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Upadhyay PK, Shah N, Kumar V, Mirza SB. Hydroxyapatite ceramic-coated femoral components in younger patients followed up for 27 to 32 years. Bone Jt Open 2024; 5:286-293. [PMID: 38591124 PMCID: PMC11002557 DOI: 10.1302/2633-1462.54.bjo-2023-0136.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: 04/10/2024] Open
Abstract
Aims This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged less than 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component. Methods We describe the survival, radiological, and functional outcomes of 33 patients (38 THAs) at a mean follow-up of 27 years (25 to 32) between 1988 and 2018. Results Of the surviving 30 patients (34 THAs), there were four periprosthetic fractures: one underwent femoral revision after 21 years, two had surgical fixation as the stem was deemed stable, and one was treated nonoperatively due to the patient's comorbidities. The periprosthetic fracture patients showed radiological evidence of change in bone stock around the femoral stem, which may have contributed to the fractures; this was reflected in change of the canal flare index at the proximal femur. Two patients (two hips) were lost to follow-up. Using aseptic loosening as the endpoint, 16 patients (18 hips; 48%) needed acetabular revision. None of the femoral components were revised for aseptic loosening, demonstrating 100% survival. The estimate of the cumulative proportion surviving for revisions due to any cause was 0.97 (standard error 0.03). Conclusion In young patients with high demands, the Furlong HAC-coated femoral component gives excellent long-term results.
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Affiliation(s)
- Piyush K. Upadhyay
- Cumberland Infirmary, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
- School of Engineering University of Warwick, Coventry, UK
| | - Nirav Shah
- University Hospitals Sussex NHS Foundation Trust, West Sussex, UK
| | - Vishal Kumar
- Manchester University NHS Foundation Trust (MFT), Manchester, UK
| | - Saqeb B. Mirza
- Trauma and Orthopaedics, University Hospital Wales, Cardiff, UK
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Kim WT, Woodruff R, Kalore NV, Vallem MM, Cyrus JW, Krumme JW, Patel NK, Golladay GJ. Hydroxyapatite-Coated Femoral Stems in Primary Total Hip Arthroplasty: An Updated Meta-Analysis. J Arthroplasty 2024; 39:846-850.e2. [PMID: 37648098 DOI: 10.1016/j.arth.2023.08.071] [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: 05/09/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Most primary total hip arthroplasties (THAs) performed in the United States utilize cementless fixation with porous or hydroxyapatite (HA) coating. A previous meta-analysis comparing HA-coated versus non-HA-coated stems in primary THA published in 2013 found no significant difference between the 2. However, an updated analysis of the current literature is needed to assess the potential benefit of HA-coated stems in primary THA. METHODS Various libraries were searched through May 2022 according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies included were randomized controlled trials comparing HA-coated femoral stems to non-HA-coated stems in primary THA. Outcomes included Harris Hip Score (HHS), endosteal bone formation, radiolucent lines, linear wear rate, revision for aseptic loosening, thigh pain, and heterotopic ossification. RESULTS There were significantly fewer revisions for aseptic loosening (P = .004) and decreased postoperative thigh pain (P = .03) for patients who have with HA-coated stems. There was no significant difference in HHS (P = .20), endosteal bone formation (P = .96), radiolucent lines (P = .75), linear wear rate (P = .41), or heterotopic ossification (P = .71) between HA-coated and non-HA-coated stems. CONCLUSION We found that HA-coated femoral stems in primary THA led to significantly fewer stem revisions for aseptic loosening and less postoperative thigh pain compared to non-HA-coated stems. These findings suggest HA-coated femoral stems should be preferred over non-HA-coated femoral stems in primary THA.
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Affiliation(s)
| | - Robert Woodruff
- Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina
| | - Niraj V Kalore
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Madan M Vallem
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - John W Cyrus
- Health Sciences Library, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - John W Krumme
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, Missouri
| | - Nirav K Patel
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Saldivar RM, Buller LT, Deckard ER, Sonn KA, Meneghini RM. Durability of Primary Total Hip Arthroplasty With Cementless Stems Without a Collar in Elderly Patients Age 75 Years and Over. J Arthroplasty 2024:S0883-5403(24)00177-3. [PMID: 38408715 DOI: 10.1016/j.arth.2024.02.058] [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: 08/22/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Cementless femoral fixation in total hip arthroplasty (THA) has increased in prevalence worldwide. However, cementless fixation in elderly patients is controversial due to the risks of periprosthetic fracture and aseptic loosening. This study evaluated outcomes in patients undergoing primary THA utilizing a cementless stem without a collar, comparing those less than 75 years to those older than 75 years. METHODS Between 2011 and 2021, there were 2,605 cementless THAs performed by 4 surgeons utilizing a highly porous metal fixation surface without a collar and consistent clinical protocols. There were 469 patients who had an age ≥ 75 years. Revision rates, intraoperative fractures, and 90-day mortality were compared between cohorts. In the ≥ 75 year age group, there were more women, more American Society of Anesthesiologists physical status classification III or IV, a lower body mass index, and more kidney disease, osteoporosis, and thyroid disease (P ≤ .002). RESULTS All-cause revision rates trended lower for the ≥75 year age group compared to < 75 year (1.9 versus 3.5%, P = .082) at 20-months of follow-up. Moreover, there was no difference in all-cause femoral component revisions comparing ≥ 75 to < 75 year age groups (1.5 versus 2.2%, P = .375), with only 3 of 10 femoral revisions due to aseptic loosening being in the ≥ 75 year age group. Intraoperative fracture (0.2 versus 0.5%, P = .701) and 90-day mortality (0.2 versus 0.1%, P = .460) did not differ between ≥ 75 and < 75 year age groups. CONCLUSIONS Older patients had comparable revision rates compared to younger patients using cementless femoral fixation without a collar. Furthermore, there was no difference in 90-day mortality or intraoperative fracture rates. Study findings provide evidence for the safety and durability of cementless THA using collarless femoral stems in elderly patients ≥ 75 years of age. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Robert M Saldivar
- Surgery Residency, Medical University of South Carolina, Charleston, South Carolina
| | - Leonard T Buller
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - Kevin A Sonn
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana Joint Replacement Institute, Indianapolis, Indiana
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Berliner ZP, Jawad MU, Matzko C, Cooper HJ, Rodriguez JA, Hepinstall MS. Proximal radiolucent lines around fully hydroxyapatite-coated tapered femoral stems: should we be concerned? Hip Int 2024; 34:49-56. [PMID: 37306146 DOI: 10.1177/11207000231178269] [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] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Radiolucent lines occasionally develop around the proximal aspect of fully hydroxyapatite (HA)-coated tapered femoral stems after total hip arthroplasty (THA). It was hypothesised that distal wedging of stems may predispose to proximal radiolucent line formation, which may negatively impact clinical outcome. METHODS All primary THA performed with a collarless fully HA-coated stem that had a minimum of 1 year of radiographic follow-up were identified in a surgical database (n = 244). Radiographic measures of proximal femoral morphology and femoral canal fill at the middle and distal thirds of the stem were analysed for association with the presence of proximal radiolucent lines. Linear regression was used to explore any association between radiolucent lines and patient reported outcome measures (PROMs), available in 61% of patients. RESULTS Proximal radiolucent lines developed in 31 cases (12.7%) at final follow-up. Dorr A femoral morphology and increased canal-fill at the distal ⅓ of the stem correlated with the development of radiolucent lines (p < 0.001). No correlation was observed between pain or PROMs and the presence of proximal radiolucent lines. DISCUSSION We observed an unexpectedly high incidence of proximal femoral radiolucent lines about collarless fully HA coated stems. Distal-only implant wedging in Dorr A bone may compromise proximal fixation. Although this finding did not correlate with short-term outcomes, the long-term clinical impact requires further study.
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Affiliation(s)
- Zachary P Berliner
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Muhammad Umar Jawad
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Chelsea Matzko
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - H John Cooper
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jose A Rodriguez
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Singh A, Gandavaram S, Patel K, Herlekar D. Use of a Trephine to Extract a Fractured Corail Femoral Stem During Revision Total Hip Arthroplasty: Tips From Our Case Report. Cureus 2024; 16:e52996. [PMID: 38410283 PMCID: PMC10896462 DOI: 10.7759/cureus.52996] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
Despite the significant advancements in the field of total hip arthroplasty (THA) and prosthesis designs, fracture of the modular femoral stem after THA can occur rarely and needs attention. Orthopaedic surgeons face a daunting task when it comes to the removal of a broken stem. The use of a trephine reamer has been evaluated for extracting the distal femoral stem, and this case report tries to address some key tips for the same. A 67-year-old obese male, without any major medical comorbidities, presented to the Royal Lancaster Infirmary orthopaedic outpatient department with a complaint of acute-on-chronic right anterior thigh pain that worsened over a few weeks. He had a history of bilateral staged uncemented THA done around 12 years ago. The plain radiological images confirmed the presence of a fracture of the Corail femoral stem. A posterior approach was used to dislocate the hip and the distal broken part of the stem was removed using trephines. Reamers were used and care was taken to prevent thermal necrosis by using intermittent saline lavage. After the removal of the fractured femoral stem, a cemented femoral revision THA was performed, which was uneventful. The patient walked without any aid or thigh pain postoperatively during his last follow-up. Using trephines to remove broken femoral stems is an effective and safe method. Intraoperative measures can help in avoiding heat necrosis while using a trephine reamer for extracting the fractured femoral stem. Regular follow-up and counselling are important after THA, to avoid a delayed diagnosis of non-traumatic femoral stem fractures.
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Affiliation(s)
- Abhimanyu Singh
- Orthopaedics and Trauma, Royal Lancaster Infirmary, Lancaster, GBR
| | | | - Kuntal Patel
- Orthopaedics and Trauma, Royal Lancaster Infirmary, Lancaster, GBR
| | - Deepak Herlekar
- Orthopaedics and Trauma, Royal Lancaster Infirmary, Lancaster, GBR
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Wellauer H, Heuberger R, Gautier E, Tannast M, Steinke H, Wahl P. The history of the development of the regular straight stem in hip arthroplasty. EFORT Open Rev 2023; 8:548-560. [PMID: 37395710 DOI: 10.1530/eor-22-0122] [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] [Indexed: 07/04/2023] Open
Abstract
Since the middle of the 20th century, total hip arthroplasty has become a very successful treatment for all end-stage diseases of the hip joint. Charnley solved with his low frictional torque arthroplasty the problem of wear and friction with the introduction of a new bearing couple and the reduction of the head size, which set the prerequisite for the further development of stem design. This narrative review presents the major developments of regular straight stems in hip arthroplasty. It does not only provide an overview of the history but also assembles the generally scarce documentation available regarding the rationale of developments and illustrates often-unsuspected links. Charnley's success is based on successfully solving the issue of fixation of the prosthetic components to the bone, using bone cement made of polymethyl-methacrylate. In the field of cemented anchorage of the stem, two principles showing good long-term revision rates emerged over the years: the force-closed and the shape-closed principles. The non-cemented anchorage bases on prosthesis models ensure enough primary stability for osteointegration of the implant to occur. For bone to grow onto the surface, not only sufficient primary stability is required but also a suitable surface structure together with a biocompatible prosthetic material is also necessary.
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Affiliation(s)
- Hanna Wellauer
- Department of Orthopaedic Surgery and Traumatology, HFR Fribourg Hospital, University of Fribourg, Fribourg, Switzerland
- Division of Orthopaedics and Trauma Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Emanuel Gautier
- Department of Orthopaedic Surgery and Traumatology, HFR Fribourg Hospital, University of Fribourg, Fribourg, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, HFR Fribourg Hospital, University of Fribourg, Fribourg, Switzerland
| | - Hubert Steinke
- Institute for the History of Medicine, University of Bern, Bern, Switzerland
| | - Peter Wahl
- Division of Orthopaedics and Trauma Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Faculty of Medicine, University of Berne, Berne, Switzerland
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Pais A, Alves JL, Jorge RN, Belinha J. Multiscale Homogenization Techniques for TPMS Foam Material for Biomedical Structural Applications. Bioengineering (Basel) 2023; 10:bioengineering10050515. [PMID: 37237585 DOI: 10.3390/bioengineering10050515] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/03/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Multiscale techniques, namely homogenization, result in significant computational time savings in the analysis of complex structures such as lattice structures, as in many cases it is inefficient to model a periodic structure in full detail in its entire domain. The elastic and plastic properties of two TPMS-based cellular structures, the gyroid, and the primitive surface are studied in this work through numerical homogenization. The study enabled the development of material laws for the homogenized Young's modulus and homogenized yield stress, which correlated well with experimental data from the literature. It is possible to use the developed material laws to run optimization analyses and develop optimized functionally graded structures for structural applications or reduced stress shielding in bio-applications. Thus, this work presents a study case of a functionally graded optimized femoral stem where it was shown that the porous femoral stem built with Ti-6Al-4V can minimize stress shielding while maintaining the necessary load-bearing capacity. It was shown that the stiffness of cementless femoral stem implant with a graded gyroid foam presents stiffness that is comparable to that of trabecular bone. Moreover, the maximum stress in the implant is lower than the maximum stress in trabecular bone.
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Affiliation(s)
- Ana Pais
- INEGI-Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal
| | - Jorge Lino Alves
- INEGI-Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal
- FEUP-Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal
| | - Renato Natal Jorge
- INEGI-Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal
- FEUP-Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal
| | - Jorge Belinha
- INEGI-Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal
- ISEP-School of Engineering, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 431, 4249-015 Porto, Portugal
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Bornes TD, Radomski LR, Bonello JP, Mortensen-Truscott L, Safir OA, Gross AE, Kuzyk PRT. Subsidence of a Single-Taper Femoral Stem in Primary Total Hip Arthroplasty: Characterization, Associated Factors, and Sequelae. J Arthroplasty 2023:S0883-5403(23)00382-0. [PMID: 37088226 DOI: 10.1016/j.arth.2023.04.026] [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: 12/04/2022] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND We characterized subsidence of an uncemented single-taper femoral stem in primary total hip arthroplasty (THA), determined factors associated with subsidence, and evaluated the impact of subsidence on outcome. METHODS This retrospective study included 502 primary THAs performed using a single-taper stem in Dorr type A and B femora between 2014 and 2018. Subsidence was measured based on distance from the greater trochanter to stem shoulder on calibrated X-rays. Demographics, case-specific data, and outcomes were collected. Changes in subsidence and variables associated with subsidence were determined. RESULTS Stem subsidence was 1.5 ± 2.3 mm, 1.6 ± 2.0 mm, 2.0 ± 2.6 mm, 2.3 ± 2.3 mm, 2.6 ± 2.5 mm, and 2.7 ± 3.0 mm at 6 weeks, 3 months, 6 months, 1 year, 2 years, and ≥3 years from THA, respectively. Subsidence across all patients at final mean follow-up of 24 months (range, 1 to 101 months) was 2.2 ± 2.6 mm. Pairwise comparison demonstrated that subsidence occurred predominantly within the first 6 months. Significant subsidence (≥5 mm) occurred in 17.3% and was associated with a body mass index (BMI) ≥25 (P=0.04). Dorr type, age, sex, and American Society of Anesthesiologists class were not associated with subsidence. There were two patients (0.4%) who underwent a revision that could be attributed to subsidence. There was no association between subsidence and pain, limp, need for ambulatory aid, or analgesic use. CONCLUSION In primary THAs performed using a single-taper prosthesis, average subsidence was 2.2 mm and significant subsidence occurred in 17.3%. Patient BMI was associated with subsidence. Revision surgery related to subsidence was infrequent (0.4%).
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Affiliation(s)
- Troy D Bornes
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Royal Alexandra Hospital, Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta.
| | - Lenny R Radomski
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario; Department of Orthopaedic Surgery, University of California San Francisco (UCSF) Medical Center, UCSF, San Francisco, California
| | | | | | - Oleg A Safir
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Allan E Gross
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Paul R T Kuzyk
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
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9
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Cook SD, Patron LP, Lavernia CJ, Gibian J, Hong T, Bendich I. Fracture of Contemporary Femoral Stems: Common Trends in This Rare Occurrence. J Arthroplasty 2023:S0883-5403(23)00364-9. [PMID: 37086930 DOI: 10.1016/j.arth.2023.04.025] [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: 11/20/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Fracture of contemporary femoral stems is a rare occurrence in total hip arthroplasty (THA). A knowledge gap remains regarding manufacturing, patient, and surgeon factors that may contribute to the increased risk of this complication. METHODS We analyzed 13 contemporary fractured porous coated femoral stems of various designs to determine cause and contributing factors of mechanical failure. Cases included 12 men and one woman who had an average age at index surgery of 53 years (range, 34 to 76). There were ten of 13 patients who had a body mass index (BMI) greater than 30 (obese); 3 of the 10 had a BMI greater than 40. The mean time to fracture was 7.6 years (range, 7 months to 12 years). RESULTS There were four titanium alloy stems that fractured an average of 3.6 years post-revision surgery for head/cup exchange, and had associated iatrogenic mechanical and electrocautery damage to the femoral neck at fracture initiation sites. There were six modular stems that failed at the stem-sleeve or stem-neck interfaces with evidence of fretting corrosion. For two stem-neck fractures, mis-matched head/stem combinations from different manufacturers resulted in untested mechanical offsets and loading. There were two proximal neck fractures and one mid-shaft fracture of coated cobalt-chromium alloy stems that occurred in three obese men. The neck fractures (10 to 12 years) were well-fixed stems. Lack of proximal fixation contributed to the mid-shaft fracture (7 months). CONCLUSION While rare, femoral stem fractures pose catastrophic outcomes in primary and revision THA. Manufacturing, patient, and surgical factors contributing to stem failures were identified, including patient obesity, heat-treatment reduction of mechanical properties, iatrogenic implant damage, and mixing of different vendor stems and heads.
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Affiliation(s)
- Stephen D Cook
- Fellowship of Orthopaedic Researchers, 320 Metairie-Hammond Hwy, Suite 406, Metairie, LA 70005.
| | - Laura P Patron
- Fellowship of Orthopaedic Researchers, 320 Metairie-Hammond Hwy, Suite 406, Metairie, LA 70005
| | | | - Joseph Gibian
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
| | - Thomas Hong
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
| | - Ilya Bendich
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
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10
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Xiao Z, Wu L, Wu W, Tang R, Dai J, Zhu D. Multi-Scale Topology Optimization of Femoral Stem Structure Subject to Stress Shielding Reduce. Materials (Basel) 2023; 16:3151. [PMID: 37109987 PMCID: PMC10143993 DOI: 10.3390/ma16083151] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 06/19/2023]
Abstract
Hip replacement femoral implants are made of substantial materials that all have stiffness considerably higher than that of bone, which can cause significant bone resorption secondary to stress shielding and lead to severe complications. The topology optimization design method based on the uniform distribution of material micro-structure density can form a continuous mechanical transmission route, which can better solve the problem of reducing the stress shielding effect. A multi-scale parallel topology optimization method is proposed in this paper and a topological structure of type B femoral stem is derived. Using the traditional topology optimization method (Solid Isotropic Material with Penalization, SIMP), a topological structure of type A femoral stem is also derived. The sensitivity of the two kinds of femoral stems to the change of load direction is compared with the variation amplitude of the structural flexibility of the femoral stem. Furthermore, the finite element method is used to analyze the stress of type A and type B femoral stem under multiple conditions. Simulation and experimental results show that the average stress of type A and type B femoral stem on the femur are 14.80 MPa, 23.55 MPa, 16.94 MPa and 10.89 MPa, 20.92 MPa, 16.50 MPa, respectively. For type B femoral stem, the average error of strain is -1682με and the average relative error is 20.3% at the test points on the medial side and the mean error of strain is 1281με and the mean relative error is 19.5% at the test points on the outside.
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Wilson JM, Smartt AA, Abdel MP, Mabry TM, Berry DJ, Trousdale RT, Sierra RJ. Can Selected Use of Cemented and Uncemented Femoral Components in a Broad Population Produce Comparable Results Following Primary Total Hip Arthroplasty for Osteoarthritis? J Arthroplasty 2023:S0883-5403(23)00347-9. [PMID: 37044223 PMCID: PMC10367059 DOI: 10.1016/j.arth.2023.04.002] [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] [Received: 12/02/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION Registry data have demonstrated lower rates of revision and periprosthetic fracture in select cohorts with cemented femoral fixation at primary total hip arthroplasty (THA). Whether this is true of all component designs is not known. We hypothesized that selected use of ream-and-broach, triple-tapered uncemented stem designs may provide comparable results to cemented stems. METHODS From 2000 to 2018, 5,809 primary THAs were performed with either a cemented (1,304) or ream-and-broach triple-tapered uncemented stem (4,505). Implant choice was at surgeon discretion. The cemented group was older, more often women, and had slightly lower body mass index. A subgroup analysis was performed on patients ≥75-years of age. Statistical weighting accounted for baseline cohort differences. RESULTS At 10 years, there was a trend toward higher all-cause revision (Hazards ratio (HR) 1.6, P=0.053) and higher all-cause reoperation (HR 1.6, P=0.02) in the cemented fixation cohort. The cemented fixation group had fewer intraoperative periprosthetic fractures (HR 0.21, P<0.001), but no difference in postoperative fractures (HR 0.99, P=0.96). The same was true in patients ≥75-years. In the ≥75-years subgroup, there was no difference in revision or reoperation at 10 years. CONCLUSION Compared to cemented stems, the use of ream-and-broach triple-tapered uncemented stems in select patients, including those ≥75-years, was associated with more intraoperative fractures, but no difference in 10-year implant survivorship. These findings are different than some registry data and suggest that specific uncemented components, implanted in selected patients by experienced surgeons, can perform as well as cemented implants in a broad patient population.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Anne A Smartt
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Tad M Mabry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Robert T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905.
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12
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Codirenzi AM, Lanting BA, Teeter MG. What Patient and Implant Factors Affect Trunnionosis Severity? An Implant Retrieval Analysis of 664 Femoral Stems. J Arthroplasty 2023; 38:376-382. [PMID: 36084756 DOI: 10.1016/j.arth.2022.08.023] [Citation(s) in RCA: 1] [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: 05/12/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Corrosion at the modular head-neck taper interface of total and hemiarthroplasty hip implants (trunnionosis) is a cause of implant failure and thus a clinical concern. Patient and device factors contributing to the occurrence of trunnionosis have been investigated in prior implant retrieval studies but generally with limited sample sizes and a narrow range of models. The purpose of the present investigation was to determine which patient and device factors were associated with corrosion damage on the femoral stem taper across a large collection of different implant models retrieved following revision hip arthroplasty. METHODS A retrieval study of 664 hip arthroplasty modular stem components was performed. Patient and device information was collected. Trunnions were imaged under digital microscopy and scored for corrosion damage using a scaling system. Damage was related to patient and device factors using regression analyses. RESULTS Greater duration of implantation (P = .005) and larger head size (P < .001) were associated with an elevated corrosion class. Older age at index surgery (P = .035), stainless steel stem material (P = .022), indication for revision as bone or periprosthetic fracture (P = .017), and infection (P = .018) and certain larger taper geometries were associated with a decreased corrosion class. CONCLUSION Factors identified as contributing to a higher or lower risk of more severe corrosion are consistent with most prior smaller retrieval studies. Surgeons should be aware of these risk factors when selecting implants for their patients and when diagnosing trunnionosis in symptomatic hip arthroplasty patients.
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Affiliation(s)
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Matthew G Teeter
- School of Biomedical Engineering, Western University, London, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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13
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Anderson CG, Brilliant ZR, Jang SJ, Sokrab R, Mayman DJ, Vigdorchik JM, Sculco PK, Jerabek SA. Validating the use of 3D biplanar radiography versus CT when measuring femoral anteversion after total hip arthroplasty : a comparative study. Bone Joint J 2022; 104-B:1196-1201. [PMID: 36317354 DOI: 10.1302/0301-620x.104b11.bjj-2022-0194.r2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIMS Although CT is considered the benchmark to measure femoral version, 3D biplanar radiography (hipEOS) has recently emerged as a possible alternative with reduced exposure to ionizing radiation and shorter examination time. The aim of our study was to evaluate femoral stem version in postoperative total hip arthroplasty (THA) patients and compare the accuracy of hipEOS to CT. We hypothesize that there will be no significant difference in calculated femoral stem version measurements between the two imaging methods. METHODS In this study, 45 patients who underwent THA between February 2016 and February 2020 and had both a postoperative CT and EOS scan were included for evaluation. A fellowship-trained musculoskeletal radiologist and radiological technician measured femoral version for CT and 3D EOS, respectively. Comparison of values for each imaging modality were assessed for statistical significance. RESULTS Comparison of the mean postoperative femoral stem version measurements between CT and 3D hipEOS showed no significant difference (p = 0.862). In addition, the two version measurements were strongly correlated (r = 0.95; p < 0.001), and the mean paired difference in postoperative femoral version for CT scan and 3D biplanar radiography was -0.09° (95% confidence interval -1.09 to 0.91). Only three stem measurements (6.7%) were considered outliers with a > 5° difference. CONCLUSION Our study supports the use of low-dose biplanar radiography for the postoperative assessment of femoral stem version after THA, demonstrating high correlation with CT. We found no significant difference for postoperative femoral version when comparing CT to 3D EOS. We believe 3D EOS is a reliable option to measure postoperative femoral version given its advantages of lower radiation dosage and shorter examination time.Cite this article: Bone Joint J 2022;104-B(11):1196-1201.
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Affiliation(s)
- Christopher G Anderson
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Zachary R Brilliant
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Seong J Jang
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Ruba Sokrab
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - David J Mayman
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Seth A Jerabek
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
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14
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Kim YH, Park JW, Jang YS, Kim EJ. Does an Ultra-Short Anatomic Cementless Femoral Stem Improve Long-Term (Up to 17 Years) Results in Patients Younger Than 30 Years? J Arthroplasty 2022; 37:2225-2232. [PMID: 35691512 DOI: 10.1016/j.arth.2022.06.003] [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: 04/26/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this long-term (up to 17 years) follow-up study was to determine: (1) clinical results and evidence of clicking or squeaking sounds; (2) radiographic results, including rates of osseointegration, bone remodeling, and osteolysis; (3) rates of complications including thigh pain, periprosthetic fracture, and ceramic fracture; (4) rates of revision; and (5) survival rates of implants in patients younger than 30 years. METHODS We analyzed the results of 240 consecutive primary total hip arthroplasty in 180 patients (118 men and 62 women who had a mean age of 27 years (range, 21 to 30 years)). The mean follow-up was 16 years (range, 14 to 17 years). RESULTS Mean Harris hip score, Western Ontario and McMaster Universities score, and University of California, Los Angeles activity score were 93 points, 18 points, and 7 points, respectively, at final follow-up. Radiographically, all of the acetabular components and all but two femoral components were well-fixed at the final follow-up. No hip had osteolysis or exhibited Grade 3 stress shielding. All but two patients had no groin or thigh pain. No hip had a periprosthetic or ceramic fracture. Eight hips (3%) exhibited squeaking sounds. Two acetabular components and two femoral stems were revised. The survival of the acetabular and femoral component was 99.2% (95% confidence interval, 94 to 100%). CONCLUSION The results of the present long-term study of ultra-short anatomic cementless femoral stems suggest excellent clinical and radiographic results in patients younger than 30 years.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center of Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Young-Soo Jang
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Eun-Jung Kim
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
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15
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Kavak M, Turgut A, Turgut A. Trunnion fracture of a cobalt-chrome fully porous-coated femoral stem: A case report. Acta Orthop Traumatol Turc 2022; 56:408-411. [PMID: 36567545 PMCID: PMC9885723 DOI: 10.5152/j.aott.2022.22051] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Modular femoral stem-head systems are used increasingly due to their ease of application and offset adjustment. However, this modular ity has brought complications of trunnion wear and breakage. Although very rarely encountered, trunnion fracture is a catastrophic com plication that requires challenging revision surgery. This report presents a trunnion fracture of a cobalt-chrome alloy, fully porous-coated femoral stem. Following single-stage revision surgery, full weight-bearing was achieved in six weeks, and the patient was painlessly mobile with a single cane and had a Hip Score of 81 in the last follow-up. Despite all the advantages of the femoral stem and head modu larity, one should remember that a catastrophic complication such as trunnion wear and fracture that require revision surgery is possible.
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16
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Toci GR, Magnuson JA, DeSimone CA, Stambough JB, Star AM, Saxena A. A Systematic Review and Meta-Analysis of Non-database Comparative Studies on Cemented Versus Uncemented Femoral Stems in Primary Elective Total Hip Arthroplasty. J Arthroplasty 2022; 37:1888-94. [PMID: 35398225 DOI: 10.1016/j.arth.2022.03.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cemented and uncemented femoral stems have shown excellent survivorship and outcomes in primary total hip arthroplasty (THA). Cementless stems have become increasingly common in the United States; however, multiple large database studies have suggested that elderly patients may have fewer complications with a cemented stem. As conclusions from large databases may be limited due to variations in data collection, this study investigated femoral stem survivorship and complication rates based on cement status in non-database studies. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were utilized to identify articles for inclusion up until June 2021. Included articles directly compared outcomes and complications between patients undergoing primary THA without femoral stem cementing to those with cementing. Studies were excluded if they utilized large databases or consisted of patients with a preoperative diagnosis of trauma. RESULTS Of the 1700 studies, 309 were selected for abstract review and nineteen for full-text review. A total of seven studies were selected. Meta-analyses indicated substantial heterogeneity between studies. There were no differences in revision rates (cementless: 5.53% vs. cemented 8.91%, P = .543), infection rates (cementless: 0.60% vs. cemented: 0.90%, P = .692), or periprosthetic fracture rates (cementless: 0.52% vs. cemented: 0.51%, P = .973) between groups. CONCLUSION There is scarce literature comparing outcomes and complications between cemented and cementless femoral stems in primary elective THA without utilizing a database methodology. In our study, there were no differences in complications detected on meta-analyses. Given previous findings in database studies, additional high-quality cohort studies are required to determine if selected patients may benefit from a cemented femoral stem.
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17
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Rajpura A, Asle SG, Ait Si Selmi T, Board T. The accuracy of restoration of femoral head centre of rotation in the anteroposterior plane after uncemented total hip arthroplasty : a CT-based study. Bone Joint Res 2022; 11:180-188. [PMID: 35343251 PMCID: PMC8963361 DOI: 10.1302/2046-3758.113.bjr-2021-0378.r2] [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] [Indexed: 11/05/2022] Open
Abstract
AIMS Hip arthroplasty aims to accurately recreate joint biomechanics. Considerable attention has been paid to vertical and horizontal offset, but femoral head centre in the anteroposterior (AP) plane has received little attention. This study investigates the accuracy of restoration of joint centre of rotation in the AP plane. METHODS Postoperative CT scans of 40 patients who underwent unilateral uncemented total hip arthroplasty were analyzed. Anteroposterior offset (APO) and femoral anteversion were measured on both the operated and non-operated sides. Sagittal tilt of the femoral stem was also measured. APO measured on axial slices was defined as the perpendicular distance between a line drawn from the anterior most point of the proximal femur (anterior reference line) to the centre of the femoral head. The anterior reference line was made parallel to the posterior condylar axis of the knee to correct for rotation. RESULTS Overall, 26/40 hips had a centre of rotation displaced posteriorly compared to the contralateral hip, increasing to 33/40 once corrected for sagittal tilt, with a mean posterior displacement of 7 mm. Linear regression analysis indicated that stem anteversion needed to be increased by 10.8° to recreate the head centre in the AP plane. Merely matching the native version would result in a 12 mm posterior displacement. CONCLUSION This study demonstrates the significant incidence of posterior displacement of the head centre in uncemented hip arthroplasty. Effects of such displacement include a reduction in impingement free range of motion, potential alterations in muscle force vectors and lever arms, and impaired proprioception due to muscle fibre reorientation. Cite this article: Bone Joint Res 2022;11(3):180-188.
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Affiliation(s)
- Asim Rajpura
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | | | | | - Tim Board
- Orthopaedics, Wrightington Hospital, Wigan, UK
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18
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Macheras GA, Lepetsos P, Galanakos SP, Papadakis SA, Poultsides LA, Karachalios TS. Early failure of an uncemented femoral stem, as compared to two other stems with similar design, following primary total hip arthroplasty performed with direct anterior approach. Hip Int 2022; 32:166-173. [PMID: 32662662 DOI: 10.1177/1120700020940671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 02/06/2023]
Abstract
INTRODUCTION An increased risk of early femoral component loosening has been reported using the direct anterior approach (DAA) compared with other common surgical approaches. However, long-term data are scarce. The purpose of this study is: (1) to determine the incidence of early femoral loosening in a high volume, single surgeon's practice utilising the DAA approach; and (2) to examine the effect of stem design and type of coating on aseptic loosening in the early and mid-term postoperative period. METHODS A retrospective review of 1650 consecutive patients (1800 hips) who underwent total hip arthroplasty (THA) using the DAA between August 2011 and December 2017 was conducted at our institution. 3 types of uncemented femoral stems (Quadra-S, Avenir, TwinSys), with similar design, but different coating, were implanted. Patients were evaluated clinically and radiologically at 4 weeks, 3 months, 1 year, and annually thereafter. RESULTS After a mean follow-up of 46.4 months, the total incidence of revision for aseptic loosening was 0.44% (n = 8). All loose stems were Quadra-S, failing to achieve osseointegration, for an overall incidence of 0.96% (p = 0.002). None of the other stems were loose. Radiolucent lines around the proximal stem portion were visible in 75 Quadra-S stems (4.1%) on radiographs taken at 1 year postoperatively and continued to deteriorate at the latest follow-up. CONCLUSIONS In this specific cohort of patients, the increased rate of femoral stem aseptic loosening was implant-related and was attributed only to a specific type of femoral stem (Quadra-S). No relation to other factors was proven suggesting that the surface characteristics of this femoral stem and the lack of bioactive coating are responsible for the observed early femoral failures. These findings should be confirmed by additional registry work and larger population sample sizes are needed to evaluate the prosthesis performance after implantation through the DAA.
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Affiliation(s)
- George A Macheras
- 4th Department of Trauma and Orthopaedics, KAT Hospital, Athens, Greece
| | | | | | | | - Lazaros A Poultsides
- 3rd Academic Department of Orthopaedics and Trauma, Aristotle University Medical School, Thessaloniki, Greece
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19
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Mulford JS, Mathew R, Penn D, Cuthbert AR, De Steiger R. Periprosthetic fracture as a late mode of failure of the Anatomique Benoist Girard II femoral prosthesis. ANZ J Surg 2022; 92:1165-1170. [PMID: 35191171 PMCID: PMC9306843 DOI: 10.1111/ans.17547] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
Aim The Anatomique Benoist Girard (ABG) II femoral implant was a commonly used stem for primary total hip replacement (THR) at our institution (Launceston, Tasmania Australia). We identified peri‐prosthetic fracture as the main cause of late failure. Methods The late periprosthetic fracture rate for ABG II implants was reviewed with national statistics, using Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data. National revision rates for periprosthetic fracture were used to compare ABG II with all other cementless femoral stems. Result ABG II stems accounted for 1% (2719 implants) of all femoral stem implants in Australia during the 12‐year review period, compared to 23% (587 implants) in Launceston Hospitals. Although the Launceston cumulative percent revision rate for the ABG II stem was lower than the National rate at all time points, the reasons for revision were similar. The most common reason for revision of ABG II was fracture (56.8%), followed by loosening (15.3%). This differs from the reasons for revision in other cementless prostheses (loosening 23.9%, fracture 20.8%, dislocation 18.7%). Cumulative percent revision rates from late periprosthetic fracture, were higher for the ABG II stem than other cementless femoral prostheses. Conclusion This review of the AOANJRR has confirmed a local and national higher revision rate of the ABG II stem due to late periprosthetic fracture compared with other cementless stems. Stem design must be considered to reduce the risk of late periprosthetic fracture.
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Affiliation(s)
- Jonathan S Mulford
- Orthopaedic Department, Department of Surgery, Launceston General Hospital, Launceston, Tasmania, Australia.,Launceston Clinical School, School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Ronnie Mathew
- Orthopaedic Department, Department of Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - David Penn
- Orthopaedic Department, Department of Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Alana R Cuthbert
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Richard De Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia.,Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
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20
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Sevaldsen K, Schnell Husby O, Lian ØB, Farran KM, Schnell Husby V. Is the French Paradox cementing philosophy superior to the standard cementing? A randomized controlled radiostereometric trial and comparative analysis. Bone Joint J 2022; 104-B:19-26. [PMID: 34969272 PMCID: PMC8779947 DOI: 10.1302/0301-620x.104b1.bjj-2021-0325.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [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]
Abstract
Aims Highly polished stems with force-closed design have shown satisfactory clinical results despite being related to relatively high early migration. It has been suggested that the minimal thickness of cement mantles surrounding the femoral stem should be 2 mm to 4 mm to avoid aseptic loosening. The line-to-line cementing technique of the femoral stem, designed to achieve stem press-fit, challenges this opinion. We compared the migration of a highly polished stem with force-closed design by standard and line-to-line cementing to investigate whether differences in early migration of the stems occur in a clinical study. Methods In this single-blind, randomized controlled, clinical radiostereometric analysis (RSA) study, the migration pattern of the cemented Corail hip stem was compared between line-to-line and standard cementing in 48 arthroplasties. The primary outcome measure was femoral stem migration in terms of rotation and translation around and along with the X-, Y-, and Z- axes measured using model-based RSA at three, 12, and 24 months. A linear mixed-effects model was used for statistical analysis. Results Results from mixed model analyses revealed a lower mean retroversion for line-to-line (0.72° (95% confidence interval (CI) 0.38° to 1.07°; p < 0.001), but no significant differences in subsidence between the techniques (-0.15 mm (95% CI -0.53 to 0.227; p = 0.429) at 24 months. Radiolucent lines measuring < 2 mm wide were found in three and five arthroplasties cemented by the standard and line-to-line method, respectively. Conclusion The cemented Corail stem with a force-closed design seems to settle earlier and better with the line-to-line cementing method, although for subsidence the difference was not significant. However, the lower rate of migration into retroversion may reduce the wear and cement deformation, contributing to good long-term fixation and implant survival. Cite this article: Bone Joint J 2022;104-B(1):19–26.
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Affiliation(s)
- Kirsti Sevaldsen
- Department of Orthopaedic Surgery, Kristiansund Hospital, Kristiansund, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Otto Schnell Husby
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Orthopaedics, Rheumatology and Dermatology, Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway
| | - Øystein Bjerkestrand Lian
- Department of Orthopaedic Surgery, Kristiansund Hospital, Kristiansund, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Vigdis Schnell Husby
- Clinic of Orthopaedics, Rheumatology and Dermatology, Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway.,Department of Health Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Ålesund, Norway
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21
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Babazadeh S, de Steiger RN, Holder C, van Bavel D. Cemented Polished Tapered Stems Have Lower Revision Rates Than Commonly Used Cementless Implant up to 17 Years of Follow-Up: An Analysis of 201,889 Total Hip Replacements From the Australian Orthopedic Association National Joint Replacement Registry. J Arthroplasty 2022; 37:110-8. [PMID: 34592358 DOI: 10.1016/j.arth.2021.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Data assessing femoral stems may be influenced by grouping together matt and polished stems, despite their differing reported survivorship. The aim of this study is to assess the difference in revision rates between commonly used cemented and cementless stems when polished tapered stems are assessed independently of matt stems. METHODS Australian Orthopaedic Association National Joint Replacement Registry data from 1999 to 2019 were used to assess difference in revision rates between the 5 most commonly implanted femoral cemented and cementless stems for osteoarthritis. Cemented matt femoral stems, stems using line-to-line cementing techniques and procedures using non-cross-linked polyethylene, large head (>32 mm) metal-on-metal bearing surfaces or exchangeable necks were excluded. Cumulative percent revision was used to help compare survivorship between stems. RESULTS There were 201,889 total hip replacements meeting the inclusion criteria, of which 50.0% were cemented and 50.0% cementless. Cemented stems had a lower rate of revision at all time points compared to cementless stems. This was most significant during the first 2 weeks (hazard ratio 0.48, 95% confidence interval 0.40-0.58, P < .001) compared to 2 weeks postoperatively and onwards (hazard ratio 0.85, 95% confidence interval 0.81-0.90, P < .001). A subanalysis of head size, bearing type, and surgeon volume further supported the use of a cemented stem. CONCLUSION Commonly used cemented polished tapered stems have a lower revision rate when compared to commonly used cementless prostheses, and are recommended in all age groups for both low-volume and high-volume surgeons especially when head size 32 mm or smaller is used.
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22
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Abstract
Cementless femoral stems are prone to stress shielding of the femoral bone, which is caused by a mismatch in stiffness between the femoral stem and femur. This can cause bone resorption and resultant loosening of the implant. It is possible to reduce the stress shielding by using a femoral stem with porous structures and lower stiffness. A porous structure also provides a secondary function of allowing bone ingrowth, thus improving the long-term stability of the prosthesis. Furthermore, due to the advent of additive manufacturing (AM) technology, it is possible to fabricate femoral stems with internal porous lattices. Several review articles have discussed porous structures, mainly focusing on the geometric design, mechanical properties and influence on bone ingrowth. However, the safety and effectiveness of porous femoral stems depend not only on the characteristic of porous structure but also on the macro design of the femoral stem; for example, the distribution of the porous structure, the stem geometric shape, the material, and the manufacturing process. This review focuses on porous femoral stems, including the porous structure, macro geometric design of the stem, performance evaluation, research methods used for designing and evaluating the femoral stems, materials and manufacturing techniques. In addition, this review will evaluate whether porous femoral stems can reduce stress shielding and increase bone ingrowth, in addition to analyzing their shortcomings and related risks and providing ideas for potential design improvements.
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Affiliation(s)
- Bolun Liu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Huizhi Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ningze Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Min Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Cheng-Kung Cheng
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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23
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Frazer AR, Tanzer M. New Implant Introduction in Total Hip Arthroplasty Using Radiostereometric Analysis: A Cautionary Note. J Arthroplasty 2020; 35:643-6. [PMID: 31678017 DOI: 10.1016/j.arth.2019.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/22/2019] [Accepted: 10/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It has been proposed that the introduction of new hip implant technology in orthopedic surgery be conducted in a more controlled manner in order to properly ensure patient safety and the likelihood of favorable outcomes. This stepwise introduction would first require a prospective randomized study in a small cohort of patients, using radiostereometric analysis (RSA). The aim of this study is to determine if the recent literature supports the use of RSA as an early screening tool to accurately predict the long-term outcomes of cementless femoral stems. METHODS A review of the recent published literature identified 11 studies that used RSA to predict the long-term stability of a cementless femoral component. These RSA predictive data were compared to the 10-year revision rate reported in the Australian Registry or in the published literature to determine its reliability. RESULTS RSA data did not universally predict long-term stem fixation. In 2 of the 11 cases (18%), the RSA study incorrectly predicted the ability of the cementless stem to reliably osseointegrate. Of the 9 stems considered stable in the RSA studies, the 10 year registry and literature data confirmed that 6 implants had a low revision rate and were well performing. One stem has not performed well clinically and has been listed as having a higher than anticipated rate of revision in the registry. Two stems do not have sufficient follow-up. Of the 2 stems RSA predicted to do poorly, 1 is well performing at 10 years, and 1 has a high revision rate at 8 years. CONCLUSION In the stepwise introduction of new hip implants, RSA should be best considered as an adjunct tool in deciding whether or not an implant should be evaluated in a larger multicenter clinical studies, rather than the sole criterion.
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Ahmet S, İsmet KÖ, Mehmet E, Eren Y, Remzi T, Önder Y. Midterm results of the cylindrical fully porous-coated uncemented femoral stem in revision patients with Paprosky I-IIIA femoral defects. J Orthop Surg (Hong Kong) 2019; 26:2309499018783906. [PMID: 29969950 DOI: 10.1177/2309499018783906] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The aim of this study was to analyze the survival of the Echelon® femoral stems in revision hip surgeries in patients with Paprosky I-IIIA femoral defects. PATIENTS AND METHODS Sixty-six patients (70 hips) who underwent revision hip surgery with at least 3 years of follow-up data were included in the study between 2000 and 2013. The mean patient age was 64.5 (32-83) years, and the mean follow-up period was 93 (45-206) months. The reasons for revision were aseptic loosening in 55 (78.6%) patients, periprosthetic joint infection in 9 (12.9%) patients, periprosthetic fracture in 4 (5.7%) patients, and stem fracture in 2 (2.9%) patients. The preoperative and postoperative follow-up X-rays and functional scores were evaluated. RESULTS Five patients died in an average of 70 (45-86) months after surgery due to non-related diseases. We encountered sciatic nerve palsy in two patients and early hip dislocation in two patients, whereas 54 patients were able to walk without any assistive device. The remaining 12 patients required an assistive device to walk. The mean Harris hip score significantly increased from 34 (7-63) preoperatively to 72 (43-96) postoperatively. Aseptic loosening was observed in one patient. The survival of the porous-coated anatomical uncemented femoral stem was 98.4% over 10 years. CONCLUSION This study showed that good clinical outcomes and survival can be obtained when using porous-coated anatomical uncemented femoral stems.
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Affiliation(s)
- Salduz Ahmet
- 1 Department of Orthopaedics and Traumatology, Istanbul University, Istanbul, Turkey
| | | | - Ekinci Mehmet
- 1 Department of Orthopaedics and Traumatology, Istanbul University, Istanbul, Turkey
| | - Yıldız Eren
- 3 Department of Orthopaedics and Traumatology, Antakya State Hospital, Istanbul, Turkey
| | - Tözün Remzi
- 4 Department of Orthopaedics and Traumatology, Acıbadem University, Istanbul, Turkey
| | - Yazıcıoğlu Önder
- 1 Department of Orthopaedics and Traumatology, Istanbul University, Istanbul, Turkey
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Bozkurt M, Gursoy S, Shohat N, Simsek ME, Akkaya M, Parvizi J. Definition of a Novel Proximal Femur Classification in the Sagittal Plane According to the Femur Morphometric Analysis. J Arthroplasty 2019; 34:1502-1508. [PMID: 30954411 DOI: 10.1016/j.arth.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/20/2019] [Revised: 02/26/2019] [Accepted: 03/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Studies on prosthesis positioning and implant design in total hip arthroplasty (THA) have generally focused on the anatomy of the proximal femur in the coronal plane. The aim of this study was to investigate the proximal femur morphology in the sagittal plane to provide better positioning of the femoral component in THA and contribute to the determination of proximal femur morphology through possible outcomes that can be shown also by considering the sagittal plane in the selection and design of the femoral component. METHODS Computerized tomography scans were obtained from 270 femoral bones belonging to adult skeletons, followed by 3D reconstruction using Leonardo Dr/Dsa Va30a software (Siemens, Erlangen, Germany) and measurements. Canal widths were measured in the coronal and sagittal planes at the lesser trochanter (LT) level, at 20 millimeters proximal to the LT(LT+20) and at various levels distal to the lesser trochanter in 25 mm jumps up to 200 mm from the lesser trochanter. RESULTS The average width was wider at the level of the lesser trochanter and all points distal to it in the sagittal plane compared to the coronal plane except LT-200 mm. At each levels from LT-25 to LT-175, the differences were statistically significant (P < .05). The ratio of the femoral width at the lesser trochanter level to the width 50 mm distal to the LT was stated as the most prevalent one, and a novel classification in the sagittal plane was developed in accordance with these findings. CONCLUSION A novel and simple classification in the sagittal plane was developed based on the findings of this study, and this classification may improve the accuracy, validity, and reliability of femoral stem fixation in total hip arthroplasty.
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Affiliation(s)
- Murat Bozkurt
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Safa Gursoy
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Noam Shohat
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mehmet Emin Simsek
- Department of Orthopedics and Traumatology, Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Mustafa Akkaya
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Javad Parvizi
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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Liu B, Ma W, Li H, Wu T, Huo J, Han Y. Incidence, Classification, and Risk Factors for Intraoperative Periprosthetic Femoral Fractures in Patients Undergoing Total Hip Arthroplasty With a Single Stem: A Retrospective Study. J Arthroplasty 2019; 34:1400-1411. [PMID: 30956049 DOI: 10.1016/j.arth.2019.03.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 01/24/2019] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The collum femoris preserving (CFP) stem was a specially designed femoral neck preserving component. The incidence, classification, and risk factors for intraoperative periprosthetic femoral fractures with this special stem remain unclear. METHODS This was a retrospective study. We analyzed the clinical and radiological data of all patients who underwent primary hip arthroplasty with a CFP stem in our hospital between January 2006 and November 2018. Demographic characteristics and radiological features were obtained from the medical records and the Picture Archiving and Communication System, respectively. The incidence, Vancouver classification, and risk factors for intraoperative periprosthetic femoral fractures were identified. RESULTS A total of 1633 hips were included. The incidence rate of periprosthetic femoral fractures in patients undergoing total hip arthroplasty with a CFP stem was 3.2%. According to the Vancouver classification, there were 24 patients (45.3%) with Vancouver type A fractures, 27 patients (50.9%) with Vancouver type B fractures, and 2 patients (3.8%) with Vancouver type C fractures. Five independent risk (protective) factors were found, including surgical history (odds ratio [OR] = 3.275, 95% confidence interval [CI] = 1.192-8.997), neck-shaft angle (OR = 1.104, 95% CI = 1.058-1.152), neck length preserved (OR = 0.913, 95% CI = 0.850-0.980), canal flare index (OR = 0.636, 95% CI = 0.413-0.980), and bone mineral density (OR = 0.083, 95% CI = 0.016-0.417). CONCLUSION The detailed characteristics of intraoperative periprosthetic femoral fractures in patients who received a CFP stem were identified in this study. Cracks of the femoral neck and fractures on the front side of the proximal femur were more common in patients with CFP stems. As a kind of a femoral neck preserving stem, the anatomical features (eg, neck-shaft angle, preserving length) of the remaining femoral neck might influence the incidence and characteristics of intraoperative periprosthetic femoral fractures in patients with CFP stems.
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Affiliation(s)
- Bo Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Wenhui Ma
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Huijie Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Tao Wu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Jia Huo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yongtai Han
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
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Greco NJ, Lombardi AV, Morris MJ, Hobbs GR, Berend KR. Direct Anterior Approach and Perioperative Fracture With a Single-Taper Wedge Femoral Component. J Arthroplasty 2019; 34:145-150. [PMID: 30301574 DOI: 10.1016/j.arth.2018.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 06/19/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite growing interest in direct anterior approach total hip arthroplasty, perioperative femoral fracture and early aseptic loosening are increasingly recognized complications. Previous research has documented the role of surgeon experience in association with these femoral complications. The purpose of this study was to explore the relationship between femoral component design and early periprosthetic femoral complications. METHODS This was an extension of previous work with an updated patient cohort of 5090 consecutive direct anterior primary total hip arthroplasties at a single institution with a single-taper, wedge femoral stem comprising 4 variants involving length and geometry: group 1, full-length, standard profile; group 2, full-length, reduced distal profile; group 3, short-length, standard profile; and group 4, short-length, reduced distal profile. Records were reviewed retrospectively for the incidence of early postoperative periprosthetic fracture or aseptic loosening and analyzed with regard to patient demographics and femoral stem type. RESULTS There were 42 (0.83%) periprosthetic femur complications observed in the early postoperative period. Increased age (P < .001) and female gender (P = .023) were significantly associated with incidence of femoral complications in univariate analysis, while age maintained this significant relationship in multivariate analysis (P < .001). There was a trend toward increased complication rate in patients receiving a short stem with full profile taper (1.27%, P = .0539). CONCLUSION Despite an overall low rate of femoral complications after direct anterior total hip arthroplasty, the risk is increased in elderly patients and females. Furthermore, femoral stem design may portend an elevated risk of these complications.
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Affiliation(s)
- Nicholas J Greco
- Joint Implant Surgeons, Inc., New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc., New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael J Morris
- Joint Implant Surgeons, Inc., New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Gerald R Hobbs
- Department of Statistics, West Virginia University, Morgantown, WV
| | - Keith R Berend
- Joint Implant Surgeons, Inc., New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
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MacDonald DW, Chen AF, Lee GC, Klein GR, Mont MA, Kurtz SM, Cates HE, Kraay MJ, Rimnac CM. Fretting and Corrosion Damage in Taper Adapter Sleeves for Ceramic Heads: A Retrieval Study. J Arthroplasty 2017; 32:2887-2891. [PMID: 28668212 DOI: 10.1016/j.arth.2017.04.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/09/2016] [Revised: 04/05/2017] [Accepted: 04/13/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND During revision surgery with a well-fixed stem, a titanium sleeve can be used in conjunction with a ceramic head to achieve better stress distribution across the taper surface. In vitro testing suggests that corrosion is not a concern in sleeved ceramic heads; however, little is known about the in vivo fretting corrosion of the sleeves. The purpose of this study was to investigate fretting corrosion in sleeved ceramic heads in retrieved total hip arthroplasties. METHODS Thirty-seven sleeved ceramic heads were collected during revision. The femoral heads and sleeves were implanted 0.0-3.3 years. The implants were revised predominantly for instability, infection, and loosening. Fifty percent of the retrievals were implanted during a primary surgery. Fretting corrosion was assessed using the Goldberg-Higgs semiquantitative scoring system. RESULTS Mild-to-moderate fretting corrosion scores (score = 2-3) were observed in 92% of internal tapers, 19% of external tapers, and 78% of the stems. Severe fretting corrosion was observed in 1 stem trunnion that was previously retained during revision surgery and none of the retrieved sleeves. There was no difference in corrosion damage of sleeves used in primary or revision surgery. CONCLUSION The fretting corrosion scores in this study were predominantly mild and lower than reported fretting scores of cobalt-chrome heads in metal-on-polyethylene bearings. Although intended for use in revisions, we found that the short-term in vivo corrosion behavior of the sleeves was similar in both primary and revision surgery applications. From an in vivo corrosion perspective, sleeves are a reasonable solution for restoring the stem taper during revision surgery.
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Affiliation(s)
- Daniel W MacDonald
- Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania
| | - Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregg R Klein
- Department of Orthopaedic Surgery, Hartzband Center for Hip and Knee Replacement, Paramus, New Jersey
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Kurtz
- Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania; Department of Biomedical Engineering, Exponent, Inc, Philadelphia, Pennsylvania
| | | | - Harold E Cates
- Department of Orthopaedic Surgery, Tennessee Orthopaedic Clinics, Knoxville, Tennessee
| | - Matthew J Kraay
- Department of Mechanical and Aerospace Engineering, Center for the Evaluation of Implant Performance, Case Western Reserve University, Cleveland, Ohio
| | - Clare M Rimnac
- Department of Mechanical and Aerospace Engineering, Center for the Evaluation of Implant Performance, Case Western Reserve University, Cleveland, Ohio
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Abstract
Micromotion-induced interstitial fluid flow at the bone-implant interface has been proposed to play an important role in aseptic loosening of cementless implants. High fluid velocities are thought to promote aseptic loosening through activation of osteoclasts, shear stress induced control of mesenchymal stem cells differentiation, or transport of molecules. In this study, our objectives were to characterize and quantify micromotion-induced fluid flow around a cementless femoral stem using finite element modeling. With a 2D model of the bone-implant interface and full-factorial design, we first evaluated the relative influence of material properties, and bone-implant micromotion and gap on fluid velocity. Transverse sections around a femoral stem were built from computed tomography images, while boundary conditions were obtained from experimental measurements on the same femur. In a second step, a 3D model was built from the same data-set to estimate the shear stress experienced by cells hosted in the peri-implant tissues. The full-factorial design analysis showed that local micromotion had the most influence on peak fluid velocity at the interface. Remarkable variations in fluid velocity were observed in the macrostructures at the surface of the implant in the 2D transverse sections of the stem. The 3D model predicted peak fluid velocities extending up to 2.2 mm/s in the granulation tissue and to 3.9 mm/s in the trabecular bone. Peak shear stresses on the cells hosted in these tissues ranged from 0.1 to 12.5 Pa. These results offer insight into mechanical stimuli encountered at the bone-implant interface.
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Affiliation(s)
- Valérie Malfroy Camine
- a Laboratory of Biomechanical Orthopedics , Ecole Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
| | - Alexandre Terrier
- a Laboratory of Biomechanical Orthopedics , Ecole Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
| | - Dominique P Pioletti
- a Laboratory of Biomechanical Orthopedics , Ecole Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
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Abstract
BACKGROUND Proximal femur has a significant functional modification on erect bipedal posture. Various proximal femoral parameters were analyzed in Western literature. This information was utilized in prosthetic designing. Implants designed for Western people are used in Indian patients undergoing hip surgeries such as internal fixation and replacement arthroplasty. MATERIALS AND METHODS The study was done among 200 individuals (400 hips) with a normal hip joint after ethical committee clearance. Computed tomography scanning of proximal femur was done. Neck-shaft angle (NSA), neck width (NW), head diameter (HD), acetabular angle (AA) of sharp, horizontal offset (HO), vertical offset (VO), medullary canal diameter at the level of lesser trochanter (MDLT), and acetabular version (AV) were measured. These parameters were tabulated and compared with various populations and statistically analyzed. RESULTS The mean values were NSA 135°, NW 27 mm, femoral HD (HD) 42.5 mm, AA of sharp 35.5°, HO 37 mm, VO 46 mm, MDLT20 mm, and AV 18.64°. The values differ when compared with Western population. This study results differed when compared with other Indian studies done in Northern and Northeast Indian population. Significant differences noted in the parameters between sexes and between the sides of the hip joint. CONCLUSION This study indicates that there are significant differences in anthropometric parameters of proximal femur among the South Indian population compared with Western population. Even within the Indian population, the anthropometric parameters vary region to region.
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Affiliation(s)
| | | | - J Saravana Kumar
- Department of Orthopaedics, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India
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Graceffa A, Indelli PF, Latella L, Poli P, Fulco A, Marcucci M. Clinical outcome of design modifications to the CLS Spotorno Stem in total hip replacement. Joints 2016; 4:134-141. [PMID: 27900304 DOI: 10.11138/jts/2016.4.3.134] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE historically, the original CLS Spotorno Stem has demonstrated excellent survival. The design of this stem was recently modified, resulting in the introduction of a shorter, modular version (CLS Brevius). The purpose of the current study was to evaluate the functional, radiological and survivorship outcomes of the cementless CLS Brevius Stem in a multi-surgeon, single center, consecutive series study at two years post-surgery. METHODS the Authors performed 170 total hip arthroplasties in 155 patients using the shorter, triple-taper stem design (CLS Brevius). The patients' diagnoses were primary hip osteoarthritis (OA) in 74.4%, secondary hip OA in 22.6%, and post-traumatic hip OA in 3%. All operations were performed through a mini-posterior approach, with the patient in the lateral decubitus position. The mean follow-up was 32 months (24-44 months). Outcome was assessed using the Harris Hip Score (HHS). RESULTS the mean HHS improved from 32 preoperatively to 92 points at final follow-up, while the stem survival rate was 99.4%. Overall, the results were excellent in148 hips (87%), good in 14 hips (8.2%), fair in six hips (3.6%), and poor in two hips (1.2%). Intraoperative complications included a calcar fissure in three hips (1.7%). Correct femoral offset was reproduced in 97% while the planned center of hip rotation was achieved in 98%. Only one hip underwent early stem revision; this was due to major subsidence. CONCLUSIONS the modified CLS stem design showed excellent short-term results with a low rate of early postoperative complications. One of the main findings of this study was the high correlation between the planned femoral offset and center of hip rotation and the final radiographic measurements. This high reproducibility, which indicates the ability of the system to restore normal hip anatomy, is indeed due to the extensive modularity that characterizes this stem system. Long-term follow-up studies are necessary to fully compare the outcomes of the new design with its highly successful predecessor. LEVEL OF EVIDENCE Level IV, therapeutic cases series.
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Affiliation(s)
- Angelo Graceffa
- Centro Eccellenza Sostituzioni Articolari Toscana (CESAT), Clinica Ortopedica Università di Firenze, Florence, Italy; Fondazione Onlus "...In Cammino...", Fucecchio, Italy
| | - Pier Francesco Indelli
- The Department of Orthopaedics and Bioengineering, Stanford University School of Medicine, Stanford, USA
| | - Leonardo Latella
- Centro Eccellenza Sostituzioni Articolari Toscana (CESAT), Clinica Ortopedica Università di Firenze, Florence, Italy; Fondazione Onlus "...In Cammino...", Fucecchio, Italy
| | - Paolo Poli
- Centro Eccellenza Sostituzioni Articolari Toscana (CESAT), Clinica Ortopedica Università di Firenze, Florence, Italy; Fondazione Onlus "...In Cammino...", Fucecchio, Italy
| | | | - Massimiliano Marcucci
- Centro Eccellenza Sostituzioni Articolari Toscana (CESAT), Clinica Ortopedica Università di Firenze, Florence, Italy; Fondazione Onlus "...In Cammino...", Fucecchio, Italy
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Gómez-Robledo J. [Three successive fractures of different hip femoral stems on the same patient]. Acta Ortop Mex 2016; 30:138-143. [PMID: 27984687] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The clinical case of an 80-year-old female who suffered three fractures in uncemented stems implanted in her right hip in a period of three years is presented. A fracture occurred in the prosthetic neck and the other two at the juncture of the conical and cylindrical stem portion, coinciding with the metaphyseal-diaphyseal junction of the femur. The main causes of the failure were an increasing concentration of forces at the level of the implant as a consequence of the increased length of the neck and lateralization of the femur (offset). Other causes that have contributed to this prosthetic failure are analyzed.
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Affiliation(s)
- J Gómez-Robledo
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Sierrallana, Torrelavega, España
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Kim YH, Park JW, Kim JS, Kim IW. Twenty-Five- to Twenty-Seven-Year Results of a Cemented vs a Cementless Stem in the Same Patients Younger Than 50 Years of Age. J Arthroplasty 2016; 31:662-7. [PMID: 26601637 DOI: 10.1016/j.arth.2015.09.045] [Citation(s) in RCA: 24] [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: 07/16/2015] [Revised: 09/17/2015] [Accepted: 09/25/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND No study to our knowledge evaluated the long-term survivorship of the contemporary cemented vs cementless stems more than 25 years of follow-up in the same patients younger than 50 years of age. PURPOSE OF STUDY The purpose of the study is to determine (1) validated outcome scores, (2) prevalence of polyethylene wear and osteolysis, and (3) survivorship of the cemented vs cementless femoral components in the same young patients at minimum follow-up of 25 years. METHODS We report 171 patients (mean age, 47.7 years) at the time of the surgery who received simultaneous bilateral total hip arthroplasty with a cemented stem in one hip and a cementless stem in the other (26.1-year follow-up). A cementless acetabular component was used in all hips. There were 125 men and 46 women. The mean age at the time of the arthroplasty was 47.7 ± 10.7 years (range, 21-50 years). RESULTS The average Harris hip scores were similar between the groups of cemented stem (mean, 91 points) and cementless stem (93 points). Survival rate of the acetabular component (79% vs 78%) and that of the femoral component (96% vs 95%) at 26.1 years were similar between the 2 groups. CONCLUSIONS The long-term fixation of the acetabular metallic shell and cemented or cementless femoral stem was outstanding. Polyethylene wear and periacetabular osteolysis were contributing factors to reduce the long-term survival of the contemporary total hip arthroplasties with or without cement in young patients. New bearing surfaces such as ceramic on ceramic or ceramic on highly cross-linked polyethylene would improve wear of the bearing surfaces.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Center, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - In-Woo Kim
- The Joint Replacement Center, Ewha Womans University School of Medicine, Seoul, Republic of Korea
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Smith MA, Deakin AH, Allen D, Baines J. Midterm Outcomes of Revision Total Hip Arthroplasty Using a Modular Revision Hip System. J Arthroplasty 2016; 31:446-50. [PMID: 26432674 DOI: 10.1016/j.arth.2015.08.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/17/2015] [Accepted: 08/24/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The growth in hip arthroplasty surgery has meant a corresponding escalating revision burden with increasing challenges for the orthopaedic surgeon. The purpose of this study was to review clinical outcomes of a modular revision hip system within a single institution. METHODS We retrospectively reviewed a cohort of modular revision hip system stems performed in our institution between January 2005 and October 2012 giving a potential minimum follow-up of 2 years. Clinical outcomes data on complications, Oxford Hip Score (OHS, 0-48) and patient satisfaction were collected. Radiographic outcomes including subsidence were assessed. Implant survival was estimated using Kaplan Meier analysis. RESULTS 115 stems in 106 patients were identified. All cause survival was 82% (95%CIs: 73%-89%) at 6.1 years; survival excluding infection being 99% (95%CIs: 93%-100%). There was a low incidence of subsidence (seven stems) and no peri-prosthetic fractures. Primary cause of re-revision in this series was re-infection with only one re-revision for mechanical failure. Median Oxford Hip Score at mean follow up 4.1 years (2-9) was 40 (14-48) and 93% of patients reported being satisfied with their revision surgery. CONCLUSION This study showed good clinical outcomes and survival using a modular revision stem with low mechanical failure and subsidence. Recurrence of infection remains a challenge in revision surgery.
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Kusserow A, Ficklscherer A, Kreuz PC, Finze S, Mittelmeier W, Jansson V, Milz S, Wegener B. Importance of a distal centralizer in experimental malpositioning of cemented stems. A biomechanical study on human femora. Arch Med Sci 2015; 11:1324-9. [PMID: 26788098 PMCID: PMC4697065 DOI: 10.5114/aoms.2015.56361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 11/20/2013] [Accepted: 01/30/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Femoral centralizers in total hip arthroplasty (THA) are designed to improve the neutral implant position and ensure a homogeneous cement mantle without implant-bone impingement. To date there are no data about the cement mantle configuration and implant position after malinsertion, as seen in mini-open approaches or adipose patients with a limited view. The present biomechanical study was performed to investigate whether a distal centralizer may correct and optimize the position of a malinserted femoral stem. MATERIAL AND METHODS Thirteen MS 30 stems with and without a distal centralizer each were implanted in paired fresh human femora. Malinsertion was performed using a 3D guiding device with 10° deviation to the femoral axis in the sagittal plane. The thickness of the cement mantle was measured on the anterior, posterior, medial and lateral side of the implanted stem at a distance of 1 cm each. For each side data were taken at 13 points. RESULTS Digital evaluation of the cement mantle thickness revealed compareable values in frontal plane when a centralizer was used (p > 0.4). In contrast the cement mantle thicknesses without a centralizing device varied in the distal region between 3.38 mm and 5.09 mm (p ≤ 0.001) and in the central region between 3.52 mm and 4.19 mm (p ≤ 0.009). CONCLUSIONS A distal centralizer allows a more uniform cement mantle and neutral alignment even with a malinsertion of the femoral stem. This could reduce the failure rate and early loosening in complex THA.
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Affiliation(s)
- Andreas Kusserow
- Department of Orthopaedic Surgery, University Medical Center Rostock, Rostock, Germany
| | - Andreas Ficklscherer
- Department of Orthopedics, Ludwig Maximilians University Munich, Munich, Germany
| | - Peter Cornelius Kreuz
- Department of Orthopaedic Surgery, University Medical Center Rostock, Rostock, Germany
| | - Susanne Finze
- Department of Orthopaedic Surgery, University Medical Center Rostock, Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedic Surgery, University Medical Center Rostock, Rostock, Germany
| | - Volkmar Jansson
- Department of Orthopedics, Ludwig Maximilians University Munich, Munich, Germany
| | - Stefan Milz
- Department of Anatomy II, Ludwig Maximilians University Munich, Munich, Germany
| | - Bernd Wegener
- Department of Orthopedics, Ludwig Maximilians University Munich, Munich, Germany
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Abstract
The purpose of this study was to assess whether subsidence occurs in collarless Corail hip replacement (CCHR) and to ascertain the extent and timing of subsidence if present. Retrospective case notes analysis was performed. Sixty eight patients who had CCHR were identified from our database. Male to female ratio was 32:36. Their mean age was 74.2 years (range 37-95 years). Indications for surgery were osteoarthritis in 64 (94%) patients, rheumatoid arthritis in two (3%) patients and avascular necrosis in two (3%) patients. Subsidence was measured at 6 weeks, 6 months and 1 year post-op compared to initial post-op x-rays. At 6 weeks x-ray 21 patients did not have any subsidence, 18 patients had 1 millimeter (mm) subsidence, 10 patients had 2mms subsidence, 4 patients had 3mms subsidence, 5 patients had 4mms subsidence, 1 patient had 5mms subsidence, 4 patients had 6 mms subsidence and 1 patient each had subsidence of 7mms, 9mms, 11mms, 13mms and 26 mms respectively. When compared with 6 months x-rays only 2 patients had a further subsidence of 2mms while another patient had 3mms subsidence. No further subsidence occurred at 1 year follow up x-rays. One patient had revision surgery due to symptomatic subsidence (29mms) at 6 months follow up. Subsidence does occur in the first 6 weeks in collarless Corail hip replacement, and to a lesser extent until 6 months postoperatively, but does not progress further.
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Affiliation(s)
| | | | - Vishal Sahni
- Southport & Ormskirk NHS Hospital Trust, Liverpool, L1 8LP, UK
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Nam D, Sauber TJ, Barrack T, Johnson SR, Brooks PJ, Nunley RM. Radiographic parameters associated with pain following total hip and surface arthroplasty. J Arthroplasty 2015; 30:495-501. [PMID: 25456636 DOI: 10.1016/j.arth.2014.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 07/03/2014] [Revised: 09/01/2014] [Accepted: 10/01/2014] [Indexed: 02/01/2023] Open
Abstract
Pain following total hip arthroplasty (THA) and surface arthroplasty (SRA) remains a significant source of patient dissatisfaction. Two hundred twenty-four SRA and 196 THA patients completed a pain drawing questionnaire and postoperative radiographic measurements of component positioning were performed. In the SRA cohort, 11 of 21 patients (52%) with acetabular uncoverage of ≥5 mm versus 43 of 147 (29%) with acetabular uncoverage of ≤4.9 mm reported groin pain (P=.03). In the THA cohort, an increased distal-third canal fill ratio and a lower canal calcar ratio trended towards a higher incidence of thigh pain (P=.10 and .06), while a decreased mid-third canal fill ratio was associated with increased severity of thigh pain (P=.04). This study identifies associations between radiographic findings and pain following THA and SRA.
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Affiliation(s)
- Denis Nam
- Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | | | - Toby Barrack
- Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Staci R Johnson
- Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | | | - Ryan M Nunley
- Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
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Cip J, von Strempel A, Bach C, Luegmair M, Benesch T, Martin A. Implication of femoral stem on performance of articular surface replacement (ASR) XL total hip arthroplasty. J Arthroplasty 2014; 29:2127-35. [PMID: 25108735 DOI: 10.1016/j.arth.2014.06.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/14/2014] [Accepted: 06/29/2014] [Indexed: 02/01/2023] Open
Abstract
Taper junctions of large diameter metal-on-metal femoral heads and femoral stems were described as metal ion generator due to accelerated wear and corrosion. However, literature about the Articular Surface Replacement (ASR) total hip arthroplasty (THA) invariably deals with stems manufactured by DePuy Orthopedics (Warsaw, IN, USA). Nothing is known whether different stems with common 12/14 mm tapers affect failure rate or ion release. 99 ASR THA (88 patients) implanted with CoxaFit or ARGE Geradschaft stems (K-Implant, Hannover, Germany) were retrospectively analyzed. After a mean follow-up of 3.5 years revision rate was 24.5%, mostly due to adverse reaction to metal debris (ARMD). CT scan revealed component loosening in 10.3% and pseudotumoral lesions in 12.6%. Elevated ion concentrations (>7 μg/l) were found in 38.6%.
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Silverton CD, Jacobs JJ, Devitt JW, Cooper HJ. Midterm results of a femoral stem with a modular neck design: clinical outcomes and metal ion analysis. J Arthroplasty 2014; 29:1768-73. [PMID: 24895065 DOI: 10.1016/j.arth.2014.04.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 01/24/2014] [Revised: 04/17/2014] [Accepted: 04/29/2014] [Indexed: 02/01/2023] Open
Abstract
Modular neck femoral stems have a higher-than-anticipated rate of failure in registry results, but large single-center cohort studies are lacking. This is a retrospective cohort of 152 hips implanted with a single titanium stem with a modular titanium neck, presenting clinical, radiographic, and metal ion results at a mean 4.5-year follow-up. Five hips were revised during the study period, for an overall Kaplan-Meier survival of 0.894 at 8 years. There was one modular neck fracture (0.66%), but others demonstrated corrosion or adverse tissue reaction. Serum metal levels demonstrated wide variability. Despite good clinical results in the majority of patients, we confirmed an increased rate of femoral revision at mid-term follow-up, and therefore urge caution in the use of this particular stem design.
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Affiliation(s)
- Craig D Silverton
- Department of Orthopaedic Surgery, Henry Ford Hospital, Henry Ford Health System, Detroit, Michigan
| | - Joshua J Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jeffrey W Devitt
- Department of Orthopaedic Surgery, Henry Ford Hospital, Henry Ford Health System, Detroit, Michigan
| | - H John Cooper
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
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Abstract
Femoral loosening is one of the most prevalent causes of revision orthopedic surgeries. Cement mantle thickness has been directly correlated with femoral loosening. If the mantle is too thick, there is an increased risk of radiolucent lines and inconsistent densities. Also, the more bone that is reamed out during the procedure can lead to instability, especially if the quality of the bone is compromised due to osteoporosis. Too thin of a mantle can lead to a higher probability for cement fracture, loosening the prosthetic even further. This study has shown that there is an ideal thickness range between 2 to 5 mm that should be kept. From radiographic images one can measure the thickness of the cement mantle showing the loosening characteristics.
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Affiliation(s)
- Elizabeth Gunn
- Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH, USA
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Cooper HJ, Rodriguez JA. Early Post-operative Periprosthetic Femur Fracture in the Presence of a Non-cemented Tapered Wedge Femoral Stem. HSS J 2010; 6:150-4. [PMID: 21886528 PMCID: PMC2926362 DOI: 10.1007/s11420-010-9161-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [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: 12/13/2009] [Accepted: 02/17/2010] [Indexed: 02/07/2023]
Abstract
Non-cemented femoral fixation in hip arthroplasty has become the standard of practice in the USA. However, recent literature has brought attention to an increasing incidence of periprosthetic femur fractures with certain stem designs. This study examines reasons for early periprosthetic femur fractures in patients with a hip arthroplasty performed using a non-cemented tapered wedge stem design. A multivariate analysis using a matched-cohort design was performed to assess any potential risk factors that may predispose to such fractures. Six of 2,220 hips (0.3%) suffered a periprosthetic femur fracture within the first year after surgery; five of six were Vancouver Type B2. The average time to fracture was 9 weeks. This group of patients had a significantly higher canal-flare index and lower canal-calcar ratio. This complication may be preventable by having a better appreciation of the fit between the implant and the bone during pre-operative planning, with the goal of avoiding a proximal-distal mismatch.
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Affiliation(s)
- H. John Cooper
- Department of Orthopaedic Surgery, Lenox Hill Hospital, William Black Hall, 11th Floor, 130 East 77th Street, New York, NY 10075 USA
| | - José A. Rodriguez
- Department of Orthopaedic Surgery, Lenox Hill Hospital, William Black Hall, 11th Floor, 130 East 77th Street, New York, NY 10075 USA
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