss was higher in the radiolucent cement group. CONCLUSIONS The presence of radiopaque agents in bone cement may influence DXA measurements of bone remodelling.ClinicalTrials.gov identifier NCT00473421.
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Affiliation(s)
- Bernhard Flatøy
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Jon Dahl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Lars Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
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5
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Kristensen TB, Dybvik E, Furnes O, Engesæter LB, Gjertsen JE. More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures. Bone Joint J 2018; 100-B:1565-1571. [DOI: 10.1302/0301-620x.100b12.bjj-2018-0262.r1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this large registry-based study was to compare mid-term survival rates of cemented femoral stems of different designs used in hemiarthroplasty for a fracture of the femoral neck. Patients and Methods From the Norwegian Hip Fracture Register (NHFR), 20 532 primary cemented bipolar hemiarthroplasties, which were undertaken in patients aged > 70 years with a femoral neck fracture between 2005 and 2016, were included. Polished tapered stems (n = 12 065) (Exeter and CPT), straight stems (n = 5545) (Charnley, Charnley Modular, and Spectron EF), and anatomical stems (n = 2922) (Lubinus SP2) were included. The survival of the implant with any reoperation as the endpoint was calculated using the Kaplan–Meier method and hazard ratios (HRs), and the different indications for reoperation were calculated using Cox regression analysis. Results The one-year survival was 96.0% (95% confidence interval (CI) 95.6 to 96.4) for the Exeter stem, 97.0% (95% CI 96.4 to 97.6) for the Lubinus SP2 stem, 97.6% (95% CI 97.0 to 98.2) for the Charnley stem, 98.1% (95% CI 97.3 to 98.9) for the Spectron EF stem, and 96.4% (95% CI 95.6 to 97.2) for the Charnley Modular stem, respectively. The hazard ratio for reoperation after one year was lower for Lubinus SP2 (HR 0.77, 95% CI 0.60 to 0.97), Charnley (HR 0.64, 95% CI 0.48 to 0.86), and Spectron EF stems (HR 0.44, 95% CI 0.29 to 0.67) compared with the Exeter stem. Reoperation for periprosthetic fracture occurred almost exclusively after the use of polished tapered stems. Conclusion We were able to confirm that implant survival after cemented hemiarthroplasty for a hip fracture is high. Differences in rates of reoperation seem to favour anatomical and straight stems compared with polished tapered stems, which had a higher risk of periprosthetic fracture.
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Affiliation(s)
- T. B. Kristensen
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - E. Dybvik
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - O. Furnes
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - L. B. Engesæter
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - J-E. Gjertsen
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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6
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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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7
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Bonin N, Gedouin JE, Pibarot V, Bejui-Hughues J, Bothorel H, Saffarini M, Batailler C. Proximal femoral anatomy and collared stems in hip arthroplasty: is a single collar size sufficient? J Exp Orthop 2017; 4:32. [PMID: 28975538 PMCID: PMC5626675 DOI: 10.1186/s40634-017-0107-3] [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] [Received: 07/26/2017] [Accepted: 09/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background Even if the benefits of collars are unclear, they remain widely used, in several femoral stem designs. This study aimed to determine whether collar size should be proportional to hip dimensions and morphology. The hypothesis was that the collar should be larger for greater stem sizes and for varus femoral necks. Methods Computed Tomography scans of 204 healthy hips were digitally analysed and manually templated to determine principle dimensions, appropriate stem size and model, as well as cortical distance at the femoral calcar (ideal collar size). Results Univariable analysis revealed that cortical distance was moderately correlated with mediolateral offset (r = 0.572; p < 0.0001) and stem model (r = 0.520; p < 0.0001). Cortical distance was weakly correlated with head diameter (r = 0.399; p < 0.0001), stem size (r = 0.200; p = 0.017), and patient gender (r = 0.361; p < 0.0001). Multivariable analysis confirmed that stem model (p < 0.0001) and head diameter (p = 0.0162) are directly correlated to cortical distance. Conclusion We found that cortical distance along the femoral calcar is directly correlated with the model of the stem implanted (‘standard’ or ‘varus’) and with the head diameter. This cortical distance indicates optimal collar size, which would grant maximum calcar coverage without prosthetic overhang. Collar size should be proportional to the size of the operated hip, and should be larger for ‘varus’ stem models than for ‘standard’ stem models.
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Affiliation(s)
- Nicolas Bonin
- Lyon Ortho Clinic, 29B Avenue des sources, Lyon, France
| | | | - Vincent Pibarot
- Service de chirurgie orthopédique et traumatologique, Hôpital Edouard Herriot, Lyon, France
| | | | - Hugo Bothorel
- ReSurg SA, Chemin de la Vuarpillière 35, 1260, Nyon, Switzerland
| | - Mo Saffarini
- ReSurg SA, Chemin de la Vuarpillière 35, 1260, Nyon, Switzerland.
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Junnila M, Laaksonen I, Eskelinen A, Pulkkinen P, Ivar Havelin L, Furnes O, Marie Fenstad A, Pedersen AB, Overgaard S, Kärrholm J, Garellick G, Malchau H, Mäkelä KT. Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty Register Association database. Acta Orthop 2016; 87:546-553. [PMID: 27550058 PMCID: PMC5119435 DOI: 10.1080/17453674.2016.1222804] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - According to previous Nordic Arthroplasty Register Association (NARA) data, the 10-year implant survival of cemented total hip arthroplasties (THAs) is 94% in patients aged 65-74 and 96% in patients aged 75 or more. Here we report a brand-level comparison of cemented THA based on the NARA database, which has not been done previously. Patients and methods - We determined the rate of implant survival of the 9 most common cemented THAs in the NARA database. We used Kaplan-Meier analysis with 95% CI to study implant survival at 10 and 15 years, and Cox multiple regression to assess survival and hazard ratios (HRs), with revision for any reason as endpoint and with adjustment for age, sex, diagnosis, and femoral head material. Results - Spectron EF THA (89.9% (CI: 89.3-90.5)) and Elite THA (89.8% (CI: 89.0-90.6)) had the lowest 10-year survivorship. Lubinus (95.7% survival, CI: 95.5-95.9), MS 30 (96.6%, CI: 95.8-97.4), and C-stem THA (95.8%, CI: 94.8-96.8) had a 10-year survivorship of at least 95%. Lubinus (revision risk (RR) = 0.77, CI: 0.73-0.81), Müller (RR =0.83, CI: 0.70-0.99), MS-30 (RR =0.73, CI: 0.63-0.86), C-stem (RR =0.70, CI: 0.55-0.90), and Exeter Duration THA (RR =0.84, CI: 0.77-0.90) had a lower risk of revision than Charnley THA, the reference implant. Interpretation - The Spectron EF THA and the Elite THA had a lower implant survival than the Charnley, Exeter, and Lubinus THAs. Implant survival of the Müller, MS 30, CPT, and C-stem THAs was above the acceptable limit for 10-year survival.
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Affiliation(s)
- Mika Junnila
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku;,Correspondence:
| | - Inari Laaksonen
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere;,The Finnish Arthroplasty Register
| | - Pekka Pulkkinen
- Department of Public Health, Helsinki University, Helsinki, Finland
| | - Leif Ivar Havelin
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Alma B Pedersen
- Competence Centre for Clinical Epidemiology and Biostatistics, North, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus;,The Danish Hip Arthroplasty Register, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, and Institute of Clinical Research, University of Southern Denmark, Odense;,The Danish Hip Arthroplasty Register, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Garellick
- The Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Malchau
- The Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden;,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA;,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Keijo T Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku;,The Finnish Arthroplasty Register
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9
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Johanson PE, Antonsson M, Shareghi B, Kärrholm J. Early Subsidence Predicts Failure of a Cemented Femoral Stem With Minor Design Changes. Clin Orthop Relat Res 2016; 474:2221-9. [PMID: 27188836 PMCID: PMC5014811 DOI: 10.1007/s11999-016-4884-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Radiostereometry (RSA) measurements of early micromotion can predict later failure in hip and knee prostheses. In hip implants, RSA has been particularly helpful in the evaluation of composite-beam stem designs. The Spectron EF Primary stem (Smith & Nephew, London, UK) has shown inferior performance compared with its predecessors in both clinical studies and registry reports. Early RSA studies have shown somewhat greater subsidence for the Spectron EF Primary stem compared with the earlier Spectron EF, but still within boundaries considered to be safe. QUESTIONS/PURPOSES Our primary research question was whether stem subsidence and rotation for this stem design measured with RSA at 2 years can predict later stem failure. A secondary question was whether high femoral stem offset and small stem sizes, both features specific to the Spectron EF Primary stem compared with its predecessors, are associated with stem failure rate. METHODS Two hundred forty-seven hips (209 patients with median age 63 years [range, 29-80 years], 65% female, and 77% primary osteoarthritis) with a valid RSA examination at 2 years were selected from four different RSA studies (totaling 279 hips in 236 patients) in our department. The studies were primarily aimed at evaluating cup fixation, bone cement, and polyethylene types. All study patients received a cemented Spectron EF Primary stem. The selected hips had complete followup until stem failure, death, or the end of the followup period. Stem failure was defined as revision of a loose femoral stem or radiological failure with significant osteolysis in Gruen zones 2 to 6. Cox regression analyses were performed to evaluate if stem subsidence and rotation after 2 years, adjusted for age, sex, stem size, standard/high stem offset, and conventional/highly crosslinked polyethylene, could predict later clinical aseptic failure of the stem. We identified 32 stem failures (27 revisions, five radiological failures) at 14 years median followup (range, 3-18 years). Ten-year stem survival was 94% (95% confidence interval [CI], 90%-96%). RESULTS Stem subsidence at 2 years (adjusted hazard ratio [HR], 6.0; 95% CI, 2.5-15; p < 0.001) and retrotorsion of the stem (adjusted HR, 1.7; 95% CI, 1.1-2.5; p = 0.018) were associated with later stem failure. Further risk factors were male sex (subsidence analysis HR, 6.9; p > 0.001), use of the two smallest stem sizes (HRsize 1, 8.0; p > 0.001, HRsize 2, 1 [reference], HRsize 3+, 0.06; p = 0.035), and the high offset option (HR, 3.1; p = 0.005). CONCLUSIONS Stem subsidence and retrotorsion at 2 years can predict later failure in the Spectron EF Primary stem, consistent with earlier findings on composite-beam cemented stems. Small stem size and high-offset stems comprise the main group of underperforming stems. We recommend that premarket small-scale RSA studies be performed after any design change to a THA femoral component, because even seemingly minor design changes may unexpectedly result in inferior performance. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Per-Erik Johanson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Sahlgrenska University Hospital/Sahlgrenska, 413 45, Gothenburg, Sweden.
| | - Martin Antonsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bita Shareghi
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Clarke A, Pulikottil-Jacob R, Grove A, Freeman K, Mistry H, Tsertsvadze A, Connock M, Court R, Kandala NB, Costa M, Suri G, Metcalfe D, Crowther M, Morrow S, Johnson S, Sutcliffe P. Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation. Health Technol Assess 2015; 19:1-668, vii-viii. [PMID: 25634033 DOI: 10.3310/hta19100] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Total hip replacement (THR) involves the replacement of a damaged hip joint with an artificial hip prosthesis. Resurfacing arthroplasty (RS) involves replacement of the joint surface of the femoral head with a metal surface covering. OBJECTIVES To undertake clinical effectiveness and cost-effectiveness analysis of different types of THR and RS for the treatment of pain and disability in people with end-stage arthritis of the hip, in particular to compare the clinical effectiveness and cost-effectiveness of (1) different types of primary THR and RS for people in whom both procedures are suitable and (2) different types of primary THR for people who are not suitable for hip RS. DATA SOURCES Electronic databases including MEDLINE, EMBASE, The Cochrane Library, Current Controlled Trials and UK Clinical Research Network (UKCRN) Portfolio Database were searched in December 2012, with searches limited to publications from 2008 and sample sizes of ≥ 100 participants. Reference lists and websites of manufacturers and professional organisations were also screened. REVIEW METHODS Systematic reviews of the literature were undertaken to appraise the clinical effectiveness and cost-effectiveness of different types of THR and RS for people with end-stage arthritis of the hip. Included randomised controlled trials (RCTs) and systematic reviews were data extracted and risk of bias and methodological quality were independently assessed by two reviewers using the Cochrane Collaboration risk of bias tool and the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A Markov multistate model was developed for the economic evaluation of the technologies. Sensitivity analyses stratified by sex and controlled for age were carried out to assess the robustness of the results. RESULTS A total of 2469 records were screened of which 37 were included, representing 16 RCTs and eight systematic reviews. The mean post-THR Harris Hip Score measured at different follow-up times (from 6 months to 10 years) did not differ between THR groups, including between cross-linked polyethylene and traditional polyethylene cup liners (pooled mean difference 2.29, 95% confidence interval -0.88 to 5.45). Five systematic reviews reported evidence on different types of THR (cemented vs. cementless cup fixation and implant articulation materials) but these reviews were inconclusive. Eleven cost-effectiveness studies were included; four provided relevant cost and utility data for the model. Thirty registry studies were included, with no studies reporting better implant survival for RS than for all types of THR. For all analyses, mean costs for RS were higher than those for THR and mean quality-adjusted life-years (QALYs) were lower. The incremental cost-effectiveness ratio for RS was dominated by THR, that is, THR was cheaper and more effective than RS (for a lifetime horizon in the base-case analysis, the incremental cost of RS was £11,284 and the incremental QALYs were -0.0879). For all age and sex groups RS remained clearly dominated by THR. Cost-effectiveness acceptability curves showed that, for all patients, THR was almost 100% cost-effective at any willingness-to-pay level. There were age and sex differences in the populations with different types of THR and variations in revision rates (from 1.6% to 3.5% at 9 years). For the base-case analysis, for all age and sex groups and a lifetime horizon, mean costs for category E (cemented components with a polyethylene-on-ceramic articulation) were slightly lower and mean QALYs for category E were slightly higher than those for all other THR categories in both deterministic and probabilistic analyses. Hence, category E dominated the other four categories. Sensitivity analysis using an age- and sex-adjusted log-normal model demonstrated that, over a lifetime horizon and at a willingness-to-pay threshold of £20,000 per QALY, categories A and E were equally likely (50%) to be cost-effective. LIMITATIONS A large proportion of the included studies were inconclusive because of poor reporting, missing data, inconsistent results and/or great uncertainty in the treatment effect estimates. This warrants cautious interpretation of the findings. The evidence on complications was scarce, which may be because of the absence or rarity of these events or because of under-reporting. The poor reporting meant that it was not possible to explore contextual factors that might have influenced study results and also reduced the applicability of the findings to routine clinical practice in the UK. The scope of the review was limited to evidence published in English in 2008 or later, which could be interpreted as a weakness; however, systematic reviews would provide summary evidence for studies published before 2008. CONCLUSIONS Compared with THR, revision rates for RS were higher, mean costs for RS were higher and mean QALYs gained were lower; RS was dominated by THR. Similar results were obtained in the deterministic and probabilistic analyses and for all age and sex groups THR was almost 100% cost-effective at any willingness-to-pay level. Revision rates for all types of THR were low. Category A THR (cemented components with a polyethylene-on-metal articulation) was more cost-effective for older age groups. However, across all age-sex groups combined, the mean cost for category E THR (cemented components with a polyethylene-on-ceramic articulation) was slightly lower and the mean QALYs gained were slightly higher. Category E therefore dominated the other four categories. Certain types of THR appeared to confer some benefit, including larger femoral head sizes, use of a cemented cup, use of a cross-linked polyethylene cup liner and a ceramic-on-ceramic as opposed to a metal-on-polyethylene articulation. Further RCTs with long-term follow-up are needed. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003924. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Aileen Clarke
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Amy Grove
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karoline Freeman
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hema Mistry
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Martin Connock
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Matthew Costa
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Gaurav Suri
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - David Metcalfe
- Warwick Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Michael Crowther
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Morrow
- Oxford Medical School, University of Oxford, Oxford, UK
| | - Samantha Johnson
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Sutcliffe
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
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The Outcome of 241 Charnley Total Hip Arthroplasties Performed by One Surgeon 30 to 40 Years Ago. J Arthroplasty 2015; 30:1767-71. [PMID: 25956524 DOI: 10.1016/j.arth.2015.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 02/01/2023] Open
Abstract
We present the outcome of 241 consecutive low friction arthroplasties (LFAs) performed by one surgeon (GH) 30 to 40 years ago. The overall survival rate at 30 years with revision for any reason or removal of the components as the end point was 53% (43.2-62.8%) when 40 hips remained in the study. Cox regression analysis for the possible risk factors of age, gender and diagnosis revealed higher risk of the overall failure in younger patients, and higher risk of failure due to loosening in younger patients and in those with congenital hip disease. Our follow-up study at 30 to 40 years following Charnley LFA can be used as a benchmark for comparison with the newer methods of total hip arthroplasty.
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High failure rates of the Spectron EF stem at a minimum of 10 year's follow-up. J Arthroplasty 2014; 29:1956-60. [PMID: 24927867 DOI: 10.1016/j.arth.2014.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/16/2014] [Accepted: 05/05/2014] [Indexed: 02/01/2023] Open
Abstract
We prospectively followed 112 hips, undergoing THA with a Spectron EF stem. At mean follow-up of 11.2years, 21 patients had died. We obtained radiological follow-up in 99% and clinical follow-up in 100% of the surviving 91 hips. Fifty-four percent demonstrated osteolysis in at least one Gruen zone. Twenty-two hips required revision for all causes, with a further five stems radiologically loose. With endpoint being stem revision for aseptic loosening or radiological failure, survivorship at 11years was 0.783. We believe the addition of a rougher surface finish has contributed to the high levels of osteolysis and stem failure seen with the Spectron EF.
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Madanat R, Mäkinen TJ, Aro HT, Bragdon C, Malchau H. Adherence of hip and knee arthroplasty studies to RSA standardization guidelines. A systematic review. Acta Orthop 2014; 85:447-55. [PMID: 24954489 PMCID: PMC4164860 DOI: 10.3109/17453674.2014.934187] [Citation(s) in RCA: 6] [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: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Guidelines for standardization of radiostereometry (RSA) of implants were published in 2005 to facilitate comparison of outcomes between various research groups. In this systematic review, we determined how well studies have adhered to these guidelines. METHODS We carried out a literature search to identify all articles published between January 2000 and December 2011 that used RSA in the evaluation of hip or knee prosthesis migration. 2 investigators independently evaluated each of the studies for adherence to the 13 individual guideline items. Since some of the 13 points included more than 1 criterion, studies were assessed on whether each point was fully met, partially met, or not met. RESULTS 153 studies that met our inclusion criteria were identified. 61 of these were published before the guidelines were introduced (2000-2005) and 92 after the guidelines were introduced (2006-2011). The methodological quality of RSA studies clearly improved from 2000 to 2011. None of the studies fully met all 13 guidelines. Nearly half (43) of the studies published after the guidelines demonstrated a high methodological quality and adhered at least partially to 10 of the 13 guidelines, whereas less than one-fifth (11) of the studies published before the guidelines had the same methodological quality. Commonly unaddressed guideline items were related to imaging methodology, determination of precision from double examinations, and also mean error of rigid-body fitting and condition number cutoff levels. INTERPRETATION The guidelines have improved methodological reporting in RSA studies, but adherence to these guidelines is still relatively low. There is a need to update and clarify the guidelines for clinical hip and knee arthroplasty RSA studies.
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Affiliation(s)
- Rami Madanat
- Helsinki University Central Hospital, Helsinki,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Hannu T Aro
- Turku University Hospital and University of Turku, Turku, Finland
| | - Charles Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Mesnil P, Vasseur L, Wavreille G, Fontaine C, Duquennoy A, Migaud H. Is cemented metal-polyethylene 22.2mm hip arthroplasty a gold standard? Results of a series of 105 primary arthroplasties at a minimum of ten years follow-up. Orthop Traumatol Surg Res 2014; 100:369-73. [PMID: 24768433 DOI: 10.1016/j.otsr.2014.02.004] [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] [Received: 04/08/2013] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although Charnley-Kerboull metal-on-polyethylene 22.2mm cemented total hip arthroplasty (THA) is considered to be the gold standard in France, results with this prosthesis are conflicting, in particular in relation to Scandinavian registers. The goal of this retrospective study was to confirm the validity of this prosthesis at a minimum of 10years follow-up. HYPOTHESIS Survival of this type of THA would fulfill NICE conditions (survival at 10 years of at least 90%). MATERIALS AND METHODS One hundred and five primary THA were performed in 93 patients (30 men and 63 women) mean age 72.6 years old (60-86) between January 1998 and March 2001. After a mean follow-up of 10.6 years (10-13 years), 21 patients (23 THA) were lost to follow-up and 32 (35 THA) had died leaving 40 patients (47 THA) for clinical analysis (Merle d'Aubigné and Oxford scores) and X-ray assessment. Survival was calculated with revision for any cause and radiological loosening with or without revision as end-points. RESULTS The mean Oxford score at the final follow-up was 22/60 (13-45), the PMA score was 14.2 (11-17). Eight patients underwent revision surgery after a mean 7.5 years (2-11) (1 early dislocation and 7 acetabular cup loosenings). Survival at 10 years was 89.4% (CI95%: 78-95) for all causes of revision and 78% (CI95%: 61-91) for loosening with (n=7) or without (n=3) revision. No cases of septic or femoral loosening were observed. Twelve of the 47 revised hip replacements (25.5%) presented wear≥2mm. DISCUSSION Although functional results were acceptable for this elderly population, survival did not reach the NICE value and was lower than results in the literature for this type of implant. Cup loosening and wear were the main causes of revision. LEVEL OF EVIDENCE IV retrospective.
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Affiliation(s)
- P Mesnil
- Service d'Orthopédie B, CHRU de Lille, rue Émile-Laine, 59000 Lille, France; Université Lille-Nord de France, 59000 Lille, France.
| | - L Vasseur
- Université Lille-Nord de France, 59000 Lille, France; Service d'Orthopédie D, CHRU de Lille, rue Émile-Laine, 59000 Lille, France
| | - G Wavreille
- Service d'Orthopédie B, CHRU de Lille, rue Émile-Laine, 59000 Lille, France; Université Lille-Nord de France, 59000 Lille, France; Laboratoire d'anatomie, CHRU de Lille, rue Émile-Laine, 59000 Lille, France
| | - C Fontaine
- Service d'Orthopédie B, CHRU de Lille, rue Émile-Laine, 59000 Lille, France; Université Lille-Nord de France, 59000 Lille, France; Laboratoire d'anatomie, CHRU de Lille, rue Émile-Laine, 59000 Lille, France
| | - A Duquennoy
- Service d'Orthopédie B, CHRU de Lille, rue Émile-Laine, 59000 Lille, France; Université Lille-Nord de France, 59000 Lille, France
| | - H Migaud
- Université Lille-Nord de France, 59000 Lille, France; Service d'Orthopédie C, CHRU de Lille, rue Émile-Laine, 59000 Lille, France
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Broeke RHMT, Harings SEJM, Emans PJ, Jutten LMC, Kessels AGH, Geesink RGT. Randomized comparison between the cemented Scientific Hip Prosthesis and Omnifit: 2-year DEXA and minimum 10-year clinical follow-up. J Arthroplasty 2013; 28:1354-61. [PMID: 23453292 DOI: 10.1016/j.arth.2012.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 08/26/2012] [Accepted: 09/10/2012] [Indexed: 02/01/2023] Open
Abstract
Radiostereometry (RSA) of the cemented Scientific Hip Prosthesis (SHP) reported excessive migration and predicted high failure rates. In a prospective randomized clinical trial we compared minimum 10 years results of the SHP (n=38) with the Omnifit-stem (n=37). Two-year bone remodelling, compared with dual energy x-ray absorptiometry and assessed in regions of interest A-D based on the 7 Gruen zones, showed better periprosthetic bone preservation around the SHP in all but one regions (P<.05). At 10 years Harris Hip Score was better for the SHP (P=.0001) but Oxford Hip Score was the same (P=.79). There were no revisions in either group, but radiographic loosening was definite in 1 SHP and 1 Omnifit. Based on earlier RSA studies, the rough surface finish of the SHP was expected to cause cement abrasion, osteolysis and inferior survival. However our clinical and remodelling results could not confirm these expectations, suggesting that the link of early migration and mid-term clinical results is not sufficiently clear for the SHP.
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Affiliation(s)
- René H M Ten Broeke
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
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Clauss M, Gersbach S, Butscher A, Ilchmann T. Risk factors for aseptic loosening of Müller-type straight stems: a registry-based analysis of 828 consecutive cases with a minimum follow-up of 16 years. Acta Orthop 2013; 84:353-9. [PMID: 23799347 PMCID: PMC3768033 DOI: 10.3109/17453674.2013.810517] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose Even small differences in design variables for the femoral stem may influence the outcome of a hip arthroplasty. We performed a risk factor analysis for aseptic loosening of 4 different versions of cemented Müller-type straight stems with special emphasis on design modifications (2 shapes, MSS or SL, and 2 materials, CoNiCrMo (Co) or Ti-6Al-7Nb (Ti)). Methods We investigated 828 total hip replacements, which were followed prospectively in our in-house register. All stems were operated in the same setup, using Sulfix-6 bone cement and a second-generation cementing technique. Demographic and design-specific risk factors were analyzed using an adjusted Cox regression model. Results The 4 versions showed marked differences in 15-year stem survival with aseptic loosening as the endpoint: 94% (95% CI: 89-99) for MSS Co, 83% (CI: 75-91) for SL Co, 81% (CI: 76-87) for MSS Ti and 63% (CI: 56-71) for SL Ti. Cox regression analysis showed a relative risk (RR) for aseptic loosening of 3 (CI: 2-5) for stems made of Ti and of 2 (CI: 1-2) for the SL design. The RR for aseptic stem loosening increased to 8 (CI: 4-15) when comparing the most and the least successful designs (MSS Co and SL Ti). Interpretation Cemented Müller-type straight stems should be MSS-shaped and made of a material with high flexural strength (e.g. cobalt-chrome). The surface finish should be polished (Ra < 0.4 µm). These technical aspects combined with modern cementing techniques would improve the survival of Müller-type straight stems. This may be true for all types of cemented stems.
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Affiliation(s)
- Martin Clauss
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland Liestal
| | - Silke Gersbach
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland Liestal
| | | | - Thomas Ilchmann
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland Liestal
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Lindalen E, Dahl J, Nordsletten L, Snorrason F, Høvik Ø, Röhrl S. Reverse hybrid and cemented hip replacement compared using radiostereometry and dual-energy X-ray absorptiometry: 43 hips followed for 2 years in a prospective trial. Acta Orthop 2012; 83:592-8. [PMID: 23116437 PMCID: PMC3555444 DOI: 10.3109/17453674.2012.742393] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Total hip replacement (THR) with a reverse hybrid (RH), a combination of a cemented polyethylene cup and a cementless femoral stem, has been increasingly used in Scandinavia. In a randomized trial, we compared an RH THR with a proximal hydroxyapatite- (HA-) coated stem to a conventional cemented THR. Both groups received the same polyethylene cup. PATIENTS AND METHODS 51 patients (52 hips) were included. Radiostereometry (RSA) and dual-energy X-ray absorptiometry (DEXA) were performed postoperatively and after 6, 12, and 24 months. 42 patients (43 hips) were followed for 2 years. RESULTS Mean cup rotation around the x-axis was 0.13° for the cemented group and -0.24° for the RH group (p = 0.03). Cup migration in the other axes, and stem migration and wear were similar between the 2 study groups. Bone remodeling around the cup was also similar between the groups. Bone loss in Gruen zone 1 was 18% for the cementless stems, as compared to an increase of 1.4% for the cemented ones (p < 0.001). Bone loss was similar in the other Gruen zones. Harris hip score and Oxford hip score were similar pre- and postoperatively in the 2 groups. INTERPRETATION In the present study, RH THR with a cementless hydroxyapatite-coated stem and conventional cemented THR did not show any major differences regarding stem migration and bone loss after 2 years of follow-up.
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Affiliation(s)
- Einar Lindalen
- Department of Orthopaedics, Lovisenberg Deaconal Hospital, Oslo
| | - Jon Dahl
- Department of Orthopaedics, Oslo University Hospital, Oslo
| | - Lars Nordsletten
- Department of Orthopaedics, Oslo University Hospital, Oslo,University of Oslo, Oslo, Norway
| | | | - Øystein Høvik
- Department of Orthopaedics, Lovisenberg Deaconal Hospital, Oslo
| | - Stephan Röhrl
- Department of Orthopaedics, Oslo University Hospital, Oslo
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Head material influences survival of a cemented total hip prosthesis in the Norwegian Arthroplasty Register. Clin Orthop Relat Res 2012; 470:3007-13. [PMID: 22644422 PMCID: PMC3462857 DOI: 10.1007/s11999-012-2396-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High prosthesis survival is reported for total hip prostheses with metal and alumina heads, but direct comparisons of a single prosthesis design with one of two different head materials has seldom been studied. Prostheses with zirconia heads are less commonly used than metal and alumina heads, and the few reports suggest variable results with zirconia heads. QUESTIONS/PURPOSES We therefore asked: (1) Would metal heads provide better survival of a cemented total hip arthroplasty (THA) than alumina heads? (2) Would metal heads provide better survival of a cemented THA than zirconia heads? METHODS We searched in the Norwegian Arthroplasty Register for cemented primary THA cup/stem combinations that simultaneously had been used with different head materials. The only THA that fulfilled these inclusion criteria was the cemented Reflection All-Poly/Spectron EF (cup/stem) that had during 2001 to 2006 been used both with alumina (n = 448) and cobalt-chromium (n = 5229) heads; that implant had also been used with zirconia (n = 275) and cobalt-chromium heads (n = 3195) during 1997 to 2003, and we included patients with this THA from these two time intervals in the study. All cups were conventional polyethylene. We estimated prosthesis survival and relative revision risks adjusting for age, sex, and diagnosis. The followup in the two study materials was until December 2010. RESULTS The survival at 8 years of the Spectron EF/Reflection THAs, inserted with alumina and cobalt-chromium heads during 2001 to 2006, was 92.3% and 94.0%, respectively. The Reflection/Spectron EF THA had inferior survival with zirconia heads compared with cobalt-chromium heads (relative risk, 1.7). At 12 years, the survival rate was 88.1% with cobalt-chromium heads and 74.8% with zirconia heads. CONCLUSIONS Alumina femoral heads provided no advantage over cobalt-chromium heads on midterm prosthesis survival. THAs with zirconia heads had inferior survival. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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