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Klein A, Bordes M, Viste A, Fessy M. Dual-mobility tripod cup for revision hip arthroplasty: long-term (five to fourteen years) evaluation of a new generation cementless implant. Int Orthop 2024; 48:1241-1247. [PMID: 38499712 DOI: 10.1007/s00264-024-06144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/06/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE The aims of this study were to evaluate the survivorships of a new generation cementless DMC with tripod additional fixation in revision total hip arthroplasty and complications at a minimum five year follow-up. METHODS One hundred and fifteen revisions (THA) treated with tripod DMC performed between 2009 and 2015 were included in this retrospective study. Acetabular defects were classified as Paprosky 1 (n = 38, 33%), 2 (n = 75, 65%) or 3 (n = 2, 2%). Unipolar or bipolar revision was performed for the following indications: aseptic acetabular loosening (63%), infection (14%), aseptic bipolar loosening (11%), instability (4%), aseptic femoral loosening (3%), ALVAL (3%) and iliopsoas impingement (2%). Mean follow-up was 9.4 years ± two (range, 5 to 14). RESULTS At the final follow-up, a single episode of dislocation occurred within three months after the procedure (0.8%) with no revision. Three cases of aseptic loosening were diagnosed (2.6%). Four infections (3.5%) required reoperation: three required a two stage bipolar revision; one was treated by DAIR procedure. At the latest follow-up, the survivorship of the acetabular cup for aseptic loosening was 98% [95% CI (91.2-99.4)] and for any reasons was 94.4% [95% CI (90.1%-98.9%)]; the mean HHS improved from 60 points (range, 18-94 points) to 83 points (range, 37-100 points) (p < .001). CONCLUSION This study reports a low complication rate in favour of the use of a tripod DMC in revision THA with a satisfactory survivorship at a ten year follow-up.
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Affiliation(s)
- Aurélien Klein
- Hospices Civils de Lyon, Hôpital Lyon Sud, Chirurgie Orthopédique Et Traumatologique, 165 Chemin du Grand Revoyet, 69495, Pierre Benite Cedex, France
| | - Maxence Bordes
- Hospices Civils de Lyon, Hôpital Lyon Sud, Chirurgie Orthopédique Et Traumatologique, 165 Chemin du Grand Revoyet, 69495, Pierre Benite Cedex, France
| | - Anthony Viste
- Hospices Civils de Lyon, Hôpital Lyon Sud, Chirurgie Orthopédique Et Traumatologique, 165 Chemin du Grand Revoyet, 69495, Pierre Benite Cedex, France.
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR_T9406, 69622, Lyon, France.
| | - Michel Fessy
- Hospices Civils de Lyon, Hôpital Lyon Sud, Chirurgie Orthopédique Et Traumatologique, 165 Chemin du Grand Revoyet, 69495, Pierre Benite Cedex, France
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR_T9406, 69622, Lyon, France
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Noor EA, Dilogo IH, Silitonga J, Ramadhani R. Analysis on association between sagittal stem alignment and early functional and radiological outcome following primary cementless total hip replacement. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03904-y. [PMID: 38557890 DOI: 10.1007/s00590-024-03904-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Accurate reconstruction of hip anatomy and biomechanics is mandatory for achieving good clinical outcomes following total hip replacement (THR). Optimal stem alignment is essential to avoid impingement or loosening. This study aimed to evaluate sagittal stem position following cementless THR and its relationship with patient's functional outcome and post-operative radiological parameters. METHOD We performed analytical observational study with cross-sectional design on 71 hips (67 patients, ranged 18-85 years old) that underwent primary cementless THR in two orthopedic centers in Jakarta, Indonesia. All hips were operated through either anterolateral or posterior approach using either extended/full-coating wedge-tapered stem or proximal-coated wedge-tapered stem. Clinical outcomes were evaluated at follow-up time using mHHS questionnaire, VAS level of thigh pain, and hip ROM. Stem sagittal alignment and other radiological parameters, including combined anteversion and offset, were measured from conventional radiograph. RESULTS There were no significant differences on mHHS score, VAS level on thigh pain, and ROM between stem alignment groups. Post-operative anteversion and offset of the implant were not affected by the stem sagittal position. All influencing factors have significant effect on sagittal stem alignment. Linear regression test on femur morphology showed 0.69° increase in stem posterior tilt for every 1° increase in the anterior bowing (coeff. = 0.502). CONCLUSION Stem tilting in sagittal plane did not affect patient's functional outcome or post-operative radiological parameters. In addition, for every degree of increased anterior femoral bowing, 0.69° increase in posterior stem tilting can be expected.
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Affiliation(s)
- Erwin Ardian Noor
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo General Hospital - Faculty of Medicine Universitas Indonesia, Pangeran Diponegoro Street Number 71, Central Jakarta, Jakarta, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo General Hospital - Faculty of Medicine Universitas Indonesia, Pangeran Diponegoro Street Number 71, Central Jakarta, Jakarta, Indonesia
| | - Jamot Silitonga
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Rahadiansyah Ramadhani
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo General Hospital - Faculty of Medicine Universitas Indonesia, Pangeran Diponegoro Street Number 71, Central Jakarta, Jakarta, Indonesia.
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Kutzner KP, Walz A, Afghanyar Y, Drees P, Schneider M. Calcar-guided short-stem total hip arthroplasty in fractures of the femoral neck: a prospective observational study of 68 hips. Arch Orthop Trauma Surg 2024; 144:1793-1802. [PMID: 38172436 DOI: 10.1007/s00402-023-05170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION The indications for cementless short-stem total hip arthroplasty (THA) have been expanded due to encouraging results. However, no evidence in cases of femoral neck fractures (FNFs) is available. We aimed to prospectively obtain data on the safety and the clinical outcomes of a cementless calcar-guided short stem in patients with FNFs. MATERIALS AND METHODS We conducted a prospective observational study of 68 patients diagnosed with FNFs who underwent short-stem THA between 2016 and 2019 with a calcar-guided stem. Complications during follow-up leading to revision were documented, and patient reported outcome measurements recorded. Stem migration was analyzed using the Einzel-Bild-Röntgen-Analysis Femoral Component Analysis software. RESULTS The mean follow-up was 33.8 ± 14.8 months. The patient mortality at last follow-up was 10.6%. Two patients required stem revision, due to periprosthetic fracture and late aseptic loosening, respectively, corresponding to 96.2% stem survival. Survivorship for the endpoint of revision for any reason was 91.1% at 6 years. All revisions occurred in females. The mean Harris Hip Score at the last follow-up was 93.0 ± 8.9. The mean axial migration at last follow-up was 1.90 ± 1.81 mm. No significant influence on migration was found regarding gender, age, weight, and body mass index. CONCLUSIONS The clinical and radiological findings were satisfying and most patients benefited from the minimally invasive procedure. However, as for conventional THA as well, implant survivorship and mortality were markedly worse compared to results regarding osteoarthritis. Especially in elderly female patients with FNF, cementless short-stem THA is a concern and a cemented THA should be the first choice.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Alexander Walz
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Yama Afghanyar
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Michael Schneider
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
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de Leissegues T, Viste A, Fessy MH. Revision of total hip arthroplasty by long locking stem with fully hydroxyapatite-coated modular metaphysis (Reef™): A continuous series of 78 cases at a minimum 2-year follow-up. Orthop Traumatol Surg Res 2024; 110:103786. [PMID: 38070731 DOI: 10.1016/j.otsr.2023.103786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 07/15/2023] [Accepted: 07/24/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Since the Wagner and Vives stems were introduced in the 1980s, the range of uncemented implants for femoral revision has grown with increasing demand. Cementless modular implants with a wide range of lengths and diameters improved adaptation to the bone and secondary metaphyseal integration. Data are sparse for the Reef™ locking stem (Depuy-Synthes, Saint-Priest, France) and we therefore conducted a retrospective study at more than 2 years' follow-up, in a continuous series of total hip arthroplasty (THR) revision procedures using this long fully-hydroxyapatite-coated modular locking stem, assessing (1) implant survival, (2) clinical and functional results, and (3) radiographic results. HYPOTHESIS The study hypothesis was that all-cause≥2-year survival is>90%. PATIENTS AND METHODS Between 2007 and 2018, 413 femoral stem exchanges were performed in our center, a Reef™ model being needed in 93 cases. Etiologies comprised: Vancouver B2 or B3 periprosthetic fracture (57%, n=53), aseptic loosening (33%, n=30), septic loosening (10%, n=9) and 1 case of aseptic non-union under the stem (1%, n=1). Clinical and functional assessment used Harris Hip Score (HHS), Postel Merle d'Aubigné score (PMA) and Oxford-12 Hip Score (OHS). Radiographic assessment used immediate postoperative views and last follow-up radiographs, assessing osseointegration, filling index and stress shielding. Implant survival was estimated following Kaplan-Meier with 95% confidence intervals. RESULTS Mean follow-up was 6±3 years (range, 2-12). Last follow-up included 78 cases for analysis (12 deaths [13%] and 3 patients lost to follow-up before 2 years [3%]). Ten-year Reef™ implant survival was 98.7% (95% CI: 96.3-100) free of aseptic loosening (n=1) and 94% (95% CI: 87-100) for all causes (n=3). The failures related to aseptic loosening involved femoral stem fracture away from the modular part; the 2 cases of septic loosening did not undergo reimplantation for medical reasons. Preoperatively (scheduled surgeries, excluding periprosthetic fractures: n=40), mean HHS was 43±12 and 77±12 at last follow-up (81±13 in scheduled surgery [n=40] and 73±11 in emergency surgery for periprosthetic fracture [n=53]), mean PMA score was 13±2 and mean OHS was 26±9. The infection rate was 11% (n=9) including 7.6% new infection (n=6). The dislocation rate was 6% (n=5). The radiographic stress shielding rate was 11% (n=9) and significantly associated with low metaphyseal filling index (76±7% vs. 83±8% [p=0.009]). DISCUSSION Like other recent data, the present good survival results support the trend for uncemented stems in femoral revision, as encouraged by the 1999 symposium of the French Society of Orthopedic Surgery and Traumatology (SoFCOT). Primary diaphyseal fixation enables secondary metaphyseal integration on an implant with modularity ensuring good bone adaptation. Close contact between the bone and hydroxyapatite surfaces is a key-point in the surgical strategy. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Tristan de Leissegues
- Service de chirurgie orthopédique, hôpital Lyon Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - Anthony Viste
- Service de chirurgie orthopédique, hôpital Lyon Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; LBMC UMR_T9406, université de Lyon, université Gustave-Eiffel, université Claude-Bernard Lyon 1, 69622 Lyon, France.
| | - Michel-Henri Fessy
- Service de chirurgie orthopédique, hôpital Lyon Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; LBMC UMR_T9406, université de Lyon, université Gustave-Eiffel, université Claude-Bernard Lyon 1, 69622 Lyon, France
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Monarrez R, Dubin J, Bains SS, Hameed D, Moore MC, Chen Z, Mont MA, Delanois RE, Nace J. Cemented is not superior to cementless total knee arthroplasty for complications: a propensity score matched analysis. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03847-4. [PMID: 38429555 DOI: 10.1007/s00590-024-03847-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION There is continued debate regarding the survivorship and revision rate of cementless versus cemented total knee arthroplasty (TKA) prostheses. This includes the assessment of early revision surgery due to aseptic loosenings and periprosthetic joint infections (PJIs). Studies have not always taken into account the impact of comorbidities, such as diabetes, obesity, and tobacco. Therefore, we compared revisions in a large population of patients undergoing cemented or cementless TKAs at 90 days, 1 year, and 2 years. METHODS A review of an administrative claims database was used to identify patients undergoing primary TKA, either cementless (n = 8,890) or cemented (n = 215,460), from October 1, 2015 to October 31, 2020. Revision surgery for PJI and aseptic loosening were identified with diagnosis and associated procedural codes at 90 days, 1 year, and 2 years and then compared between groups. A propensity matched-analysis was performed for age, sex, Charles Comorbidity Index (CCI) > 3, alcohol abuse, tobacco use, obesity, and diabetes. Chi square tests assessed statistical significance of differences in the matched cohorts using odds ratios (ORs) with 95% confidence intervals (CIs). A P < 0.05 was defined as statistically significant. RESULTS Cementless TKA was associated with similar revisions rates due to PJIs at 90 days (OR, 1.04, 95% CI 0.79-1.38, p = 0.83), 1 year (OR, 0.93, 95% CI 0.75-1.14, p = 0.53, and 2 years (OR, 0.87, 95% CI 0.73-1.05, p = 0.17) in comparison to the cemented TKA cohort. The odds ratio of revision due to aseptic loosening was similar as well at 90 days (OR, 0.67, 95% CI 0.34-1.31, 0.31), 1 year (OR, 1.09, 95% CI 0.73-1.61, p = 0.76), and 2 years (OR, 1.00, 95% CI 0.73-1.61, p = 0.99). CONCLUSIONS This study found a comparable risk of PJI and aseptic loosening in cementless and cemented TKA when controlling for several comorbidities, such as tobacco, diabetes, and alcohol. Therefore, with proper patient selection, cementless TKAs can be performed with expectation of low risks of infections and aseptic loosenings.
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Affiliation(s)
- Ruben Monarrez
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Jeremy Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Sandeep S Bains
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Daniel Hameed
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Mallory C Moore
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Zhongming Chen
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Michael A Mont
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Ronald E Delanois
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
| | - James Nace
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
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Formica M, Zanirato A, Bori E, Revetria TA, Ditting J, Innocenti B. Biomechanical analysis of different THA cementless femoral stem designs in physiological and osteoporotic bone during static loading conditions. Arch Orthop Trauma Surg 2024; 144:917-926. [PMID: 37796284 DOI: 10.1007/s00402-023-05080-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The influence of THA stem design on periprosthetic femoral fractures (PFFs) risk is subject of debate. This study aims to compare the effects of different cementless stem designs on stress-strain distributions in both physiological and osteoporotic femur under various loading conditions. MATERIALS A biomechanical study using finite-element analysis was conducted. Four models were developed: three with implanted femurs and a native one chosen as control. Each model was analyzed for both healthy and osteoporotic bone. The following stem designs were examined: short anatomical stem with femoral neck preservation, double-wedge stem, and anatomical standard stem. Three loading conditions were assessed: gait, sideways falling, and four-point bending. RESULTS During gait in physiological bone, the anatomical stem and the short anatomical stem with femoral neck preservation showed stress distribution similar to the native model. The double-wedge stem reduced stress in the proximal area but concentrated it in the meta-diaphysis. In osteoporotic bone, the double-wedge stem design increased average stress by up to 10%. During sideways falling, the double-wedge stem exhibited higher stresses in osteoporotic bone. No significant differences in average stress were found in any of the studied models during four-point bending. CONCLUSION In physiological bone, anatomical stems demonstrated stress distribution comparable to the native model. The double-wedge stem showed uneven stress distribution, which may contribute to long-term stress shielding. In the case of osteoporotic bone, the double-wedge stem design resulted in a significant increase in average stress during both gait and sideways falling, potentially indicating a higher theoretical risk of PFF.
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Affiliation(s)
- Matteo Formica
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università Degli Studi di Genova, Viale Benedetto XV N°6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, UO Clinica Ortopedica, Largo Rosanna Benzi N° 10, 16132, Genoa, Italy
| | - Andrea Zanirato
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università Degli Studi di Genova, Viale Benedetto XV N°6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, UO Clinica Ortopedica, Largo Rosanna Benzi N° 10, 16132, Genoa, Italy
| | - Edoardo Bori
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium.
| | - Tullio Andrea Revetria
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università Degli Studi di Genova, Viale Benedetto XV N°6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, UO Clinica Ortopedica, Largo Rosanna Benzi N° 10, 16132, Genoa, Italy
| | - Juljana Ditting
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
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Wojtowicz R, Otten V, Henricson A, Crnalic S, Nilsson KG. Uncemented trabecular metal high-flex posterior-stabilized monoblock total knee arthroplasty in patients aged 60 years or younger. Knee 2024; 46:99-107. [PMID: 38070382 DOI: 10.1016/j.knee.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/10/2023] [Accepted: 11/13/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Uncemented trabecular metal (TM) monoblock tibial components in total knee arthroplasty (TKA) have shown excellent clinical results for up to 10 years. However, these studies were performed in highly specialized units, with few surgeons and often excluding knees with secondary osteoarthritis (OA), severe malalignments and previous surgery. The purpose of this study was to investigate implant survivorship and clinical and radiological outcome of the uncemented TM high-flex posterior stabilized (PS) monoblock tibial component in routine clinical practice. METHODS A retrospective study of 339 knees (282 patients) operated with the implant in routine clinical practice at two hospitals on patients aged 60 years or younger between 2007 and 2015. The operations were performed by 12 surgeons and there were no specific contraindications for use of the implant. Follow up ended in 2020. The status of the implant of deceased patients at death and those not attending follow up was checked with the Swedish Knee Arthroplasty Register. Clinical follow up consisted of clinical investigation, PROMs, and knee X-ray. RESULTS Follow up was mean (range) 8.5 (5-13.8) years, and the 8-year survival rate was 0.98 (standard error 0.007). Five patients five knees) were deceased, five knees were revised (none due to aseptic loosening), and 16 patients did not attend the clinical follow up. Forty-four percent of the knees had secondary OA and 45% had had previous operations. 93% were satisfied or very satisfied with the operation and forgotten joint score (FJS) was median (interquartile range) 81 (44-94). Radiographic analysis revealed bone in close contact with the tibial tray and pegs in most cases, and in only 2% of the knees were potential radiolucent lines found. CONCLUSION The results indicate that this uncemented implant performs excellently in routine clinical practice and also in younger patients with secondary OA or previous knee operations.
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Affiliation(s)
- Radoslaw Wojtowicz
- Department of Surgical and Perioperative Sciences - Orthopedics, Umeå University, Umeå, Sweden.
| | - Volker Otten
- Department of Surgical and Perioperative Sciences - Orthopedics, Umeå University, Umeå, Sweden
| | - Anders Henricson
- Department of Orthopedics, Falun General Hospital, Falun, Sweden
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences - Orthopedics, Umeå University, Umeå, Sweden
| | - Kjell G Nilsson
- Department of Surgical and Perioperative Sciences - Orthopedics, Umeå University, Umeå, Sweden
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Mosegaard SB, Odgaard A, Madsen F, Rømer L, Kristensen PW, Vind TD, Søballe K, Stilling M. Comparison of cementless twin-peg, cemented twin-peg and cemented single-peg femoral component migration after medial unicompartmental knee replacement: a 5-year randomized RSA study. Arch Orthop Trauma Surg 2023; 143:7169-7183. [PMID: 37568057 PMCID: PMC10635966 DOI: 10.1007/s00402-023-04991-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/10/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND The component design and fixation method of joint arthroplasty may affect component migration and survival. The aim of this study was to compare fixation of cementless twin-peg (CLTP), cemented twin-peg (CTP) and cemented single-peg (CSP) femoral components of medial unicompartmental knee replacement (UKR). METHODS Eighty patients (mean age = 63 years, 48 males) with medial knee osteoarthritis were randomized in three ways to CLTP (n = 25), CTP (n = 26) or CSP (n = 29) femoral UKR components. The patients were followed 5 years postoperatively with RSA, bone mineral density (BMD), PROMs and radiological evaluation of radiolucent lines (RLL), femoral component flexion angle and complications. RESULTS At the 5-year follow-up, femoral component total translation was comparable between the three groups (p = 0.60). Femoral component internal rotation was 0.50° (95% CI 0.3; 0.69) for the CLTP group, 0.58° (95% CI 0.38; 0.77) for the CTP group and 0.25° (95% CI 0.07; 0.43) for the CSP group (p = 0.01). BMD decreased peri-prosthetically (range - 11.5%; - 14.0%) until 6-month follow-up and increased toward the 5-year follow-up (range - 3.6%; - 5.8%). BMD change did not correlate with component migration. Lower flexion angle was correlated with higher 5-year subsidence, total translation, varus rotation and maximum total point motion (p = 0.01). Two patients (1 CLTP, 1 CTP) had RLL in the posterior zone. There were two revisions. CONCLUSION At 5-year follow-up, fixation of UKA femoral components with twin-peg was not superior to the single-peg design. Cementless and cemented twin-peg femoral components had similar fixation. A lower flexion angle was correlated with higher component migration.
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Affiliation(s)
- Sebastian Breddam Mosegaard
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Frank Madsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Per Wagner Kristensen
- Department of Orthopaedic Surgery, Vejle Hospital, Beriderbakken 4, 7100, Vejle, Denmark
| | - Tobias Dahl Vind
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
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9
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Rahman A, Martin B, Jenkins C, Mohammad H, Barker K, Dodd C, Jackson W, Price A, Mellon S, Murray DW. Less pain reported 5 years after cementless compared to cemented unicompartmental knee replacement: an analysis of pain, neuropathy, and co-morbidity scores. Knee Surg Sports Traumatol Arthrosc 2023; 31:5180-5189. [PMID: 37776359 PMCID: PMC10598111 DOI: 10.1007/s00167-023-07589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/11/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE To compare patient-reported pain scores and assess the influence of neuropathy and co-morbidity, on knee pain following cemented and cementless medial unicompartmental knee replacement (UKR) 5 years after surgery. METHOD In this longitudinal study, 262 cemented and 262 cementless Oxford UKR performed for the same indications and with the same techniques were recruited. Patients were reviewed at five years, evaluating patient-reported pain and association with clinical outcomes. Intermittent and Constant Osteoarthritis Pain (ICOAP), PainDETECT (PD), Charnley score, Oxford Knee Score (OKS) and American Knee Society Score (AKSS) were compared. RESULTS In both cohorts, intermittent pain was more common than constant pain (47% vs 21%). Cementless knees reported significantly less pain than cemented (ICOAP-Total 5/100 vs 11/100, p < 0.0001). A greater proportion of cementless knees experienced no pain at all (ICOAP = 0/100, 61% vs 43%, p < 0.0001) and 75% fewer experienced severe or extreme pain. Pain sub-scores in PD, OKS and AKSS follow this trend. Pain was unlikely to be neuropathic (PD positive: 5.26%), but patients reporting high levels of 'strongest' pain were three times more likely to be neuropathic. Patients with co-morbidities (Charnley C) experienced greater pain than those without (Charnley A+B) across all knee-specific scores, despite scores being knee specific. CONCLUSION Both cemented and cementless UKR in this study had substantially less pain than that reported in literature following TKR. Cementless UKR had significantly less pain than cemented UKR in all scores. Two-thirds of patients with a cementless UKR had no pain at all at 5 years, and pain experienced was most likely to be mild and intermittent with no patients in severe or extreme pain. Patients with cementless UKR that had higher levels of pain were more likely to have co-morbidity or evidence or neuropathic pain. It is unclear why cementless UKR have less pain than cemented; further study is necessary.
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Affiliation(s)
- Azmi Rahman
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Benjamin Martin
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cathy Jenkins
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hasan Mohammad
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christopher Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - William Jackson
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Price
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen Mellon
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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10
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Shichman I, Lawrence KW, Berzolla E, Hernandez CS, Man-El R, Warschawski Y, Snir N, Schwarzkopf R, Hepinstall MS. Comparison of canal fill and radiolucent line formation between two fully coated, hydroxyapatite tapered stems: a 2-year follow-up after total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:6945-6954. [PMID: 37428271 DOI: 10.1007/s00402-023-04944-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 06/04/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Comparison between fully hydroxyapatite (HA)-coated stems with differing geometry are lacking in the total hip arthroplasty (THA) literature. This study aimed to compare femoral canal fill, radiolucency formation, and 2-year implant survivorship between two commonly used, HA-coated stems. METHODS All primary THAs performed with two fully HA-coated stems (Polar stem, Smith&Nephew, Memphis, TN and Corail stem, DePuy-Synthes, Warsaw, IN) with a minimum 2-year radiographic follow-up were identified. Radiographic measures of proximal femoral morphology based on the Dorr classification and femoral canal fill were analyzed. Radiolucent lines were identified by Gruen zone. Perioperative characteristics and 2-year survivorship were compared between stem types. RESULTS A total of 233 patients were identified with 132 (56.7%) receiving the Polar stem (P) and 101 (43.3%) receiving the Corail stem (C). No differences were observed with respect to proximal femoral morphology. Femoral stem canal fill at the middle third of the stem was greater for P stem patients than for C stem patients (P stem; 0.80 ± 0.08 vs. C stem; 0.77 ± 0.08, p = 0.002), while femoral stem canal fill at the distal third of the stem and presence of subsidence were comparable between groups. A total of six and nine radiolucencies were observed in P stem and C stem patients, respectively. Revision rate at 2-year (P stem; 1.5% vs C stem; 0.0%, p = 0.51) and latest follow-up (P stem; 1.5% vs C stem; 1.0%, p = 0.72) did not differ between groups. CONCLUSION Greater canal fill at the middle third of the stem was observed for the P stem compared to the C stem, however, both stems demonstrated robust and comparable freedom from revision at 2-year and latest follow-up, with low incidences of radiolucent line formation. Mid-term clinical and radiographic outcomes for these commonly used, fully HA-coated stems remain equally promising in THA despite variations in canal fill.
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Affiliation(s)
- Ittai Shichman
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA.
- Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel.
| | - Kyle W Lawrence
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
| | - Emily Berzolla
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
| | - Carlos Sandoval Hernandez
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
| | - Rani Man-El
- Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel
| | - Nimrod Snir
- Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
| | - Matthew S Hepinstall
- Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA
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Mangin M, Aouzal Z, Leclerc G, Sergent AP, Bouiller K, Patry I, Garbuio P. One-stage revision hip arthroplasty for infection using primary cementless stems as first-line implants: About 35 cases. Orthop Traumatol Surg Res 2023; 109:103642. [PMID: 37302525 DOI: 10.1016/j.otsr.2023.103642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 02/19/2023] [Accepted: 04/26/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION During infected total hip arthroplasty revisions (THAR), the need for systematic antibiotic cementation remains undefined. HYPOTHESIS Implantation of a primary cementless stem as first-line implant in 1-stage septic THAR provides results as good as those from a stem cemented with antibiotics in terms of infection resolution. MATERIALS AND METHODS We retrospectively examined 35 patients operated on for septic THAR with Avenir® cementless stem placement - between 2008 and 2018 at Besançon University Hospital - with a minimum follow-up of 2 years to define healing in the absence of infectious recurrence. Clinical outcomes were assessed using the Harris, Oxford, and Merle D'Aubigné scores. Osseointegration was analyzed by the Engh radiographic score. RESULTS The median follow-up was 5±2.6 years (2-11). The infection was cured in 32 of 35 (91.4%) patients. The median scores of the following were: Harris 77/100, Oxford 47.5/60 and Merle d'Aubigné 15/18. Of 32 femoral stems, 31 (96.8%) had radiographically stable osseointegration. Age greater than 80 years was a risk factor for failure to cure the infection during septic THAR. DISCUSSION A primary cementless stem as first-line implant plays a role in 1-stage septic THAR. It confers good results in terms of infection resolution and stem integration in the setting of loss of femoral bone substances rated Paprosky 1. LEVEL OF EVIDENCE IV; retrospective case series.
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Affiliation(s)
- Matthieu Mangin
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France.
| | - Zouhair Aouzal
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France
| | - Grégoire Leclerc
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France
| | - Anne Pauline Sergent
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France
| | - Kévin Bouiller
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France
| | - Isabelle Patry
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France
| | - Patrick Garbuio
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France
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12
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Meißner N, Halder AM, Schrednitzki D. Cemented and hybrid total hip arthroplasty lead to lower blood loss in primary total hip arthroplasty: a retrospective study. Arch Orthop Trauma Surg 2023; 143:6447-6451. [PMID: 37036500 PMCID: PMC10088768 DOI: 10.1007/s00402-023-04851-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/18/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Little scientific evidence exists on blood loss and transfusion rates depending on the fixation technique. The hypothesis of this study was that the blood loss and transfusion rate are lower in cemented and hybrid total hip arthroplasty (THA) compared to cementless THA. METHODS We retrospectively compared a total of 1500 patients who received either cementless, cemented, hybrid or reverse hybrid THA. All patients underwent THA in 2021 at a single orthopedic center in Germany. RESULTS The lowest blood loss was found in patients who received a fully cemented THA (695 ± 74 ml). Hybrid THA with a cemented stem showed a blood loss of 845 ± 30 ml and reverse hybrid THA showed the highest blood loss with an average of 994 ± 74 ml. Cementless THA caused an average blood loss of 957 ± 16 ml. There was a significant difference between cementless THA, hybrid THA (cemented stem), and fully cemented THA (p < 0.05). Transfusion rates ranged from 1.3% (cementless THA) to 7.9% (cemented THA) between the groups with a transfusion rate of 2.5% overall. CONCLUSION We found significantly lower blood loss in cemented THA and hybrid THA compared to cementless THA. Although blood loss was lower in cemented and hybrid THA, this did not result in lower transfusion rates. This could be due to other confounders such as age, comorbidities, and preoperative anemia.
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Affiliation(s)
- Nils Meißner
- Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Waldhausstr. 44, 16766, Kremmen, Germany.
| | - Andreas M Halder
- Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Waldhausstr. 44, 16766, Kremmen, Germany
| | - Daniel Schrednitzki
- Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Waldhausstr. 44, 16766, Kremmen, Germany
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13
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Awwad GEH, Ahedi H, Angadi D, Kandhari V, Coolican MRJ. A prospective randomised controlled trial of cemented and uncemented tibial baseplates: functional and radiological outcomes. Arch Orthop Trauma Surg 2023; 143:5891-5899. [PMID: 37000266 DOI: 10.1007/s00402-023-04831-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 02/28/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION With the success of uncemented fixation in younger patients undergoing total hip arthroplasty and the growing demand for total knee arthroplasty (TKA) in a younger cohort of patients, there has been an increasing interest in cementless tibial baseplate fixation. We sought to determine whether there was a clear advantage to the use of three different forms of tibial baseplate fixation. The primary outcome of this study was survivorship and secondary outcomes were functional and radiological outcomes, up until 10 years. MATERIALS AND METHODS We conducted a randomised controlled trial and recruited 224 patients with 274 knees. Patients underwent TKA by a single surgeon utilising a standard surgical technique. All patients received a cruciate retaining TKA with a cementless femoral component, and were randomised to receive either a cemented tibial component, a pegged porous coated cementless tibial component with screws or a cementless tantalum monoblock tibial component with pegs. Patient reported outcome measures (PROMS), radiological data and survivorship were assessed until 10 years post-operatively. RESULTS Pre-operative range of motion, alignment and PROMS were similar between the three groups. The use of cemented, cementless with screws or cementless with pegs fixation options, lead to differences in functional outcomes. There was greater improvement in the Oxford score and Knee Society Score in patients who received a cemented baseplate compared to tantalum and the pegged porous groups. However, radiological and survival outcomes were similar in all three groups. Overall survivorship was 99.6%, with one knee with cementless tibial fixation and screws revised for subsidence at 3 years. There were no cases of venous thromboembolism, periprosthetic fracture or infection. CONCLUSIONS Irrespective of tibial fixation method, functional and radiological outcomes remain similar at follow-up at 10 years, with no clear difference in outcome between each group. Each method of fixation also had excellent survivorship over this period and should reassure surgeons that whichever method of fixation they choose, long-term outcomes are likely to be satisfactory.
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Affiliation(s)
- George E H Awwad
- Sydney Orthopaedic Research Institute, Sydney, Australia.
- Flinders Medical Centre, Adelaide, Australia.
| | - H Ahedi
- Sydney Orthopaedic Research Institute, Sydney, Australia
- University of Tasmania, Tasmania, Australia
| | - D Angadi
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - V Kandhari
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - M R J Coolican
- Sydney Orthopaedic Research Institute, Sydney, Australia
- Royal Northshore Hospital, Sydney, Australia
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14
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Moon JK, Lee S, Kim CH, Yoon JY, Lee S, Lee KS, Yoon PW. Forte ceramic-on-delta ceramic cementless total hip arthroplasty: an 8- to 15-year follow-up study. Arch Orthop Trauma Surg 2023; 143:5475-5483. [PMID: 36871241 DOI: 10.1007/s00402-023-04793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/22/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Forte ceramic head on delta ceramic liner articulation showed satisfactory midterm results without ceramic-related complication. We aimed to investigate the clinical and radiological outcomes of cementless total hip arthroplasty (THA) with forte ceramic head on delta ceramic liner articulation. MATERIALS AND METHODS Overall, 107 patients (57 men, 50 women; 138 hips) who underwent cementless THA with forte ceramic head on delta ceramic liner articulation were enrolled. The mean follow-up duration was 11.6 years. For the clinical assessments, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), presence of thigh pain, and presence of squeaking were evaluated. Radiographs were assessed to search for osteolysis, stem subsidence, loosening of implants. Kaplan-Meier survival curves were evaluated. RESULTS The mean HHS and WOMAC improved from 57.1 and 28.1 preoperatively to 81.4 and 13.1 at the final follow-up, respectively. Nine revisions (6.5%) were performed; 5 hips for stem loosening, 1 hip for ceramic liner fracture, 2 hips for periprosthetic fracture, and 1 hip for progressive osteolysis around cup and stem. Thirty-two patients (37 hips) complained squeaking, in which 4 cases (2.9%) were identified as ceramic-related noises. After a mean follow-up period of 11.6 years, 91% (95% CI 87.8-94.2) were free from revision of both femoral and acetabular components due to any reason. CONCLUSIONS Cementless THA with forte ceramic-on-delta ceramic articulation showed acceptable clinical and radiological results. Serial surveillance of these patients should be performed due to the possibility of cerami- related complications such as squeaking, osteolysis, and ceramic liner fracture.
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Affiliation(s)
- Jun-Ki Moon
- Department of Orthopedic Surgery, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University, Gwangmyeong, Republic of Korea
| | - Seonjeong Lee
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, College of Medicine, Chung-Ang University Hospital, Chung-Ang University, Seoul, Republic of Korea
| | - Jae Youn Yoon
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Ilsan, Republic of Korea
| | - Sunhyung Lee
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Kang-Sik Lee
- Biomedical Engineering Research Center, Asan Institute For Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Pil Whan Yoon
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
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Ebied A, Ebied AA, Badr I, Affara M, Marei S. Medium-term outcome of the Libra ® cemented versus cementless stems in primary dual mobility total hip arthroplasty. BMC Musculoskelet Disord 2023; 24:663. [PMID: 37599372 PMCID: PMC10440918 DOI: 10.1186/s12891-023-06799-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/13/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION Despite the increasing use of cementless stems in total hip arthroplasty, the cemented stem has played a valuable role in the armamentarium of orthopedic surgeons. This study aims to compare two types of Libra® stems SERF, one cemented (Libra® C) and the other cementless hydroxyapatite coated (Libra® HA) that were conducted to analyze the medium-term outcome regarding their behavior and longevity. METHODS This is a retrospective study for patients who received primary total hip arthroplasty with Dual Mobility (DM) articulation in the period between January 2014 to January 2020 with a minimum of two years follow-up. Two-hundred hips have been identified in 196 patients. One hundred forty-three Libra® cementless versus fifty-seven Libra cemented stems were implanted and the outcome of these stems is reported. All procedures were performed through the posterior approach and cemented stems were selected for elderly patients with wide medullary canals Dorr Type C. The indications for the index procedure were fractures, avascular necrosis, rheumatoid, and osteoarthritis. One hundred thirty-nine cementless DM cups were used while sixty-one hips had cemented Novae stick cups. Radiological evaluation for cup and stem positions, cement mantle, and radiolucent lines was performed, besides clinical function using the Harris Hip Score. RESULTS The average age of patients was 60 ± 14.8. At the latest review, none of the cemented stems was revised or awaiting revision. One cementless stem was revised because of cortical perforation. Five intraoperative fractures were observed in the cementless group, but none of them needed revision or affected the stem stability. Readmission to theatre occurred in four patients to evacuate hematoma in two, a reduction of dislocation in one, and grafting bone lysis in one. CONCLUSION Cemented stems have an important role in osteoporotic patients with wide medullary canals with excellent outcomes and minimal risk of fracture. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ayman Ebied
- Department of Orthopedic Surgery, Faculty of Medicine, Menoufia University, Shibin el Kom, Menoufia, 32511, Egypt
| | - Ahmed Ali Ebied
- Department of Orthopedic Surgery, Faculty of Medicine, Menoufia University, Shibin el Kom, Menoufia, 32511, Egypt
| | - Ismail Badr
- Department of Orthopedic Surgery, Faculty of Medicine, Menoufia University, Shibin el Kom, Menoufia, 32511, Egypt.
| | - Mostafa Affara
- Department of Orthopedic Surgery, Faculty of Medicine, Menoufia University, Shibin el Kom, Menoufia, 32511, Egypt
| | - Sameh Marei
- Department of Orthopedic Surgery, Faculty of Medicine, Menoufia University, Shibin el Kom, Menoufia, 32511, Egypt
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Hipfl C, Leopold V, Becker L, Pumberger M, Perka C, Hardt S. Two-stage revision for periprosthetic joint infection in cemented total hip arthroplasty: an increased risk for failure? Arch Orthop Trauma Surg 2023; 143:4481-4490. [PMID: 36323976 PMCID: PMC10293416 DOI: 10.1007/s00402-022-04671-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of the prior fixation mode on the treatment outcome of chronic periprosthetic joint infection (PJI) of the hip is unclear. Removal of cemented total hip arthroplasty (THA) is particularly challenging and residual cement might be associated with reinfection. This study seeks to compare the results of two-stage revision for PJI in cemented and cementless THA. METHODS We reviewed 143 consecutive patients undergoing two-stage revision THA for PJI between 2013 and 2018. Thirty-six patients with a fully cemented (n = 6), hybrid femur (n = 26) or hybrid acetabulum (n = 4) THA (cemented group) were matched 1:2 with a cohort of 72 patients who underwent removal of a cementless THA (cementless group). Groups were matched by sex, age, number of prior surgeries and history of infection treatment. Outcomes included microbiological results, interim re-debridement, reinfection, all-cause revision, and modified Harris hip scores (mHHS). Minimum follow-up was 2 years. RESULTS Compared with PJI in cementless THA, patients undergoing removal of cemented THA had increasingly severe femoral bone loss (p = 0.004). Patients in the cemented group had an increased risk for positive cultures during second-stage reimplantation (22% compared to 8%, p = 0.043), higher rates of reinfection (22% compared to 7%, p = 0.021) and all-cause revision (31% compared to 14%, p = 0.039) compared to patients undergoing two-stage revision of cementless THA. Periprosthetic femoral fractures were more frequent in the group of patients with prior cementation (p = .004). Mean mHHS had been 37.5 in the cemented group and 39.1 in the cementless group, and these scores improved significantly in both groups (p < 0.01). CONCLUSION This study shows that chronic infection in cemented THA might be associated with increased bone loss, higher rates of reinfection and all-cause revision following two-stage revision. This should be useful to clinicians counselling patients with hip PJI and can guide treatment and estimated outcomes.
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Affiliation(s)
- Christian Hipfl
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Vincent Leopold
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Luis Becker
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian Hardt
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Chiou D, Li AK, Upfill-Brown A, Arshi A, Hsiue P, Chen K, Stavrakis A, Photopoulos CD. Cementless Compared to Cemented Total Knee Arthroplasty is Associated With More Revisions Within 1 Year of Index Surgery. Arthroplast Today 2023; 21:101122. [PMID: 37521088 PMCID: PMC10382689 DOI: 10.1016/j.artd.2023.101122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 01/17/2023] [Accepted: 02/05/2023] [Indexed: 08/01/2023] Open
Abstract
Background Cementless total knee arthroplasties (TKAs) have gained renewed interest due to improved implant designs and lower rates of revision than its cemented counterparts. The purpose of this study was to compare revision rates between cemented vs cementless TKAs within 1 year of primary arthroplasty. Methods This was a retrospective review from the PearlDiver Patient Record Database. International Classification of Diseases and Current Procedural Terminology codes were used to identify patients who had undergone cemented and cementless TKAs and subsequent surgical revisions. An unadjusted univariate analysis of patient demographics, Charlson Comorbidity Index score, and surgical revisions at 90 days and 1 year after TKA was performed using chi-squared testing. Multivariate logistic regression analyses were subsequently performed for 1-year surgical complications requiring revision. Results Of 324,508 patients, 312,988 (96.45%) underwent cemented TKAs, and 11,520 (3.55%) underwent cementless TKAs. Patients undergoing cementless TKA tended to be younger than patients undergoing cemented TKA (63.67 ± 9.15 cementless vs 66.22 ± 8.85 cemented, P < .001). Univariate chi-squared testing showed that cementless patients were more likely to require 1-component femoral or tibial revision at 90 days and 1 year, irrigation and debridement at 90 days and 1 year, and arthroscopy with lysis of adhesions at 1 year only. Similar findings were observed for these 3 revision procedures at 1 year after correcting for age, gender, and Charlson Comorbidity Index score using multivariate logistic regression analysis as cementless TKA patients had higher odds ratios for each of the revisions. Conclusions Small but significant differences were found in surgical revisions among cementless TKAs when compared to cemented TKAs within 1 year of the index procedure.
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Affiliation(s)
- Daniel Chiou
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
| | - Alan K. Li
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
| | | | - Armin Arshi
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
| | - Peter Hsiue
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
| | - Kevin Chen
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
| | - Alexandra Stavrakis
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
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18
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Weishorn J, Heid S, Bruckner T, Merle C, Renkawitz T, Innmann MM. How is hip anatomy reconstruction and inlay wear associated up to 10 years after primary THA using ceramic on highly crosslinked polyethylene bearings? BMC Musculoskelet Disord 2023; 24:400. [PMID: 37202754 DOI: 10.1186/s12891-023-06501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/09/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Conventional polyethylene (PE) wear has been reported to be associated with femoral offset reconstruction and cup orientation after THA. Thus, the present study aimed (1) to determine the polyethylene wear rate of 32 mm ceramic heads with highly cross-linked polyethylene (HXLPE) inlays up to 10 years postoperatively and (2) to identify patient and surgery-related factors affecting the wear rate. METHODS A prospective cohort study was performed, investigating 101 patients with 101 cementless THAs and ceramic (32 mm) on HXLPE bearings after 6-24 months, 2-5 years and 5-10 years postoperatively. The linear wear rate was determined using a validated software (PolyWare®, Rev 8, Draftware Inc, North Webster, IN, USA) by two reviewers, blinded to each other. A linear regression model was used to identify patient and surgery-related factors on HXLPE -wear. RESULTS After an initial bedding-in phase of 1 year after surgery, the mean linear wear rate was 0.059 ± 0.031 mm/y at ten years (mean 7.7 years; SD 0.6 years, range 6-10), being below the osteolysis relevant threshold of 0.1 mm/year. The regression analysis demonstrated that age at surgery, BMI, cup inclination or anteversion and the UCLA score were not associated with the linear HXLPE-wear rate. Only increased femoral offset showed a significant correlation with an increased HXLPE-wear rate (correlation coefficient of 0.303; p = 0.003) with a moderate clinical effect size (Cohen's f²=0.11). CONCLUSION In contrast to conventional PE inlays, hip arthroplasty surgeons may be less concerned about osteolysis-related wear of the HXLPE if the femoral offset is slightly increased. This allows focusing on joint anatomy reconstruction, hip stability and leg length.
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Affiliation(s)
- Johannes Weishorn
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Samira Heid
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Christian Merle
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
- Department of Orthopaedic Surgery, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Moritz M Innmann
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Nooh A, Hart A, Tanzer M. Intermediate to Long-Term Outcomes of a Short, Tapered, Highly Porous, Proximally Coated Cementless Femoral Stem. J Arthroplasty 2023:S0883-5403(23)00351-0. [PMID: 37044224 DOI: 10.1016/j.arth.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Short cementless stems in total hip arthroplasty have gained increasing popularity, yet on-going studies of many of these implants are lacking. The aim of this study was to evaluate the minimum 5 year clinical and radiological results of a short, highly porous single tapered-wedge cementless femoral implant. METHODS A retrospective study of 281 hips in 256 patients who had a minimum 5-year follow-up and underwent primary total hip arthroplasty (THA) between 2010 and 2016 were evaluated. Clinical and radiological results, complications, and the presence of postoperative thigh pain were evaluated. RESULTS The mean follow-up was 8 years (range, 5 to 12 years). Clinically, patients had significant improvement in the average patient related outcome scores (PROMS) postoperatively (Harris Hip Score: pre 47 vs post 95, University of California Los Angeles (UCLA) activity scale: pre 4 vs post 6, Western Ontario and McMaster Universities Arthritis Index (WOMAC): pre 51 vs post 3, SF-12 Physical Component Summary (PCS): pre 32 vs post 52, SF-12 Mental Component Summary (MCS): pre 49 vs post 55 (P<0.001)). Radiographic signs of ingrowth were present in all hips. There were three patients (1.1%) who developed transient thigh pain postoperatively, all of which resolved with non-operative management. CONCLUSION This study provides the longest follow-up of this short, highly porous single tapered-wedge cementless femoral stem in the literature. This short single wedge stem with its highly porous coating demonstrated reproducible bone ingrowth in all patients, and significant functional improvement with a very low rate of transient thigh pain.
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Affiliation(s)
- Anas Nooh
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada; Department of Orthopaedic Surgery, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Adam Hart
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
| | - Michael Tanzer
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
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20
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Powell D, Comer B, Hallstrom B, Zheng H, Hughes R, Markel D. Early Survivorship of Uncemented Total Knee Arthroplasty Varies by Age and Sex based on Data from the Michigan Arthroplasty Registry Collaborative Quality Initiative. J Arthroplasty 2023:S0883-5403(23)00204-8. [PMID: 36889526 DOI: 10.1016/j.arth.2023.02.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Outcome data for newer uncemented total knee arthroplasty designs has been mixed. Registry studies showed worse survivorship, but clinical trials have not demonstrated differences compared to cemented designs. There has been renewed interest in uncemented TKA with modern designs and improved technology. The utilizations of uncemented knees in Michigan, 2-year outcomes, and the effects of age and sex were evaluated. METHODS A statewide database from 2017 through 2019 was analyzed for incidence, distribution, and early survivorship of cemented vs. uncemented TKAs. There was 2-year minimum follow-up. Kaplan-Meier survival analysis was used to generate time to first revision cumulative percent revision (CPR) curves. The impacts of age and sex were examined. RESULTS Use of uncemented TKAs increased from 7.0 to 11.3%. Uncemented TKAs were more commonly men, younger, heavier, American Society of Anesthesiologists (ASA) Score>2, and opioid users (p<0.05). At 2 years, overall CPR was higher in uncemented (2.44% [2.00, 2.99] versus cemented (1.76% [1.64, 1.89]), particularly in women (uncemented (2.41 [1.87, 3.12]) vs cemented (1.64 [1.50, 1.80]). Revision rates were greater with uncemented women >70 years (1.2% 1 year, 1.02% 2 years) vs <70 years (0.56%, 0.53%), notably uncemented were inferior in both groups (p<0.05). Men, regardless of age, had similar survivorships with both cemented and uncemented designs. CONCLUSION The use of an uncemented TKA had an increased risk of early revision compared to cemented. This finding, however, was only apparent in women, especially those >70 years old. Surgeons should consider cement fixation in women >70 years.
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Affiliation(s)
- Dexter Powell
- Ascension-Providence Hospital Department of Orthopaedic Surgery, 16001 W Nine Mile Rd., Southfield, MI 48075, United States of America.
| | - Brendan Comer
- Ascension-Providence Hospital Department of Orthopaedic Surgery, 16001 W Nine Mile Rd., Southfield, MI 48075, United States of America
| | - Brian Hallstrom
- University of Michigan Department of Orthopaedic Surgery, 1500 E. Medical Center Drive, 2912 Taubman Center - Box 5328, Ann Arbor, MI 48109, United States of America; MARCQI Coordinating center, 2929 Plymouth Rd. #300, Ann Arbor, MI 48105, United States of America
| | - Huiyong Zheng
- MARCQI Coordinating center, 2929 Plymouth Rd. #300, Ann Arbor, MI 48105, United States of America
| | - Richard Hughes
- University of Michigan Department of Orthopaedic Surgery, 1500 E. Medical Center Drive, 2912 Taubman Center - Box 5328, Ann Arbor, MI 48109, United States of America; MARCQI Coordinating center, 2929 Plymouth Rd. #300, Ann Arbor, MI 48105, United States of America
| | - David Markel
- Ascension-Providence Hospital Department of Orthopaedic Surgery, 16001 W Nine Mile Rd., Southfield, MI 48075, United States of America; MARCQI Coordinating center, 2929 Plymouth Rd. #300, Ann Arbor, MI 48105, United States of America; The Core Institute, 26750 Providence Pkwy, Novi, MI 48374
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Yamamoto N, Takada R, Jinno T, Miyatake K, Watanabe N, Koga H, Yoshii T, Yagishita K, Okawa A. Wear rate and osteolysis in two types of second-generation annealed highly cross-linked polyethylene in total hip arthroplasty: A retrospective comparative study with a minimum of five years. Orthop Traumatol Surg Res 2023; 109:103147. [PMID: 34793945 DOI: 10.1016/j.otsr.2021.103147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND As no previous study has directly compared the linear wear rate in two types of second-generation annealed highly cross-linked polyethylene, we performed a retrospective study with a minimum of 5-year follow-up to assess primary arthroplasties in the (1) wear rates and (2) incidence of osteolysis of the two types of HXLPE. HYPOTHESIS There was no significant difference in the linear wear rate and the incidence of osteolysis between the two types of second-generation annealed highly cross-linked polyethylene. PATIENTS AND METHODS In this single-center study, we reviewed 257 cases of primary cementless total hip arthroplasties between 2011 and 2015, which were performed with 32mm delta ceramic on second-generation annealed highly cross-linked polyethylene (X3 and E1 were used in 105 and 103 cases, respectively.). The mean wear rate was evaluated using a computer-assisted method, and the incidence of osteolysis was evaluated based on the appearance of a localized area with loss of trabecular bone or cortical erosion adjacent to the implants during the latest follow-up. RESULTS In total, we evaluated 208 cases, followed postoperatively for over 5 years (mean, 6.1 years, range: 5.0-8.0). There were no significant differences between the two groups with respect to age (list in order of Group X, Group E, p value) (61.2±12.3, 62.7±12.1, p=0.36), sex (ratio of male: 17.1%, 14.6%, p=0.61), body mass index (22.9±3.7, 22.8±4.0, p=0.91), pre- (49.9±14.8, 48.5±13.8, p=0.49) and post-operative (91.3±9.1, 92.7±7.0, p=0.23) Japanese Orthopaedic Association Hip Score, cup size (50.8±3.0, 50.9±2.2, p=0.70), cup inclination (38.7±4.8, 37.6±4.8, p=0.10), and cup anteversion (18.7±6.9, 18.5±7.6, p=0.80). The mean linear wear rates of the X3 and E1 groups were 0.057±0.039 (range: 0-0.16) and 0.054±0.037mm/year (range: 0-0.15), respectively (p=0.61). No osteolysis was found on the final plain radiographs in both groups. DISCUSSION This study revealed that both types of highly cross-linked polyethylene have excellent linear wear rates and were equally safe to use. However, the difference between the two materials in terms of the long-term wear rate should be further validated. LEVEL OF EVIDENCE III; retrospective case control study.
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Affiliation(s)
- Naoki Yamamoto
- Department of Orthopaedic Surgery Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Ryohei Takada
- Department of Orthopaedic Surgery Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan.
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Kazumasa Miyatake
- Department of Orthopaedic Surgery Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Naoto Watanabe
- Department of Orthopaedic Surgery Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Kazuyoshi Yagishita
- Department of Orthopaedic Surgery Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
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22
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Klasan A, Bayan A, Holdaway I, Farrington WJ. Liner type has no impact on bone mineral density changes around a 3D printed trabecular titanium acetabular component. Orthop Traumatol Surg Res 2023; 109:103136. [PMID: 34715391 DOI: 10.1016/j.otsr.2021.103136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Three-dimensional printing of implants allows the ability to produce implants and interfaces which theoretically better mimic "normal" bone behaviour, leading to a possible reduction in stress shielding thus maintaining bone mineral density (BMD). This issue was not investigated in vivo using bone scan and different bearings; therefore, we did a prospective study aiming to answer: 1) is there a loss of BMD around the 3D printed trabecular titanium cup, when compared to the native hip?; 2) does liner type influence the BMD changes around the acetabulum when a 3D printed trabecular titanium cup is used? HYPOTHESIS BMD changes around the acetabulum are not influenced by the liner type, and the cup will be associated with a reduction in BMD when compared to the native hip. MATERIAL AND METHODS This is a prospective observational study of patients receiving a primary total hip arthroplasty. A 3D printed trabecular titanium uncemented acetabular component was used in all cases. All patients received a ceramic femoral head, with either a ceramic or polyethylene acetabular liner. BMD measurements using DXA were performed at 6 weeks, 6, 12 and 24 months after surgery to evaluate remodeling changes. The 3 acetabular regions of interest (ROI) of DeLee and Charnley were used for serial comparisons of peri-acetabular BMD. The study was powered as a non-inferiority study with the principle variables compared using a two-step repeated analysis of variance. RESULTS A total of 48 consecutive patients were included in the study, with all patients completing their 2 year follow-up. There were no failures, revisions or complications within this cohort. We found no statistically significant difference in the BMD change scores between the operated and the native hip in any of the 3 ROI zones. We found no differences in BMD scores when comparing ceramic to polyethylene acetabular liners, head sizes and BMI. DISCUSSION This study shows a similar pattern of BMD behaviour around a 3D printed cup when compared to the contralateral native hip. We were unable to show a clinical or radiological difference between the bearing material, head size, or BMI when used with this type of acetabular component. LEVEL OF EVIDENCE III; prospective comparative study.
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Affiliation(s)
- Antonio Klasan
- North Shore Hospital, 124, Shakespeare Road, Takapuna, 0620 Auckland, New Zealand; Kepler University Hospital Linz, Krankenhausstr. 9, 4020 Linz, Austria; Johannes-Kepler University Linz, Altenbergerstr. 69, 4040 Linz, Austria.
| | - Ali Bayan
- North Shore Hospital, 124, Shakespeare Road, Takapuna, 0620 Auckland, New Zealand
| | - Ian Holdaway
- Auckland City Hospital, 2, Park Road, Grafton, 1023 Auckland, New Zealand
| | - William J Farrington
- North Shore Hospital, 124, Shakespeare Road, Takapuna, 0620 Auckland, New Zealand
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23
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Koster LA, Rassir R, Kaptein BL, Sierevelt IN, Schager M, Nelissen RGHH, Nolte PA. A randomized controlled trial comparing two-year postoperative femoral and tibial migration of a new and an established cementless rotating platform total knee arthroplasty. Bone Joint J 2023; 105-B:148-157. [PMID: 36722052 DOI: 10.1302/0301-620x.105b2.bjj-2022-0414.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS The primary aim of this study was to compare the migration of the femoral and tibial components of the cementless rotating platform Attune and Low Contact Stress (LCS) total knee arthroplasty (TKA) designs, two years postoperatively, using radiostereometric analysis (RSA) in order to assess the risk of the development of aseptic loosening. A secondary aim was to compare clinical and patient-reported outcome measures (PROMs) between the designs. METHODS A total of 61 TKAs were analyzed in this randomized clinical RSA trial. RSA examinations were performed one day and three, six, 12, and 24 months postoperatively. The maximal total point motion (MPTM), translations, and rotations of the components were analyzed. PROMs and clinical data were collected preoperatively and at six weeks and three, six, 12, and 24 months postoperatively. Linear mixed effect modelling was used for statistical analyses. RESULTS The mean MTPM two years postoperatively (95% confidence interval (CI)) of the Attune femoral component (0.92 mm (0.75 to 1.11)) differed significantly from that of the LCS TKA (1.72 mm (1.47 to 2.00), p < 0.001). The Attune femoral component subsided, tilted (anteroposteriorly), and rotated (internal-external) significantly less. The mean tibial MTPM two years postoperatively did not differ significantly, being 1.11 mm (0.94 to 1.30) and 1.17 mm (0.99 to 1.36, p = 0.447) for the Attune and LCS components, respectively. The rate of migration in the second postoperative year was negligible for the femoral and tibial components of both designs. The mean pain-at-rest (numerical rating scale (NRS)-rest) in the Attune group was significantly less compared with that in the LCS group during the entire follow-up period. At three months postoperatively, the Knee injury and Osteoarthritis Outcome Physical Function Shortform score, the Oxford Knee Score, and the NRS-activity scores were significantly better in the Attune group. CONCLUSION The mean MTPM of the femoral components of the cementless rotating platform Attune was significantly less compared with that of the LCS design. This was reflected mainly in significantly less subsidence, posterior tilting, and internal rotation. The mean tibial MTPMs were not significantly different. During the second postoperative year, the components of both designs stabilized and low risks for the development of aseptic loosening are expected.Cite this article: Bone Joint J 2023;105-B(2):148-157.
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Affiliation(s)
- Lennard A Koster
- Department of Orthopaedics, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Rachid Rassir
- Department of Orthopaedics, Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Inger N Sierevelt
- SCORE, Specialized Centre of Orthopedic Research and Education, Xpert Orthopedie Amsterdam, Amsterdam, Netherlands
| | - Marjolein Schager
- Department of Orthopaedics, Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Peter A Nolte
- Department of Orthopaedics, Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
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24
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Patel SK, Dilley JE, Carlone A, Deckard ER, Meneghini RM, Sonn KA. Effect of Tobacco Use on Radiolucent Lines in Modern Cementless Total Knee Arthroplasty Tibial Components. Arthroplast Today 2023; 19:101082. [PMID: 36691460 PMCID: PMC9860107 DOI: 10.1016/j.artd.2022.101082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 01/15/2023] Open
Abstract
Background The link between tobacco consumption and wound complications following total knee arthroplasty (TKA) is well established. However, the effect of tobacco use on biologic fixation in cementless TKA remains unknown. This study evaluated the influence of tobacco use on the presence of radiolucent lines of tibial components in cementless TKA. Methods A total of 293 consecutive cementless TKAs of 2 contemporary designs were retrospectively reviewed. Tibial radiolucent lines and component alignment were measured using an established measurement protocol. Patients with any history of tobacco use or active tobacco use (tobacco users) were compared to those with no history of tobacco use (tobacco nonusers). No significant differences which influenced outcomes were detected between the tobacco user and tobacco nonuser groups (P ≥ .071). Results Radiolucent lines decreased from 1-month to latest follow-up (mean 2.5 years) in all 10 radiographic zones regardless of tobacco use (P ≤ .084). However, evaluating intrapatient change in radiolucent line width, the tobacco nonuser group had more radiolucent lines resolve by the latest follow-up in nearly all radiographic zones, although most differences did not reach statistical significance, except for anteroposterior zone 1 (-31% vs -19%, P = .022). No tibial components were revised for aseptic loosening. Conclusions Results from this study suggest that any tobacco use prior to cementless TKA has the potential to hinder biologic fixation of tibial components. While no tibial components were revised for aseptic loosening, follow-up was relatively short at 2.5 years and therefore warrants further study to discern the effect of persistent radiolucent lines on long-term fixation.
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Affiliation(s)
- Sohum K. Patel
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Julian E. Dilley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew Carlone
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - R. Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA,Indiana Joint Replacement Institute, Indianapolis, IN, USA,Corresponding author. Indiana Joint Replacement Institute, 1725 N 5th Street, Terre Haute, IN 47804, USA. Tel.: +1 317 620 0232.
| | - Kevin A. Sonn
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA,Indiana University Health Physicians, Indiana University Health Saxony Hospital, Fishers, IN, USA
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25
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Luger M, de Vries M, Feldler S, Hipmair G, Gotterbarm T, Klasan A. A propensity score-matched analysis on the impact of patient and surgical factors on early periprosthetic joint infection in minimally invasive anterolateral and transgluteal total hip arthroplasty. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04756-z. [PMID: 36629904 PMCID: PMC10374686 DOI: 10.1007/s00402-022-04756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Increased risk of periprosthetic joint infection (PJI) in minimally invasive (MIS) total hip arthroplasty (THA) is still debated. This study aimed to identify differences in surgical and patient-related risk factors for PJI between an MIS anterolateral approach and transgluteal-modified Hardinge approach. METHODS A retrospective cohort of 5315 THAs performed between 2006 and 2019 at a single institution was screened. Short stem THAs performed via an MIS anterolateral approach in the supine position and standard straight stem THAs performed via a transgluteal modified Hardinge approach were included. Propensity score matching was performed to control for selection bias. After matching, 1405 (34.3%) short stem THAs implanted via MIS anterolateral approach and 2687 (65.7%) straight stem THAs implanted via a transgluteal modified Hardinge approach were included. The risk of PJI due to patient-specific and surgical factors was retrospectively analyzed using chi-square test and multivariate regression analysis. RESULTS PJI occurred in 1.1% in both MIS anterolateral and transgluteal approach (p = 0.823). Multivariate regression showed an increased infection risk for patients with a BMI between 35 and 39.99 kg/m2 (OR 6.696; CI 1.799-24.923; p = 0.005), which could not be demonstrated for transgluteal approach (OR 0.900; CI 0.900-4.144; p = 0.93). A BMI ≥ 40 kg/m2 (OR 14.150; CI 2.416-82.879; p = 0.003) was detected as a risk factor for PJI only in anterolateral approach. Increased operation time ≥ 121 min showed a significantly increased risk for PJI in the general cohort (OR 6.989; CI1.286-37.972; p = 0.024). CONCLUSION Minimally invasive anterolateral and transgluteal THA show a comparable rate of early PJI within the first year of index surgery. A BMI of ≥ 35 kg/m2 was detected as a clear risk factor for infection in the anterolateral approach. Prolonged operation time ≥ 121 min increases the risk of PJI regardless of approach.
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Affiliation(s)
- Matthias Luger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria. .,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
| | - Marcel de Vries
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Sandra Feldler
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Günter Hipmair
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Antonio Klasan
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
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Park JW, Kim HS, Kim KC, Lee YK, Ha YC, Koo KH. A 10- to 12-year follow-up study of delta ceramic-on-ceramic total hip arthroplasty. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04758-x. [PMID: 36595032 DOI: 10.1007/s00402-022-04758-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND We previously reported five-to-seven-year results of total hip arthroplasty (THA) with the use of delta ceramic-on-ceramic (CoC) bearing. We conducted an extension study with a CT scan at a minimum of 10 years after surgery. METHODS From March 2009 to March 2011, 273 patients (310 hips) received cementless THA with delta CoC bearing, porous-coated cup and hydroxyapatite-coated stem. In this extended study, 252 patients (144 men and 108 women) (288 hips) with a mean age of 49.7 years (16-83) at surgery were followed for a mean of 10.4 years (10-12) with CT scans in 133 hips (46.2%, 133/288). Clinical and radiographic evaluations were made at each follow-up and Kaplan-Meier survival analysis was performed with revision and reoperation as endpoints. RESULTS There were no more ceramic fractures. Compared to mid-term results, the incidence of squeaking and RLLs increased to 3.1% (9/288) and 19.4% (56/288), respectively. The RLL progressed to focal osteolysis in 3 hips (5.4%, 3/56). No hip had detectable wear or prosthetic loosening. Two hips were reoperated due to periprosthetic joint infection and periprosthetic femoral fracture in each. The survivorship decreased to 98.3% (96.7-99.9%) at 12 years. CONCLUSION During the extended follow-up, no additional ceramic fracture occurred, and the incidence of squeak increased by 0.7%. The long-term survivorship of Delta CoC THA was encouraging. However, focal osteolysis occurred around the hydroxyapatite-coated stem in 1% (3/288). LEVEL OF EVIDENCE II (Prospective cohort study).
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-gu, Seongnam, 463-707, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hong-Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki-Choul Kim
- Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-gu, Seongnam, 463-707, South Korea. .,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-gu, Seongnam, 463-707, South Korea.,Department of Orthopaedic Surgery, Kay Joint Center, Cheil Orthopaedic Hospital, Seoul, South Korea
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Cho HS, Seo DY, Kim DS, Kang JS, Kim YU, Kwon YH, Kim MS. Biomechanical evaluation of the impact of collared cementless total hip arthroplasty stems on implant subsidence: a cadaveric study in German Shepherd. Iran J Vet Res 2023; 24:242-246. [PMID: 38269008 PMCID: PMC10804427 DOI: 10.22099/ijvr.2023.47029.6770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 01/26/2024]
Abstract
Background With the increasing use of cementless total hip arthroplasty (THA), stem subsidence has emerged as one of the primary complications. Although electron beam melting (EBM)-manufactured stems have been demonstrated to prevent subsidence, there has been limited investigation into the comparative biomechanical impact of collarless and collared EBM cementless stems on stem subsidence in veterinary medicine. Aims This study aimed to compare the stem implant resistance and failure mechanical properties between collarless and collared EBM-manufactured stems. Methods Seven pairs of femurs were harvested from canine cadavers. In each pair of femurs, the left femur was implanted with a collarless, and the right femur with a same-sized collared cementless stem. Specimen constructs were mounted to the loading frame of a testing machine and load was transferred to the femoral stem parallel to the longitudinal axis of the femur until the stem subsided 5 mm. Load and stem displacement data acquired during the tests were used to generate load-displacement curves and obtain stiffness, yield, and failure data for each specimen construct. Yield and failure energies were calculated as the areas under the load-displacement curves to the respective points. The effects of implant type and load during subsidence were analyzed using paired t-tests. Results The yield and failure loads for the collared stems were approximately 40% greater than for the collarless stems (156.39 ± 43.63 kgf vs. 112.01 ± 59.83 kgf, P<0.05). Conclusion This study supported the advantages of collared EBM stems, including subsidence prevention and better initial stability for early osteointegration.
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Affiliation(s)
- H. S. Cho
- Department of Veterinary Clinical Science, Cho Hyungsun Animal Hospital, Seoul, Republic of Korea
- These authors contributed equally to this work and were considered as the first authors
| | - D. Y. Seo
- Ph.D. Student in Veterinary Emergency and Critical Care, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
- These authors contributed equally to this work and were considered as the first authors
| | - D. S. Kim
- Ph.D. Student in Veterinary Emergency and Critical Care, Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - J. S. Kang
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Y. U. Kim
- Department of Veterinary Clinical Science, Bien Animal Medical Center, Sosagu, Republic of Korea
| | - Y. H. Kwon
- Department of Veterinary Clinical Science, Yedam Animal Medical Center, Seoul, Republic of Korea
| | - M. S. Kim
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
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Tay ML, Zeng N, Holland S, Bayan A, Farrington BJ, van Rooyen R, Sharp R, Elliott RSJ, Walker ML, Young SW. The Knee-Fix study: study protocol for a randomised controlled trial evaluating cemented and cementless components in total knee arthroplasty. Trials 2022; 23:1032. [PMID: 36539805 DOI: 10.1186/s13063-022-06974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is an effective procedure for patients with a variety of knee conditions. The main cause of aseptic TKA failure is implant loosening, which has been linked to poor cement mantle quality. Cementless components were introduced to offer better longer-term biological fixation through osseointegration; however, early designs led to increased rate of revision due to a lack of initial press-fit and bony ingrowth. Newer highly porous metal designs may alleviate this issue but randomised data of fully uncemented TKA (tibial, femoral, patella) is lacking. The aim of the Knee-Fix study is to investigate the long-term implant survival and patient outcomes of fully uncemented compared with cemented fixation in TKA. Our study hypothesis was that uncemented TKA would be as clinically reliable and durable as the gold-standard cemented TKA. METHODS The Knee-Fix study is a two-arm, single-blinded, non-inferiority randomised controlled trial with 160 patients in each arm and follow-up at 6 weeks, 6 months, 12 months, 24 months, 5 years and 10 years. The primary outcome of interest is implant fixation, which will be measured by assessment of postoperative progressive radiolucencies with the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Secondary outcome measures are patient-reported outcomes, measured using Oxford Knee Score (OKS), International Knee Society System (IKSS), Forgotten Joint Score-12 (FJS-12), EuroQol (EQ-5D-5L), VAS Pain, Patient Satisfaction Score and Net Promoter Score. DISCUSSION While cemented fixation remains the gold standard, a growing proportion of TKA are now implanted cementless. Highly porous metal cementless components for TKA can offer several benefits including potentially improved biological fixation; however, long-term outcomes need further investigation. This prospective study will help discern long-term differences between the two techniques. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616001624471 . Registered trial name: Knee-Fix study (Cemented vs Uncemented Total Knee Replacement). Registered on 24 November 2016.
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Yang H, Behnam Y, Clary C, Rullkoetter PJ. Drivers of initial stability in cementless TKA: Isolating effects of tibiofemoral conformity and fixation features. J Mech Behav Biomed Mater 2022; 136:105507. [PMID: 36209592 DOI: 10.1016/j.jmbbm.2022.105507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/18/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
The initial fixation of cementless tibial trays after total knee arthroplasty is critical to ensure bony ingrowth and long-term fixation. Various fixed-bearing implant designs that utilize different fixation features, surface coatings, and bony preparations to facilitate this initial stability are currently used clinically. However, the role of tibiofemoral conformity and the effect of different tray fixation features on initial stability are still unclear. This study assessed the implant stability of two TKA designs during a series of simulated daily activities including experimental testing and corresponding computational models. Tray-bone interface micromotions and the porous area ideal for bone ingrowth were investigated computationally and compared between the two designs. The isolated effect of femoral-insert conformity and fixation features on the micromotion was examined separately by virtually exchanging design features. The peak interface micromotions predicted were at least 47% different for the two designs, which was a combined result of different femoral-insert conformity (contributed 79% of the micromotion difference) and fixation features (21%). A more posterior femoral-insert contact due to lower tibiofemoral conformity in a force-controlled simulation significantly increased the micromotion and reduced the surface area ideal for bone ingrowth. The maximum difference in peak micromotions caused by only changing the fixation features was up to 33%. Overall, the moment arm from the insert articular contact point to the anterolateral tray perimeter was the primary factor correlated to peak and average micromotion. Our results indicated that tray-bone micromotion could be minimized by centralizing the load transfer and optimizing the fixation features.
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Affiliation(s)
- Huizhou Yang
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, 80208, USA.
| | - Yashar Behnam
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, 80208, USA
| | - Chadd Clary
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, 80208, USA
| | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, 80208, USA.
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Mikashima Y, Imamura H, Shirakawa Y, Yano K, Ikari K, Okazaki K. Modern cementless posterior stabilized mobile-bearing total knee arthroplasty shows comparable clinical and radiographical results to its cemented predecessor at 1-year follow-up. Knee Surg Sports Traumatol Arthrosc 2022; 30:3131-3137. [PMID: 35781580 DOI: 10.1007/s00167-022-07047-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/04/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate perioperative and short-term clinical and radiographical results of a modern PS mobile-bearing cementless TKA system. METHODS A retrospective review of a consecutive series of TKAs was performed by a single surgeon using a cementless or cemented TKA of the same design (Attune, DePuy Synthes, Massachusetts, USA). The 2011 Knee Society Score, Forgotten Joint Score-12, Hip-Knee-Ankle angle, and the presence of radiolucent lines (RLLs) were reviewed 1-year postoperatively with 1:1 matching performed for age, gender, body mass index, and preoperative UCLA score. Fisher's exact test or independent Student's t-test were used for statistical analyses. RESULTS Forty-five cementless and 45 cemented TKAs were reviewed after 1:1 matching. The mean operative time was 8.8 min shorter (P < .01), and the mean amount of drainage was 40.0 ml greater (P = .04) in the cementless cohort. At 1-year postoperatively, there were no significant differences in both cohorts in 2011 Knee Scores and Forgotten Joint Scores-12, with no patients requiring revision surgery (NS). The incidence of RLLs was significantly higher in cementless TKAs (51%) than that in cemented TKAs (22%, P < .01). However, the mean width of RLLs in the cementless TKAs (0.2 mm) was significantly smaller (P < .01) than that in the cemented TKAs (0.8 mm) at 1-year postoperatively with no progression. CONCLUSION A recently introduced cementless PS mobile-bearing TKA design demonstrated comparable postoperative and radiographical results to its cemented predecessor at 1-year follow-up. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Yoshinori Mikashima
- Oume Knee Surgery Center, Takagi Hospital, Imadera 5-18-19, Oume City, Tokyo, Japan.
| | - Hitoshi Imamura
- Oume Knee Surgery Center, Takagi Hospital, Imadera 5-18-19, Oume City, Tokyo, Japan
| | - Yoshiko Shirakawa
- Oume Knee Surgery Center, Takagi Hospital, Imadera 5-18-19, Oume City, Tokyo, Japan
| | - Koichiro Yano
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
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Carlson BJ, Gerry AS, Hassebrock JD, Christopher ZK, Spangehl MJ, Bingham JS. Clinical outcomes and survivorship of cementless triathlon total knee arthroplasties: a systematic review. Arthroplasty 2022; 4:25. [PMID: 35655250 PMCID: PMC9164316 DOI: 10.1186/s42836-022-00124-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Over the last decade, cementless total knee arthroplasty has demonstrated improved outcomes and survivorship due to advances in technologies of implant design, manufacturing capabilities, and biomaterials. Due to increasing interest in cementless implant design for TKA, our aim was to perform a systematic review of the literature to evaluate the clinical outcomes and revision rates of the Triathlon Total Knee system over the past decade. Methods A systematic review of the literature was conducted following PRISMA guidelines for patients who underwent total knee arthroplasty with cementless Triathalon Total Knee System implants. Patients had a minimum of two-year follow-up and data included clinical outcome scores and survivorship data. Results Twenty studies were included in the final analysis. The survivability of the Stryker Triathlon TKA due to all causes was 98.7%, with an aseptic survivability of 99.2%. The overall revision incidence per 1,000 person-years was 3.4. Re-revision incidence per 1,000 person-years was 2.2 for infection, and 1.3 for aseptic loosening. The average KSS for pain was 92.2 and the average KSS for function was 82.7. Conclusions This systematic review demonstrated excellent clinical outcomes and survivorship at a mean time of 3.8 years. Additional research is necessary to examine the long-term success of the Stryker Triathlon TKA and the use of cementless TKAs in obese and younger populations. Level of evidence III.
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Affiliation(s)
- Brian J Carlson
- Department of Orthopedics, Mayo Clinic Arizona, 5777 E Mayo Boulevard, Maricopa, Phoenix, AZ, 85260, USA
| | - Adam S Gerry
- Elson S. Floyd College of Medicine, Washington State University, 412 E Spokane Falls Blvd, Spokane, Whitman, WA, 99202, USA
| | - Jeffrey D Hassebrock
- Midwestern University, Arizona College of Osteopathic Medicine, 19555 N 59th Ave. Glendale, Los Angeles, AZ, 85308, USA
| | - Zachary K Christopher
- Midwestern University, Arizona College of Osteopathic Medicine, 19555 N 59th Ave. Glendale, Los Angeles, AZ, 85308, USA.
| | - Mark J Spangehl
- Midwestern University, Arizona College of Osteopathic Medicine, 19555 N 59th Ave. Glendale, Los Angeles, AZ, 85308, USA
| | - Joshua S Bingham
- Midwestern University, Arizona College of Osteopathic Medicine, 19555 N 59th Ave. Glendale, Los Angeles, AZ, 85308, USA
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Knudsen MB, Thillemann JK, Jørgensen PB, Jakobsen SS, Daugaard H, Søballe K, Stilling M. Electrochemically applied hydroxyapatite on the cementless porous surface of Bi-Metric stems reduces early migration and has a lasting effect : an efficacy trial of a randomized five-year follow-up radiostereometric study. Bone Joint J 2022; 104-B:647-656. [PMID: 35638207 DOI: 10.1302/0301-620x.104b6.bjj-2021-1545.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS BoneMaster is a thin electrochemically applied hydroxyapatite (HA) coating for orthopaedic implants that is quickly resorbed during osseointegration. Early stabilization is a surrogacy marker of good survival of femoral stems. The hypothesis of this study was that a BoneMaster coating yields a fast early and lasting fixation of stems. METHODS A total of 53 patients were randomized to be treated using Bi-Metric cementless femoral stems with either only a porous titanium plasma-sprayed coating (P group) or a porous titanium plasma-sprayed coating with an additional BoneMaster coating (PBM group). The patients were examined with radiostereometry until five years after surgery. RESULTS At three months, the mean total translation (TT) was 0.95 mm (95% confidence interval (CI) 0.68 to 1.22) in the P group and 0.57 mm (95% CI 0.31 to 0.83) in the PBM group (p = 0.047). From two to five years, the TT increased by a mean of 0.14 mm (95% CI 0.03 to 0.25) more in the P group than in the PBM group (p = 0.021). In osteopenic patients (n = 20), the mean TT after three months was 1.61 mm (95% CI 1.03 to 2.20) in the P group and 0.73 mm (95% CI 0.25 to 1.21) in the PBM group (p = 0.023). After 60 months, the mean TT in osteopenic patients was 1.87 mm (95% CI 1.24 to 2.50) in the P group and 0.82 mm (95% CI 0.30 to 1.33) in the PBM group (p = 0.011). CONCLUSION There was less early and midterm migration of cementless stems with BoneMaster coating compared with those with only a porous titanium plasma-sprayed coating. Although a BoneMaster coating seems to be important for stem fixation, especially in osteopenic patients, further research is warranted. Cite this article: Bone Joint J 2022;104-B(6):647-656.
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Affiliation(s)
- Martin B Knudsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Janni K Thillemann
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning, Denmark
| | - Peter B Jørgensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Stig S Jakobsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Daugaard
- Department of Orthopaedics, Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - Kjeld Søballe
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Raja BS, Gowda AK, Singh S, Ansari S, Kalia RB, Paul S. Comparison of functional outcomes and complications of cemented vs uncemented total hip arthroplasty in the elderly neck of femur fracture patients: A systematic review and meta-analysis. J Clin Orthop Trauma 2022; 29:101876. [PMID: 35515344 PMCID: PMC9062326 DOI: 10.1016/j.jcot.2022.101876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures. MATERIAL AND METHODS The search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article. RESULTS A total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups. CONCLUSION Choosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis.
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Affiliation(s)
- Balgovind S. Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aditya K.S. Gowda
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Sajid Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India,Corresponding author.
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Belgaïd V, Viste A, Fessy MH. Cementless hydroxyapatite-coated stem with dual mobility and posterior approach in over-80 year-old patients with osteoarthritis: Rates of dislocation and periprosthetic fracture at a mean 8 years' follow-up. Orthop Traumatol Surg Res 2022; 108:103196. [PMID: 34958972 DOI: 10.1016/j.otsr.2021.103196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Straight cementless stems are common in primary total hip arthroplasty (THA) in the elderly, but controversial due to higher risk of loosening and periprosthetic fracture (PPF). Apart from registries, results for the Corail implant and dual mobility (DM) in over-80 years-old are not known, notably in case of systematic association to a DM cup. We therefore performed a retrospective analysis of Corail implants in patients aged≥80years at implantation for osteoarthritis of the hip, assessing 1) PPF rate and survival for cementless straight stems associated to DM cups, 2) complications, and dislocation in particular, and 3) clinical scores. HYPOTHESIS PPF and dislocation rates are low in THA with cementless straight stem associated to DM cup in patients aged≥80years. PATIENTS METHODS A retrospective study was conducted in our department for the period July 2007 to December 2012. Inclusion criteria were age≥80years, with primary THA for osteoarthritis. Exclusion criteria were revision procedure and femoral neck fracture. One hundred and twenty-eight consecutive THAs were included, in 120 patients, with a minimum 5years' follow-up. Clinical results were assessed on Harris Hip Score (HHS) and Oxford Hip Score (OHS). Data were collected for PPF or dislocation and other complications. RESULTS At a mean 8±1 years' follow-up (range, 5-10 years), 66 patients (55%, for 68 hips) were alive, 48 (40%, for 54 hips) had died, and 6 (5%, for 6 hips) were lost to follow-up. Median age at surgery was 83years (range, 80-93years). Mean OHS at last follow-up was 41±6 (range, 21-48) and HHS 83±14 (range, 23-100) with mean gain of 32 points (95% CI, [28-36]; p<0.001)). There were 2 cases (1.6%) of PPF, at 2 and 65months, and no dislocations or cases of aseptic loosening. There were 2 cases (1.6%) of intraoperative calcar fracture, treated by wire cerclage with immediate complete weight-bearing, without further complications. With death as a competing risk, cumulative 10-year incidence of femoral stem revision was 1.6% [95% CI: 0.4-6.5], and cumulative incidence of all-cause revision was 4.1% [95% CI: 1.7-9.7]. DISCUSSION In an over-80 year-old population, primary THA with straight cementless stem and 2nd generation dual mobility cup was an effective option with low risk of PPF or dislocation after a minimum 5-year of follow-up. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Vincent Belgaïd
- Service de chirurgie orthopédique et traumatologique, hospices Civils de Lyon, hôpital Lyon Sud, 165, Chemin du Grand Revoyet, 69495 Pierre Bénite Cedex, France
| | - Anthony Viste
- Service de chirurgie orthopédique et traumatologique, hospices Civils de Lyon, hôpital Lyon Sud, 165, Chemin du Grand Revoyet, 69495 Pierre Bénite Cedex, France; Univ de Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMRT, 9406 Lyon, France.
| | - Michel-Henri Fessy
- Service de chirurgie orthopédique et traumatologique, hospices Civils de Lyon, hôpital Lyon Sud, 165, Chemin du Grand Revoyet, 69495 Pierre Bénite Cedex, France; Univ de Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMRT, 9406 Lyon, France
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Ma HH, Chou TFA, Tsai SW, Chen CF, Wu PK, Chen WM. Is there a role for cementless primary stem in hip arthroplasty for early or late fixation failures of intertrochanteric fractures? BMC Musculoskelet Disord 2022; 23:266. [PMID: 35303844 PMCID: PMC8933997 DOI: 10.1186/s12891-022-05223-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background The choice of femur stems during the hip arthroplasty procedures for patients with treatment failure of intertrochanteric fractures (ITF) remains controversial. We aimed to compare the surgical complication and reoperation rates between cementless primary and revision stems in the early (≤3 months) and late (> 3 months) fixation failures of ITF. Methods This was a retrospective, cohort study conducted in a single, tertiary referral hospital of Taipei, Taiwan. We included hip arthroplasty procedures for failed ITF using cementless primary or revision stems. There were 40 and 35 patients who had early and late fixation failure of ITF, respectively. The patient demographics, time to fixation failure, surgical complications and medical complications were recorded for analysis. Results We included 75 patients that underwent hip arthroplasty procedure for failed ITF using cementless primary (n = 38) or revision (n = 37) stems. The mean age was 79.3 years and 56% of the patients were female. In the early fixation failure group, the complication rate was similar between the primary and revision stems (44% vs. 29%, p = 0.343). However, there was a trend toward a higher reoperation rate (31% vs. 8%, p = 0.061) of using the primary stem, compared with the revision stem. In the late fixation failure group, the rate of complication and reoperation was similar between the two stem types. Conclusion For early fixation failures of ITFs, we caution against the use of cementless primary stems due to a trend towards an increased risk of reoperations compared to the use of cementless revision stems. However, in late fixation failures of ITFs, there is a role for cementless primary stems. Level of evidence III, retrospective cohort study. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05223-x.
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Affiliation(s)
- Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan. .,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Abstract
AIMS Total hip arthroplasty (THA) is a very successful and cost-effective operation, yet debate continues about the optimum fixation philosophy in different age groups. The concept of the 'cementless paradox' and the UK 'Getting it Right First Time' initiative encourage increased use of cemented fixation due to purported lower revision rates, especially in elderly patients, and decreased cost. METHODS In a high-volume, tertiary referral centre, we identified 10,112 THAs from a prospectively collected database, including 1,699 cemented THAs, 5,782 hybrid THAs, and 2,631 cementless THAs. The endpoint was revision for any reason. Secondary analysis included examination of implant survivorship in patients aged over 70 years, over 75 years, and over 80 years at primary THA. RESULTS Cemented fixation had the lowest implant survival in all age groups, with a total ten-year survivorship of 97.0% (95% confidence interval (CI) 95.8 to 97.8) in the cemented group, 97.6% (95% CI 96.9 to 98.1) in the hybrid group, and 97.9% (95% CI 96.9 to 98.6) in the cementless group. This was not statistically significant (p = 0.092). There was no age group where cemented fixation outperformed hybrid or cementless fixation. CONCLUSION While all fixation techniques performed well at long-term follow-up, cemented fixation was associated with the lowest implant survival in all age groups, including in more elderly patients. We recommend that surgeons should carefully monitor their own outcomes and use fixation techniques that they are familiar with, and deliver the best outcomes in their own hands. Cite this article: Bone Joint J 2022;104-B(2):206-211.
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Affiliation(s)
- Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jonathan J E White
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hosam E Matar
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Reshid Berber
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew R J Manktelow
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Dammerer D, Blum P, Putzer D, Krappinger D, Liebensteiner MC, Nogler M, Thaler M. Subsidence of a metaphyseal-anchored press-fit stem after 4-year follow-up: an EBRA-FCA analysis. Arch Orthop Trauma Surg 2022; 142:2075-82. [PMID: 34287700 DOI: 10.1007/s00402-021-04068-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 07/10/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Uncemented stem migration analysis by EBRA-FCA (Einzel-Bild-Roentgen Analyse, Femoral Component Analyse) has been seen to be a good predictive indicator for early implant failure. In this study, we investigated the migration behavior of a cementless metaphyseal-anchored press-fit stem after 4-year follow-up. METHODS Applying a retrospective study design, we reviewed all consecutive patients who between 2012 and 2017 received a cementless Accolade II press-fit stem at our Department. We reviewed medical histories and performed radiological measurements using EBRA-FCA software. EBRA-FCA measurements and statistical investigations were performed by two independent investigators. RESULTS A total of 102 stems in 91 patients (female 60; male 31) fulfilled our inclusion criteria. Mean age at surgery was 66.2 (range 24.3-92.6) years. EBRA migration analysis showed a mean subsidence of 1.4 mm (range 0.0-12.0) at final follow-up. The angle between stem and femur axis was 0.5° (range 0.0°-2.8°) after 48 months. No correlations between gender or Dorr types and subsidence were found (p > 0.05). A body mass index > 30 kg/m2 showed a significant increase in stem subsidence within the first 6 (p = 0.0258) and 12 months (p = 0.0466) postoperative. CONCLUSIONS Migration pattern of the metaphyseal-anchored stem and a low subsidence rate at final follow-up may predict a good long-term clinical result. TRIAL REGISTRATION Number: 20181024-1875.
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Gifstad T, Nordskar JJ, Egeberg T, Wik TS, Winther SB. Cementless unicompartmental knee arthroplasty results in higher pain levels compared to the cemented technique: a prospective register study. Knee Surg Sports Traumatol Arthrosc 2022; 30:2738-2743. [PMID: 34036403 PMCID: PMC9309142 DOI: 10.1007/s00167-021-06617-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE In recent years, the preferred fixation method for unicompartmental knee arthroplasty (UKA) has changed from cemented to cementless. The aim of this study was to compare patient-reported outcome measures (PROMs) from the cemented versus cementless techniques two- and twelve-months post-operation. METHODS From 2015 to 2019, 187 cemented and 261 cementless UKAs were included based on an institutional registry. The Oxford Unicompartmental Knee System™ (Zimmer Biomet, Bridgend, United Kingdom) was used for all patients. Three experienced surgeons performed all procedures. Data were collected pre- and peroperatively, and at two- and twelve-months postoperatively. PROMs included pain (evaluated on a numeric rating scale [NRS] during activity and at rest), and knee function (evaluated with the disease-specific short form of the Knee injury and Osteoarthritis Outcome Score [KOOS-PS]). Patients also rated postoperative joint function (better, unchanged, uncertain or worse) and were asked, "based on your experience to date, would you go through the surgery again?". Duration of surgery was noted and revisions during the first post-operative year were evaluated. RESULTS The cemented group reported significantly lower activity-related pain at both two- and twelve-month follow-up. This was also the case for pain at rest at twelve-month follow-up, and KOOS-PS at two-month follow-up. Duration of surgery (adjusted for surgeon differences) was eight minutes less on average with the cementless technique. Eleven prosthetic joint infections (PJIs) were found following the cementless fixation technique compared to three using the cemented implant. CONCLUSION UKA cases with cemented implants had lower pain scores during activity two and twelve months after surgery compared with those who had cementless implants. Differences in favor of the cemented group were also found for pain at rest one year after surgery and for KOOS-PS two months after. Surgery was significantly shorter in duration in the cementless group, but a relatively high number of PJIs were found in that same group. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Tone Gifstad
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway.
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Jørgen Jebens Nordskar
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway
| | - Tarjei Egeberg
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway
| | - Tina Strømdal Wik
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siri Bjørgen Winther
- Department of Orthopaedics, Orthopaedic Research Center, Trondheim University Hospital, Trondheim, Norway
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Dammerer D, Blum P, Putzer D, Krappinger D, Pabinger C, Liebensteiner MC, Thaler M. Migration characteristics of the Corail hydroxyapatite-coated femoral stem-a retrospective clinical evaluation and migration measurement with EBRA. Arch Orthop Trauma Surg 2022; 142:517-524. [PMID: 33999259 PMCID: PMC8843908 DOI: 10.1007/s00402-021-03926-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/29/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Uncemented stem migration analysis by EBRA-FCA (Einzel-Bild-Roentgen Analyse, Femoral Component Analysis) has been seen to be a good predictive indicator for early implant failure. In this study, we investigated the migration behavior of a cementless press-fit stem after two years follow-up. Stem type and postoperative gap between collar and femur were evaluated as a risk factor. METHODS Applying a retrospective study design, we reviewed all consecutive patients who between 2013 and 2017 received a cementless press-fit Corail stem (DePuy Orthopaedics Inc., Warsaw, IN, USA) at our Department. We reviewed medical histories and performed radiological measurements using EBRA-FCA software. RESULTS A total of 109 stems in 105 patients (female: 60; male: 45) fulfilled our inclusion criteria. Mean age at surgery was 67.8 (range, 21.6-90.5) years. EBRA migration analysis showed a mean subsidence of 1.8 mm (range, 0.0-12.1) at final follow-up. At 18 months mean subsidence of collared stems was significantly lower than in the collarless group [1.3 mm (range, 0.0-7.6) vs. 3.2 mm (range, 0.5-10.7), p = 0.0104]. Collared stems resting on the femoral cut presented a tendency to less subsidence than did collared stems showing a postoperative gap between collar and femur (1.3 vs. 2.0 mm) without finding statistical significance (p > 0.05). CONCLUSIONS Low subsidence and the migration pattern of the cementless press-fit stem may predict a good long-term result. Collared stems investigated in our study provide good stability and are able to prevent significant subsidence. Trial registration number and date of registration: Number: 20181024-1875; Date: 2018-10-24.
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Affiliation(s)
- Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Philipp Blum
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - David Putzer
- Department of Experimental Orthopaedics, Medical University of Innsbruck, Sonnenburgstr. 16, 6020 Innsbruck, Austria
| | - Dietmar Krappinger
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Christof Pabinger
- Medical University of Innsbruck, Christoph-Probst-Platz 52, 6020 Innsbruck, Austria
| | - Michael C. Liebensteiner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Martin Thaler
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Martin B, Rahman A, Jenkins C, Mohammad H, Barker K, Dodd C, Jackson W, Price A, Mellon S, Murray D. Comparison of five-year clinical outcomes of 524 cemented and cementless medial unicompartmental knee replacements. Knee 2022; 34:89-97. [PMID: 34883332 DOI: 10.1016/j.knee.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/08/2021] [Accepted: 08/13/2021] [Indexed: 02/02/2023]
Abstract
AIM To compare the outcomes of cemented and cementless Unicompartmental Knee Replacements (UKR) at 5 years after surgery. METHODS 262 cemented and 262 cementless medial mobile-bearing UKR, implanted by four high-volume surgeons using identical indications and surgical techniques, were reviewed by independent physiotherapists at 5 years. Survival, Oxford Knee Score (OKS), American Knee Society Score (AKSS), and EQ-5D-5L were assessed. The cementless cohort was mainly implanted after the cemented. Each cohort was divided into early and late sub-groups and compared, to assess if any differences were due to progressive improvement in surgical practice over time. RESULTS There were no significant differences between the cohorts for demographics, pre-operative scores, and 5-year revision (0.8%), re-operation (1.5%), and complication rates (5%). The cementless cohort had significantly better 5-year OKS (43v41, p = 0.008), AKSS-Objective (94v90, p = 0.049) and EQ-5D-5L (0.81v0.87, p = 0.0001). Pain sub-scores within OKS, AKSS, and EQ-5D-5L were also significantly better in the cementless cohort, and the differences were proportionally much greater and more significant than differences in their respective overall scores. There was no significant improvement in scores between the early and late subgroups of the cohorts, whereas the 'early-cementless' cohort had significantly better scores than the contemporaneously implanted 'late-cemented' cohort. This suggests that differences found were due to implant type, instead of improved surgical practice over time. CONCLUSION Cementless UKR is associated with better clinical outcomes than cemented UKR, which is primarily due to improved pain relief. Both cemented and cementless UKR are safe with low reoperation and complication rates, and a 5-year survival of 99%.
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Affiliation(s)
- Benjamin Martin
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Azmi Rahman
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
| | - Cathy Jenkins
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Hasan Mohammad
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christopher Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - William Jackson
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Andrew Price
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Stephen Mellon
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - David Murray
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Okowinski M, Hjorth MH, Mosegaard SB, Jürgens-Lahnstein JH, Storgaard Jakobsen S, Hedevang Christensen P, Kold S, Stilling M. Ten-year comparison of two different techniques for femoral bone cavity preparation-broaching versus compaction in patients with cementless total hip arthroplasty : a randomized radiostereometric study of 30 total hip arthroplasties in 15 patients operated bilaterally. Bone Jt Open 2021; 2:1035-1042. [PMID: 34865512 PMCID: PMC8711659 DOI: 10.1302/2633-1462.212.bjo-2021-0152.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aims Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. Methods A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. Results Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. Conclusion Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042.
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Affiliation(s)
- Maciej Okowinski
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Holm Hjorth
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Breddam Mosegaard
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan Hugo Jürgens-Lahnstein
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Kold
- Department of Orthopedics, Aalborg University Hospital, Aalborg, Denmark
| | - Maiken Stilling
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Rodriguez S, Ranawat AS. The Future is Non-cemented Total Knee Arthroplasty: Volume Trends at the Hospital for Special Surgery. Indian J Orthop 2021; 55:1096-1100. [PMID: 34629497 PMCID: PMC8487231 DOI: 10.1007/s43465-021-00508-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/02/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The optimal fixation method for total knee arthroplasty (TKA) is still a debate. Cemented fixation has excellent long-term results and is the gold standard. However, longevity in the younger, heavier, and more active population is suboptimal. Cementless TKA offers the opportunity to gain biological fixation and overcome these shortcomings. METHODS This is a retrospective review of all consecutive cementless TKA procedures performed at a single academic institution from 2016 until 2020. Demographics, aseptic revisions, and septic revisions were pulled from the electronic medical record. The number of yearly implanted cementless TKA prosthesis was determined to analyze utilization trends. RESULTS Eight-hundred and two patients were identified with a mean age of 61.57 ± 7.78 years, and a mean of BMI 32.12 ± 5.98 kg/m2. The mean time to revision was 12.31 ± 13.91 months. There were four septic failures and nine aseptic failures during the study period. Of these nine aseptic failures only five were due to mechanical loosening. There was a yearly linear increase in the use of cementless fixation. CONCLUSION Cementless fixation is here to stay, and its use will continue to increase. Early and mid-term outcomes have been excellent thus far. Changing clinical practice takes time but we have already seen this transition take place in total hip arthroplasty. As technology and design continue to evolve, we believe it is a possibility.
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Affiliation(s)
- Samuel Rodriguez
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 E70th Street, New York, NY 10021 USA
| | - Amar S. Ranawat
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 E70th Street, New York, NY 10021 USA
- Weill Cornell Medical College, New York, USA
- NewYork-Presbyterian Hospital, New York, USA
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Floría-Arnal LJ, Gómez-Blasco A, Roche-Albero A, Panisello-Sebastia JJ, Martin-Martinez A, Martin-Hernández C. Tibial tray cementation is not necessary for knee revision with titanium metaphyseal sleeves: a mid-term prospective study in AORI 2B defects. Knee Surg Sports Traumatol Arthrosc 2021; 29:3310-3315. [PMID: 32734330 DOI: 10.1007/s00167-020-06185-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Metaphyseal fixation with porous titanium sleeves in revision knee surgery provides mechanical support to the implant, promotes biological fixation, and has shown satisfactory short- and mid-term results. Cement is commonly used to fix the tibial tray to the epiphyseal area. The objective of this study is to determine whether cement should be used to achieve fixation of the tibial tray with the hypothesis that metaphyseal sleeves would provide enough axial and rotational stability making cementation unnecessary. MATERIAL AND METHODS Prospective study of 60 patients undergoing knee replacement surgery with metaphyseal sleeves in type 2B defects in femur and tibia. Patients were divided into two groups according to the use of cement on the tibial component. Analysis included the American Knee Society Score (KSS) knee and functional scales, the Western Ontario and McMaster Universities (WOMAC) index, the Short Form 12 (SF-12) health survey, and radiographic assessment with a maximum follow-up of 5 years. RESULTS No statistically significant differences were found between the two groups in any of the parameters assessed. CONCLUSION Metaphyseal sleeves showed a 100% survivorship at five years of followup. There were no differences in clinical and radiographic outcomes at five years of follow-up depending on whether or not cement was used for tibial platform fixation. Cementation of the tibial tray would therefore not be required to achieve satisfactory mid-term results. LEVEL OF EVIDENCE Level II: prospective cohort study. Therapeutic.
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Affiliation(s)
- L J Floría-Arnal
- Department of Orthopedics, University Hospital Miguel Servet, IIS Aragon, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain.
| | - A Gómez-Blasco
- Department of Orthopedics, University Hospital Miguel Servet, IIS Aragon, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain
| | - A Roche-Albero
- Department of Orthopedics, University Hospital Miguel Servet, IIS Aragon, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain
| | - J J Panisello-Sebastia
- Department of Orthopedics, University Hospital Miguel Servet, IIS Aragon, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain
| | - A Martin-Martinez
- Department of Orthopedics, University Hospital Miguel Servet, IIS Aragon, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain
| | - C Martin-Hernández
- Department of Orthopedics, University Hospital Miguel Servet, IIS Aragon, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain
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Crawford DA, Berend KR. Reduction of Periprosthetic Proximal Femur Fracture in Direct Anterior Total Hip According to Stem Design. Orthop Clin North Am 2021; 52:297-304. [PMID: 34538342 DOI: 10.1016/j.ocl.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The direct anterior approach (DAA) is gaining popularity in primary total hip arthroplasty (THA). Although DAA has demonstrated many advantages over other surgical approaches, periprosthetic femur fractures (PPFF) rates continue to be higher. Femoral stem designs that allow for easier insertion via a DAA may contribute to the higher rates of fracture seen in this approach. Certain stem designs and fixation methods may reduce the risk of PPFF via a DAA in primary THA.
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Affiliation(s)
- David A Crawford
- JIS Orthopedics, 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA.
| | - Keith R Berend
- JIS Orthopedics, 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA
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45
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Freeman MH, Kildow BJ, Larson TJ, Bailey ZC, Lyden ER, Garvin KL. Ten-Year Survivorship and Risk of Periprosthetic Fracture of a Cementless Tapered Stem. Orthop Clin North Am 2021; 52:317-21. [PMID: 34538344 DOI: 10.1016/j.ocl.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article is a retrospective review of a consecutive series of 401 primary total hip arthroplasties with the use of cementless, ream and broach Synergy stem (Smith & Nephew, Memphis, TN, USA) with minimal 10-year follow-up. We report an overall 10-year survivorship of 99.6% with a total of 15 fractures during the study period. Six of these fractures occurred intraoperatively. This is the largest series to our knowledge reporting greater than 10-year follow-up. This stem has excellent survivorship with overall low risk of periprosthetic fracture.
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Hashimoto A, Sonohata M, Kii S, Kawano S, Mawatari M. Hydroxyapatite-coated cementless total hip arthroplasty for patients undergoing dialysis: a study of 30 hips with a minimum follow-up period of 5 years. BMC Musculoskelet Disord 2021; 22:842. [PMID: 34592965 PMCID: PMC8485528 DOI: 10.1186/s12891-021-04718-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background The number of total hip arthroplasties (THAs) performed for patients undergoing dialysis is increasing. However, there are few reports of cementless THA for patients undergoing dialysis. This study investigated the mid-term to long-term results of hydroxyapatite (HA)-coated cementless THA for dialysis patients. Methods This single-center, retrospective study enrolled dialysis patients undergoing primary HA-coated cementless THA. A total of 24 patients (30 hips) were included in the final analyses. The Harris hip score and radiographic results were assessed preoperatively and during the final follow-up examination. Postoperative complications and mortality rates were recorded. The mean follow-up period was 109 months (range, 60–216 months). Results The total Harris hip score significantly improved from 40 to 84 points. The overall cumulative survival rates with revision as the endpoint were 100% at 5 years and 90.4% at both 10 and 15 years. Stress shielding was observed in 24 hips (80%). No deaths were related to the primary THA. Complications included periprosthetic fracture for one patient (3.3%), blood transfusion for nine patients (30%), shunt blockage for two patients (6.7%), deep infection for one patient (3.3%), and dislocation for two patients (6.7%). Conclusions HA-coated cementless THA resulted in good mid-term outcomes for patients undergoing dialysis with no mortality risk. However, the procedure involved a relatively high perioperative risk of blood transfusion. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04718-3.
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Affiliation(s)
- Akira Hashimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan.
| | - Sakumo Kii
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Shunsuke Kawano
- Research Center of Arthroplasty, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
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47
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Sagers KM, Creech JD, Shields JS, Pollock DC, Langfitt MK, Plate JF. Removing Well-Fixed, Collared and Noncollared Tapered Hip Stems Without an Extended Trochanteric Osteotomy Using a Novel Stem Removal System. Arthroplast Today 2021; 11:146-150. [PMID: 34541268 PMCID: PMC8435937 DOI: 10.1016/j.artd.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/17/2021] [Accepted: 07/17/2021] [Indexed: 12/29/2022] Open
Abstract
Improvements in materials, components, and surgical techniques in cementless total hip arthroplasty are resulting in improved femoral stem fixation through bony ongrowth or ingrowth. While improved femoral stem fixation is one reason for the current excellent total hip survivorship, indications for stem removal such as infection, implant fracture, or osteolysis remain. A commonly used technique for fully ingrown femoral stems is an extended trochanteric osteotomy which can result in comminuted fractures of the proximal femur during stem removal requiring additional fixation. Therefore, a novel hip stem removal was developed to facilitate removal of these well-ingrown stems without the need for an extended trochanteric osteotomy. This study describes the removal system and surgical technique and presents a case series of successfully removed ingrown stems.
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Affiliation(s)
- Kevin M Sagers
- Department of Orthopaedic Surgery, Division of Adult Reconstruction, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jonathan D Creech
- Department of Orthopaedic Surgery, Division of Adult Reconstruction, Wake Forest School of Medicine, Winston-Salem, NC
| | - John S Shields
- Department of Orthopaedic Surgery, Division of Adult Reconstruction, Wake Forest School of Medicine, Winston-Salem, NC
| | - David C Pollock
- Department of Orthopaedic Surgery, Division of Adult Reconstruction, Wake Forest School of Medicine, Winston-Salem, NC
| | - Maxwell K Langfitt
- Department of Orthopaedic Surgery, Division of Adult Reconstruction, Wake Forest School of Medicine, Winston-Salem, NC
| | - Johannes F Plate
- Department of Orthopaedic Surgery, Division of Adult Reconstruction, Wake Forest School of Medicine, Winston-Salem, NC.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
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48
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Abstract
AIMS Cementless total knee arthroplasty (TKA) offers the potential for strong biological fixation compared with cemented TKA where fixation is achieved by the mechanical integration of the cement. Few mid-term results are available for newer cementless TKA designs, which have used additive manufacturing (3D printing). The aim of this study was to present mid-term clinical outcomes and implant survivorship of the cementless Stryker Triathlon Tritanium TKA. METHODS This was a single institution registry review of prospectively gathered data from 341 cementless Triathlon Tritanium TKAs at four to 6.8 years follow-up. Outcomes were determined by comparing pre- and postoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) scores, and pre- and postoperative 12-item Veterans RAND/Short Form Health Survey (VR/SF-12) scores. Aseptic loosening and revision for any reason were the endpoints which were used to determine survivorship at five years. RESULTS At mid-term follow-up, the mean KOOS JR score improved significantly from 33.14 (0 t0 85, standard deviation (SD) 21.88) preoperatively to 84.12 (15.94 to 100, SD 20.51) postoperatively (p < 0.001), the mean VR/SF-12 scores improved significantly from physical health (PH), 31.21 (SD 5.32; 23.99 to 56.77) preoperatively to 42.62 (SD 10.72; 19.38 to 56.82) postoperatively (p < 0.001) and the mental health (MH), 38.15 (SD 8.17; 19.06 to 60.75) preoperatively to 55.09 (SD 9.64; 19.06 to 66.98) postoperatively (p < 0.001). A total of 11 revisions were undertaken, with an overall revision rate of 2.94%, including five for periprosthetic joint infection (1.34%), three for loosening (0.80%), two for instability (0.53%), and one for pain (0.27%). The overall survivorship was 97.06% and survivorship for aseptic loosening as the endpoint was 98.40%, with a 99.5% survivorship of the 3D-printed tibial component. CONCLUSION This 3D-printed cementless total knee system shows excellent survivorship at mid-term follow-up. This design and the ability to obtain cementless fixation offers promise for excellent long-term durability. Cite this article: Bone Joint J 2021;103-B(6 Supple A):32-37.
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Affiliation(s)
- Santiago Restrepo
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eric B Smith
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - William James Hozack
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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49
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Christ AB, Hornicek FJ, Fabbri N. Distal femoral replacement - Cemented or cementless? Current concepts and review of the literature. J Clin Orthop Trauma 2021; 19:11-16. [PMID: 34040980 PMCID: PMC8138588 DOI: 10.1016/j.jcot.2021.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/22/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022] Open
Abstract
Distal femoral endoprosthetic replacement has been successfully used to reconstruct distal femoral defects after tumor resection for over four decades. Despite continued advances, aseptic loosening continues to be the most common failure mode after infection. Debate still exists about a variety of design features and the optimal fixation method remains controversial. To date, no large-scale study or meta-analysis has demonstrated the superiority of one fixation technique over another. While the classic dichotomy of cemented versus cementless stems is well-known, the contemporary surgeon needs to fully understand the optimal clinical setting for each type of fixation technique and additional strategies to maximize implant stability. In clinical practice, the choice of fixation must be tailored to the individual patient. The surgeon must consider whether the operation is being performed for primary sarcoma or metastatic carcinoma, the presence of distant metastases, age, comorbidities, and whether radiotherapy has been previously given or will be required at the site of fixation. The best strategy for each patient optimizes tumor control and appropriately weighs risks of fixation failure versus the expected patient survival. This review will explore cemented and uncemented distal femoral replacement and highlight modern concepts to optimize each technique.
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Affiliation(s)
- Alexander B. Christ
- Keck Hospital of the University of Southern California, Department of Orthopaedic Surgery, Los Angeles, CA, USA
- Corresponding author. Keck Hospital of the University of Southern California, Department of Orthopaedic Surgery 1520 San Pablo Street, Suite 2000 Los Angeles, CA, 90033, USA.
| | - Francis J. Hornicek
- University of California, Los Angeles, Department of Orthopaedic Surgery, Los Angeles, CA, USA
| | - Nicola Fabbri
- Memorial Sloan Kettering Cancer Center, Department of Surgery, Orthopaedic Service, New York, NY, USA
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50
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Abstract
AIMS The aim of this prospective cohort study was to evaluate the early migration of the TriFit cementless proximally coated tapered femoral stem using radiostereometric analysis (RSA). METHODS A total of 21 patients (eight men and 13 women) undergoing primary total hip arthroplasty (THA) for osteoarthritis of the hip were recruited in this study and followed up for two years. Two patients were lost to follow-up. All patients received a TriFit stem and Trinity Cup with a vitamin E-infused highly cross-linked ultra-high molecular weight polyethylene liner. Radiographs for RSA were taken postoperatively and then at three, 12, and 24 months. Oxford Hip Score (OHS), EuroQol five-dimension questionnaire (EQ-5D), and adverse events were reported. RESULTS At two years, the mean subsidence of the head and tip for the TriFit stem was 0.38 mm (SD 0.32) and 0.52 mm (SD 0.36), respectively. The total migration of the head and tip was 0.55 mm (SD 0.32) and 0.71 mm (SD 0.38), respectively. There were no statistically significant differences between the three to 12 months' migration (p = 0.105) and 12 to 24 months' migration (p = 0.694). The OHS and EQ-5D showed significant improvements at two years. CONCLUSION The results of this study suggest that the TriFit femoral stem achieves initial stability and is likely to be stable in the mid and long term. A long-term outcome study is required to assess late mechanisms of failure and the effects of bone mineral density (BMD) related changes. Cite this article: Bone Joint J 2021;103-B(4):644-649.
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Affiliation(s)
- Joseph Alsousou
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Emeka Oragui
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alexander Martin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Louise Strickland
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Simon Newman
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ben Kendrick
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Adrian Taylor
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Siôn Glyn-Jones
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
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