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Lübbeke A, Barea C, Zingg M, Lauper N, Hannouche D, Garavaglia G. Radiographic signs and hip pain 5 years after THA with a cemented stem predict future revision for aseptic loosening: a prospective cohort study. Acta Orthop 2024; 95:32-38. [PMID: 38284749 PMCID: PMC10823869 DOI: 10.2340/17453674.2023.26190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 11/02/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the long-term predictive value of radiographic abnormality and/or hip pain assessed 5 years following primary total hip arthroplasty (THA) and the occurrence of revision for aseptic loosening between 5 and 25 years postoperatively. PATIENTS AND METHODS We included all primary THAs performed between 1996 and 2011 (same uncemented cup, polyethylene-ceramic bearing, 28 mm head, cemented stem) and prospectively enrolled in the institutional registry, for whom baseline and follow-up radiographs were available. At 5 years radiographically we assessed femoral osteolysis and/or stem migration. Pain was evaluated with the Harris Hip pain subscore. Kaplan-Meier survival and Cox regression analyses were performed. RESULTS 1,317 primary THAs were included. 25 THAs (2%) were revised for aseptic stem loosening. Any abnormal radiographic sign at 5 years was present in 191 THAs (14%). Occasional hip pain was reported by 20% and slight to severe pain by 12% of patients at 5 years. In patients < 60 years, 10 of the 12 later revised for aseptic stem loosening had abnormal radiographs at 5 years vs. 5 of the 13 later revised in those ≥ 60 years. Hazard ratios (HR) were 34 (95% confidence interval [CI] 7-155) in younger vs. 4 (CI 1-11) in the older group. HR for association of hip pain at 5 years with future revision was 3 (CI 1-5). CONCLUSION The presence of abnormal radiographic signs 5 years after THA was strongly associated with later revision for aseptic stem loosening, especially in patients < 60 years. The association between pain at 5 years and future revision was much weaker.
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Affiliation(s)
- Anne Lübbeke
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Christophe Barea
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Matthieu Zingg
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Nicolas Lauper
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Didier Hannouche
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
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Hashimoto Y, Ando W, Sakai T, Takao M, Hamada H, Sugano N. The Effects of Rasp Oversize on the Clinical and Radiographic Outcomes of Total Hip Arthroplasty With a Collared Satin-Finished Composite Beam Cemented Stem. J Arthroplasty 2021; 36:2055-2061. [PMID: 33637384 DOI: 10.1016/j.arth.2021.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to compare the clinical and radiographic outcomes of using two different oversized rasps in total hip arthroplasty (THA) with a composite beam cemented stem (DCM-J). METHODS A consecutive series of 105 hips underwent hybrid THA using the DCM-J stem between 2006 and 2010. Among the patients with a minimum 10-year follow-up, a 1.5-mm oversized rasp was used in 38 hips (group S), whereas a 0.5-mm oversized rasp was used in 36 hips (group M). The Japanese Orthopedic Association hip score and radiographic findings were evaluated, including cement mantle thickness, stress shielding, and cortical hypertrophy. RESULTS The Japanese Orthopedic Association hip score was significantly improved postoperatively with 100% of the implant survival rate in both groups when septic loosening was excluded. Radiographic assessment performed immediately postoperatively revealed that the cement mantle thickness was significantly larger in group M than group S in Gruen zone 1 but did not differ between groups in zones 2-7. Stress shielding was significantly more frequent in group M than group S at 2 years (P = .011), 5 years (P = .012), and ≥10 years postoperatively (P = .038). Cortical hypertrophy appeared in a time-dependent manner; however, the prevalence did not significantly differ between groups at final follow-up at a mean of 11.7 years (range 10-14 years) postoperatively. CONCLUSIONS The DCM-J stem achieved good clinical results in both groups. Stress shielding was significantly more frequent in THA using the 0.5-mm rasp than the 1.5-mm rasp, indicating that sufficient cement mantle room should be prepared for the cemented stem.
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Affiliation(s)
- Yoshichika Hashimoto
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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Clauss M, Hunkeler C, Manzoni I, Sendi P. Debridement, Antibiotics and Implant Retention for Hip Periprosthetic Joint Infection: Analysis of Implant Survival after Cure of Infection. J Bone Jt Infect 2020; 5:35-42. [PMID: 32117688 PMCID: PMC7045527 DOI: 10.7150/jbji.40924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 01/27/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Debridement, antibiotics and implant retention (DAIR) is a valuable option for treating early and acute periprosthetic joint infection (PJI). The inflammation caused by the infection and the surgical intervention during DAIR may influence the long-term stability of the implant. In this study, we analyzed the sequelae of DAIR on implant survival in hip PJI after cure of infection. Methods: Total hip arthroplasties (THAs) from our database implanted between 1992 and 2016 were included in a retrospective double-cohort study. THAs were exposed (DAIR cohort) or not exposed to DAIR (control cohort). The control cohort comprised patients matched 3:1 to the DAIR cohort. The outcome was implant failure over time. It was evaluated for (i) revision for any reason, (ii) aseptic loosening of any component, and (iii) radiographic evidence of loosening. Results: 57 THAs (56 patients) were included in the DAIR cohort and 170 THAs (168 patients) in the control cohort. The mean follow-up periods in the DAIR and control cohorts were 6.1 and 7.8 years, respectively. During follow-up, 20 (36%) patients in the DAIR cohort and 54 (32%) in the control cohort died after a mean of 4.1 and 7.2 years, respectively. Revision for any reason was performed in 9 (16%) THAs in the DAIR cohort and in 10 (6%) THAs (p=0.03) in the control cohort, and revision for aseptic loosening of any component in 5 (9%) and 8 (5%) THAs (p=0.32), respectively. Radiological analysis included 56 THAs in the DAIR cohort and 168 THAs in the control cohort. Two (4%) stems and 2 (4%) cups in the DAIR cohort and 7 (4%) and 1 (0.6%) in the control cohort, respectively, demonstrated radiological signs of failure (p=1). Conclusions: THAs exposed to DAIR were revised for any reason more frequently than were THAs in the control cohort. The difference was mainly caused by septic failures. After cure of PJI, the difference in revisions for aseptic loosening was not significant. There was no significant difference in radiographic evidence of loosening of any component between cohorts. These data suggest that cured hip PJI previously exposed to DAIR do not fail more frequently for aseptic reasons than do THAs not exposed to DAIR.
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Affiliation(s)
- Martin Clauss
- Interdisciplinary Septic Surgical Unit, Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland.,Center for Muscular-Skeletal Infections, Department of Orthopedics and Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christof Hunkeler
- Interdisciplinary Septic Surgical Unit, Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Isabella Manzoni
- Interdisciplinary Septic Surgical Unit, Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Parham Sendi
- Center for Muscular-Skeletal Infections, Department of Orthopedics and Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland.,Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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Born P, Manzoni I, Ilchmann T, Clauss M. Is cemented revision total hip arthroplasty a reasonable treatment option in an elderly population? Orthop Rev (Pavia) 2019; 11:8263. [PMID: 31616553 PMCID: PMC6790558 DOI: 10.4081/or.2019.8263] [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: 07/31/2019] [Accepted: 08/25/2019] [Indexed: 12/03/2022] Open
Abstract
Revision THA is increasingly performed especially in the elderly population. The surgeon’s challenge is to provide a solution that supports immediate full weight-bearing, despite poor bone quality. Shape-closed revision stems facilitate that by combining cement fixation with additional press-fit anchoring. The design tolerates varying cement mantle thickness and inconsistent cancellous bone lining of the femoral canal. Following that philosophy, we present our mid-term results using a long version of a cemented Charnley- Kerboull type stem. From 2010 to 2017, 38 long Charnley-Kerboull revision stems (Centris®, Mathys European Orthopaedics, Bettlach, Switzerland) were implanted and followed prospectively. Surgery was performed via a Hardinge approach in supine position with a third generation cementing technique. Patients were mobilized using full-weight bearing as early as possible. Survival was determined for stem revision for aseptic loosening and stem and/or cup revision for any reason. 20 stems had a minimum follow-up (f/u) of 2 years and were included for further radiological analysis. Detailed subsidence analysis as an early predictor for later aseptic loosening was performed using EBRA-FCA software. Further, the presence of osteolysis and cement debonding was evaluated. Mean follow- up was 4 years. No patient was lost to f/u.18 died of causes unrelated to THA. Stem survival was 100%. Survival for any re-operation was 82.2% (two early infections, one soft-tissue debridement, one cup exchange for recurrent dislocations). None of the cases revised for septic loosening showed signs of persistent infection at final f/u. EBRA-FCA revealed two oligosymptomatic cases of subsidence of 5mm and 6mm over a course of 2 and 12 months, respectively, with stable implants thereafter. Neither required revision. There was no development of osteolysis or debonding. The stem provides a reliable early fullweight bearing solution for revision THA with excellent mid-term survival in an elderly population. Even in two cases where subsidence was present, mobility was not impaired and re-revision could be avoided.
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Affiliation(s)
- Philipp Born
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal
| | - Isabella Manzoni
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal
| | - Thomas Ilchmann
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal.,Hirslanden Klinik Birshof, Münchenstein
| | - Martin Clauss
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal.,Department of Orthopedics and Traumatology, University Hospital Basel, University of Basel, Switzerland
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Affiliation(s)
- M Clauss
- Kantonsspital Baselland, Liestal, Switzerland; Head, Hip and Septic Surgical Unit, University Hospital Basel, Basel, Switzerland
| | - S J Breusch
- Royal Infirmary of Edinburgh, Edinburgh, UK; Honorary Senior Lecturer, University of Edinburgh, Edinburgh, UK
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Salentiny Y, Zwicky L, Ochsner PE, Clauss M. Long-term survival of the cemented Müller CDH stem: a minimum follow-up of 10 years. Arch Orthop Trauma Surg 2018; 138:1471-1477. [PMID: 30046893 PMCID: PMC6132943 DOI: 10.1007/s00402-018-3009-7] [Citation(s) in RCA: 2] [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] [Received: 11/22/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Total hip arthroplasty in patients with altered anatomy of the hip and femur, such as in congenital dysplasia of the hip, is challenging and often requires specially designed stems. Müller straight stems have shown excellent long-term results; however, long-term data on the analogous cemented Müller CDH stem are still missing. The aim of this study was to analyze long-term survival, identify potential risk factors for aseptic loosening, and analyze radiological outcome of the cemented Müller CDH stems. MATERIALS AND METHODS Between 01/1985 and 06/2005, 95 Müller CDH stems (Zimmer, Winterthur, Switzerland) made up of 3 different materials were cemented using 2 different bone cements: 38 of stainless steel/high-viscosity cement, 31 of a cobalt-chrome-based alloy (CoCr)/low-viscosity cement, and 26 of a titanium-based alloy (Ti)/low-viscosity cement. All patients had a prospective clinical and radiological follow-up according to the standards of our institution. The cumulative incidence for revision of the stem was calculated using a competing risk model. To identify demographic and implant-related risk factors for aseptic loosening of the stem, a multivariate regression model for competing risks was performed. RESULTS The cumulative risk of revision at 15 years was 12.5% (95% CI 6.6-20.5%) for aseptic loosening of the stem as endpoint, with marked differences for the various stem materials used: stainless steel 2.7% (0.2-12.3%), CoCr 12.9% (4.0-27.3%), and Ti 24.5% (9.6-43.1%). Regression modeling revealed that Ti stems in combination with low-viscosity cement (HR 10.2) and implantation with an axis deviation greater than 3° (HR 3.8) are risk factors for aseptic loosening. CONCLUSIONS Long-term survival of the cemented Müller CDH stem is comparable to other Müller-type straight stems and uncemented implants. Similar to the original Ti Müller straight stem, the Ti Müller CDH stem also showed an increased risk for aseptic loosening and should, therefore, no longer be used.
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Affiliation(s)
- Yves Salentiny
- grid.440128.bClinic for Orthopedics and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Lukas Zwicky
- grid.440128.bClinic for Orthopedics and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Peter E. Ochsner
- grid.440128.bClinic for Orthopedics and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Martin Clauss
- grid.440128.bClinic for Orthopedics and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
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Pallaver A, Zwicky L, Bolliger L, Bösebeck H, Manzoni I, Schädelin S, Ochsner PE, Clauss M. Long-term results of revision total hip arthroplasty with a cemented femoral component. Arch Orthop Trauma Surg 2018; 138:1609-1616. [PMID: 30099575 PMCID: PMC6182687 DOI: 10.1007/s00402-018-3023-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In revision total hip arthroplasty (THA), the cancellous bone is normally completely removed out of the femoral canal during stem extraction. This situation is comparable to primary THA following the shape-closed concept, with some authors advocating to remove the metaphyseal cancellous bone to enhance press-fit stability ("French paradox"). The aim of this study was to investigate the long-term outcome, regarding survival and radiological results, of a cemented straight stem when used for revision THA and to compare these results to the results of the same stem in primary THA. MATERIALS AND METHODS 178 stem revisions performed between 01/1994 and 08/2008 using the Virtec straight stem were included. The cumulative incidence for re-revision was calculated using a competing risk model. Risk factors for re-revision of the stem were analyzed using an absolute risk regression model. Radiographs analyzed for osteolysis, debonding and subsidence had a minimum follow-up of 10 years. RESULTS The cumulative incidence for re-revision due to aseptic loosening of the stem was 5.5% (95% CI, 2.9-10.2%) at 10 years. Aseptic loosening was associated with younger age, larger defect size and larger stem size. After a minimum 10-year follow-up, osteolysis was seen in 39 of 80 revision THA. Compared to the results in primary THA, the survival in revision THA with the same implant was inferior. CONCLUSIONS Cemented straight stems used for revision THA showed excellent long-term results regarding survivorship and radiological outcome. This stem therefore offers a valuable and cost-effective option in revision THA.
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Affiliation(s)
- Armin Pallaver
- grid.440128.bClinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Lukas Zwicky
- grid.440128.bClinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Lilianna Bolliger
- grid.440128.bClinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Hans Bösebeck
- grid.439024.8Heraeus Medical GmbH, Wehrheim, Germany
| | - Isabella Manzoni
- grid.440128.bClinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Sabine Schädelin
- grid.410567.1Clinical Trial Unit, University Hospital of Basel, Basel, Switzerland
| | - Peter E. Ochsner
- grid.440128.bClinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Martin Clauss
- grid.440128.bClinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
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