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Vasiliadis AV, Lording T, Canetti R, Servien E, Lustig S, Batailler C. How often do we need offset stems for revision total knee arthroplasty? About a consecutive series of 789 knees. SICOT J 2023; 9:15. [PMID: 37246944 DOI: 10.1051/sicotj/2023012] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/22/2023] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION This study aimed to determine the incidence of offset stem usage in revision total knee arthroplasty (rTKA), and to assess the necessity for their use with the femoral and tibial components. METHODS This retrospective radiological study included 862 patients who underwent rTKA between 2010 and 2022. Patients were divided into a non-stem group (group NS), offset stem group (group OS), and straight stem group (group SS). Two senior orthopedic surgeons evaluated all the post-operative radiographs of the group OS to assess the necessity of offset use. RESULTS In total, 789 patients met all eligibility inclusion criteria and were reviewed (305 males (38.7%)) with a mean age of 72.7 ± 10.2 years old [39; 96]. Eighty-eight (11.1%) patients had undergone rTKA with offset stems (34 tibia, 31 femur, 24 both) and 609 (70.2%) with straight stems. The tibial and femoral stems were diaphyseal of over 75 mm in 83 revisions (94.3%) for group OS and 444 revisions (72.9%) for group SS (p < 0.001). Offset in the tibial component was located medially in 50% of rTKA, while the offset in the femoral component was placed anteriorly in 47.3% of the rTKA. Assessment by the two independent senior surgeons found stems were only necessary in 3.4% of cases. Offset stems were only required for the tibial implant. DISCUSSION Offset stems were used in 11.1% of revision total knee replacements, however, they were deemed necessary in 3.4% and for the tibial component only.
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Affiliation(s)
- Angelo V Vasiliadis
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France - Orthopedic Department, General Hospital of Thessaloniki "Papageorgiou", 56403 Thessaloniki, Greece
| | - Timothy Lording
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia
| | - Robin Canetti
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France - LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 69100 Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France - University Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France - University Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
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Kawahara S, Mawatari T, Matsui G, Hamai S, Akasaki Y, Tsushima H, Nakashima Y. Improved surgical procedure of primary constrained total knee arthroplasty which enables use of the femoral diaphyseal straight extension stem. BMC Musculoskelet Disord 2022; 23:408. [PMID: 35501739 PMCID: PMC9063044 DOI: 10.1186/s12891-022-05367-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background In performing primary constrained total knee arthroplasties (TKA) to imbalanced knees, the offset stem is sometimes compelled to use, although this is associated with surgical difficulties. We developed a modified procedure which might be able to fit the anteroposterior (AP) and mediolateral (ML) position of the femoral component simultaneously with the straight stem. Purposes of this study were to evaluate usefulness of the modified procedure both in computer simulations and actual surgeries. Methods We included 32 knees that had undergone primary TKA using constrained implants because of the coronal imbalance. In the component-first procedure, the distal femur was prepared to fit the AP and ML position of the femoral component simultaneously at first, as in primary TKA. Finally, the stem hole is created based on the femoral component position (the component-first procedure). The femoral component and extension stem were simulated using the three-dimensional planning software (ZedKnee) following the component-first procedure. We investigated the suitability of the straight stem through computer simulation and evaluation of actual surgeries. Clinical and radiographical outcomes were also evaluated at the latest follow-up. Results The component-first procedure enabled the AP and ML position of the femoral component to be fitted simultaneously with the straight stem in simulations and actual surgeries in all cases. The stem diameter was not significantly different between simulations and actual surgeries (13.9 and 13.7 mm on average, respectively, p = 0.479) and almost similar from intraclass correlation coefficient analysis (kappa value 0.790). Clinical and radiographical outcomes were almost similar to primary TKA cases and there was no case of component loosening, cortical bone hypertrophy around the stem and stem-tip pain. Conclusions Our improved surgical procedure may facilitate use of the constrained implant for more cases of primary TKA in imbalanced knees without the usual surgical difficulties. Trial registration Retrospectively registered.
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Affiliation(s)
- Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Orthopaedic Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan.
| | - Taro Mawatari
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Orthopaedic Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan
| | - Gen Matsui
- Department of Orthopaedic Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidetoshi Tsushima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Pallaver A, Zwicky L, Bolliger L, Bösebeck H, Manzoni I, Schädelin S, Ochsner PE, Clauss M. Long-term results of revision total hip arthroplasty with a cemented femoral component. Arch Orthop Trauma Surg 2018; 138:1609-1616. [PMID: 30099575 PMCID: PMC6182687 DOI: 10.1007/s00402-018-3023-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [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: 04/24/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In revision total hip arthroplasty (THA), the cancellous bone is normally completely removed out of the femoral canal during stem extraction. This situation is comparable to primary THA following the shape-closed concept, with some authors advocating to remove the metaphyseal cancellous bone to enhance press-fit stability ("French paradox"). The aim of this study was to investigate the long-term outcome, regarding survival and radiological results, of a cemented straight stem when used for revision THA and to compare these results to the results of the same stem in primary THA. MATERIALS AND METHODS 178 stem revisions performed between 01/1994 and 08/2008 using the Virtec straight stem were included. The cumulative incidence for re-revision was calculated using a competing risk model. Risk factors for re-revision of the stem were analyzed using an absolute risk regression model. Radiographs analyzed for osteolysis, debonding and subsidence had a minimum follow-up of 10 years. RESULTS The cumulative incidence for re-revision due to aseptic loosening of the stem was 5.5% (95% CI, 2.9-10.2%) at 10 years. Aseptic loosening was associated with younger age, larger defect size and larger stem size. After a minimum 10-year follow-up, osteolysis was seen in 39 of 80 revision THA. Compared to the results in primary THA, the survival in revision THA with the same implant was inferior. CONCLUSIONS Cemented straight stems used for revision THA showed excellent long-term results regarding survivorship and radiological outcome. This stem therefore offers a valuable and cost-effective option in revision THA.
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Affiliation(s)
- Armin Pallaver
- grid.440128.bClinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Lukas Zwicky
- grid.440128.bClinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Lilianna Bolliger
- grid.440128.bClinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Hans Bösebeck
- grid.439024.8Heraeus Medical GmbH, Wehrheim, Germany
| | - Isabella Manzoni
- grid.440128.bClinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Sabine Schädelin
- grid.410567.1Clinical Trial Unit, University Hospital of Basel, Basel, Switzerland
| | - Peter E. Ochsner
- grid.440128.bClinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Martin Clauss
- grid.440128.bClinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
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Hochreiter J, Hejkrlik W, Emmanuel K, Hitzl W, Ortmaier R. Blood loss and transfusion rate in short stem hip arthroplasty. A comparative study. Int Orthop 2016; 41:1347-1353. [PMID: 27942850 DOI: 10.1007/s00264-016-3365-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 09/01/2016] [Accepted: 11/28/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Little scientific evidence on blood loss and transfusion rates after short-stem hip arthroplasty exists. The hypothesis of this study was that the blood loss and transfusion rate is lower in short stems compared to straight stems. METHODS We compared 124 patients who underwent total hip arthroplasty (THA) using a short-stem design (group 1) and 141 patients using a straight-stem design (group 2). All patients were operated on by the same surgeon, and both groups were similar in age, gender, affected side, body mass index, and ASA score. RESULTS The calculated blood loss was 1139 ml in group 1 and 1358 ml in group 2 (p < 0.001). The transfusion rate was 8% in group 1 and 15.6% in group 2 (p < 0.001). There was no significant difference between groups 1 and 2 regarding complications and operation time (p > 0.05). CONCLUSION Compared to patients after straight stem THA, both blood loss and blood transfusion rates were lower in patients after short stem THA.
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Affiliation(s)
- Josef Hochreiter
- Department of Orthopaedic Surgery, St. Vincent Hospital Linz, Seilerstätte 4, A-4020, Linz, Austria
| | - Wilfried Hejkrlik
- Department of Orthopaedic Surgery, St. Vincent Hospital Linz, Seilerstätte 4, A-4020, Linz, Austria
| | - Katja Emmanuel
- Department of Orthopaedic Surgery, St. Vincent Hospital Linz, Seilerstätte 4, A-4020, Linz, Austria
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria
| | - Wolfgang Hitzl
- Department of Biostatistics, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, St. Vincent Hospital Linz, Seilerstätte 4, A-4020, Linz, Austria.
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria.
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Siepen W, Zwicky L, Stoffel KK, Ilchmann T, Clauss M. Prospective two-year subsidence analysis of 100 cemented polished straight stems - a short-term clinical and radiological observation. BMC Musculoskelet Disord 2016; 17:395. [PMID: 27640188 PMCID: PMC5027091 DOI: 10.1186/s12891-016-1247-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [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: 04/09/2016] [Accepted: 09/09/2016] [Indexed: 01/14/2023] Open
Abstract
Background Cemented stems show good long-term results and the survival of new implants can be predicted by their early subsidence. With EBRA-FCA (Femoral Component Analysis using Einzel-Bild-Röntgen-Analyse) early subsidence as an early indicator for later aseptic loosening can be analysed. For the cemented TwinSys stem mid- and long-term data is only avalible from the New Zeeland Arthroplasty register, thus close monitoring of this implant system is still mandatory. Methods We conducted a 2 year follow up of 100 consecutive hybrid THA (Total hip arthroplasty) of a series of 285 primary THA operated between Jan 2009 und Oct 2010. These 100 received a polished, cemented collarless straight stem (twinSys®, Mathys AG® Bettlach, Switzerland) with an uncemented monobloc pressfit cup (RM pressfit®, Mathys AG® Bettlach, Switzerland). The other patients were treated with the uncemented version of this stem and the same cup. Clinical (Harris Hip Score) and radiological (ap and axial x-rays, cementing quality according to Barrack, alignment) outcomes besides an EBRA-FCA subsidence analysis were performed. Results Median age at operation was 78 (68 to 93) years. 5 patients died in the course of follow-up unrelated to surgery. The KM (Kaplan-Meier) survival at 2 years for the endpoint reoperation for any reason was 94.9 (95 % confidence interval 90.6–100 %). Survival for the endpoint aseptic loosening at 2 years was 100 %. The HHS (Harris Hip Score) improved from 56 (14–86) preoperatively to 95 (60–100) 2 years after the operation. Cementing results were judged 47 % Grade A, 45 % Grade B and 7 % Grade C. Osteolysis was found in 2 stems without clinical symptoms or correlation to subsidence or cementing quality. The EBRA-FCA analysis showed an average subsidence of -0.30 mm (95 % CI -0.5 mm to -0.1 mm). 11 patients showed a subsidence of more than 1 mm. In this group one patient showed a subsidence of 1.5 mm and one of 3.1 mm without further radiological changes. Conclusions The twinSys stem showed excellent clinical and radiologic short term results at 2 years follow-up and seems to be a reliable implant.
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Affiliation(s)
- Wolf Siepen
- Department for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, CH-4410, Liestal, Switzerland.
| | - Lukas Zwicky
- Department for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, CH-4410, Liestal, Switzerland
| | - Karl Kilian Stoffel
- Department for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, CH-4410, Liestal, Switzerland
| | - Thomas Ilchmann
- LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Martin Clauss
- Department for Orthopaedics and Trauma Surgery, Kantonsspital Baselland, CH-4410, Liestal, Switzerland
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Nikolaou VS, Korres D, Lallos S, Mavrogenis A, Lazarettos I, Sourlas I, Efstathopoulos N. Cemented Müller straight stem total hip replacement: 18 year survival, clinical and radiological outcomes. World J Orthop 2013; 4:303-308. [PMID: 24147267 PMCID: PMC3801251 DOI: 10.5312/wjo.v4.i4.303] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To present the 18 year survival and the clinical and radiological outcomes of the Müller straight stem, cemented, total hip arthroplasty (THA).
METHODS: Between 1989 and 2007, 176 primary total hip arthroplasties in 164 consecutive patients were performed in our institution by the senior author. All patients received a Müller cemented straight stem and a cemented polyethylene liner. The mean age of the patients was 62 years (45-78). The diagnosis was primary osteoarthritis in 151 hips, dysplasia of the hip in 12 and subcapital fracture of the femur in 13. Following discharge, serial follow-up consisted of clinical evaluation based on the Harris Hip Score and radiological assessment. The survival of the prosthesis using revision for any reason as an end-point was calculated by Kaplan-Meier analysis.
RESULTS: Twenty-four (15%) patients died during the follow-up study, 6 (4%) patients were lost, while the remaining 134 patients (141 hips) were followed-up for a mean of 10 years (3-18 years). HSS score at the latest follow-up revealed that 84 hips (59.5%) had excellent results, 30 (22.2%) good, 11 (7.8%) fair and 9 (6.3%) poor. There were 3 acetabular revisions due to aseptic loosening. Six (4.2%) stems were diagnosed as having radiographic definitive loosening; however, only 1 was revised. 30% of the surviving stems showed no radiological changes of radiolucency, while 70% showed some changes. Survival of the prosthesis for any reason was 96% at 10 years and 81% at 18 years.
CONCLUSION: The 18 year survival of the Müller straight stem, cemented THA is comparable to those of other successful cemented systems.
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