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Horst N, Theil C, Gosheger G, Kalisch T, Moellenbeck B. Stem subsidence in total hip arthroplasty: retrospective investigation of a short stem using a simple measurement approach. Arch Orthop Trauma Surg 2024; 145:40. [PMID: 39680151 DOI: 10.1007/s00402-024-05642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 10/28/2024] [Indexed: 12/17/2024]
Abstract
BACKGROUND Uncemented total hip arthroplasty (THA) is a successful treatment for advanced hip joint diseases. More recently, short stems became increasingly popular, but stem subsidence remains a concern. This study investigates early short stem subsidence in a large patient cohort using a simple measurement approach for everyday practice. METHODS This retrospective, single center, single implant design study included 1000 patients with primary THA. Subsidence was evaluated using standardized weight-bearing radiographs taken 3-5 days and 2-3 weeks postoperatively with full weight-bearing (FWB). A novel Subsidence Index (SID) was introduced to quantify stem subsidence in a simple and reproducible manner. The SID is calculated by averaging four distinct linear measurements between defined anatomical landmarks on the femur and the implant, captured on standard radiographs without additional software. RESULTS Out of all analyzed patients 6% (60/1000) had subsidence of more than 3 mm. The mean subsidence was 1.3 mm (range, 0 to 16.25 mm). There were 0.6% (6) who underwent stem revision for symptomatic subsidence. Men and obese patients had greater subsidence. However, patient age, BMI, stems without lateral bone contact and other demographic factors were not associated with subsidence. CONCLUSION Early subsidence is relatively frequent with this uncemented short stem, however revisions are rare. Patients with risk factors should be counseled regarding FWB and radiographic controls should be performed. The SID provides an easy, non-invasive and inexpensive tool for early subsidence assessment; however, its simplicity limits its accuracy. Further research is needed in comparison to more elaborate methods.
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Affiliation(s)
- Nicolas Horst
- Department of General Orthopaedics and Tumour Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Christoph Theil
- Department of General Orthopaedics and Tumour Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Georg Gosheger
- Department of General Orthopaedics and Tumour Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Tobias Kalisch
- Department of General Orthopaedics and Tumour Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of General Orthopaedics and Tumour Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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Budde S, Derksen A, Hurschler C, Fennema P, Windhagen H, Plagge J, Flörkemeier T, von Lewinski G, Noll Y, Schwarze M. Very early migration of a calcar-guided short stem: a randomized study of early mobilization and the influence of a calcium phosphate coating with 60 patients. Sci Rep 2024; 14:3837. [PMID: 38360840 PMCID: PMC10869691 DOI: 10.1038/s41598-023-50829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/26/2023] [Indexed: 02/17/2024] Open
Abstract
This study analyzed the migration of a calcar-guided short stem to determine the course of very early migration, as well as evaluated the effect of an additional calcium phosphate (CP) coating on a titanium plasma spray (TPS) coating, which has not been analyzed previously. Sixty patients were enrolled in this study and were treated with the A2 calcar-guided short stem. The implant coating was randomized with either the TPS or an additional CP coating, and radiostereometric analysis was performed with the baseline measurement before initial weight-bearing, along with follow-up examinations at 1 week, 6 weeks, 3 months, and 6 months. Implant migrations were 0.27 mm (standard deviation [SD], 0.13 mm) and 0.74 mm (SD, 1.11 mm) at 1 week and 6 months post-surgery, respectively, and 65% and 87% of the implants reached their final position 1 week and 6 weeks after surgery, respectively. After 6 weeks, 3 months, and 6 months, a significant increase was noted in the migration of the CP coating group vs. that of the TPS coating group. Upon the final observation at 6 months, the groups displayed on average a 0.74-mm migration. Most of the analyzed implants ceased migration within the first week post-surgery, but the CP coating demonstrated a higher and more prolonged migration compared to the TPS coating.
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Affiliation(s)
- Stefan Budde
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
- Evangelisches Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Alexander Derksen
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Christof Hurschler
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Peter Fennema
- AMR Advanced Medical Research, Männedorf, Switzerland
| | - Henning Windhagen
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Jochen Plagge
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Thilo Flörkemeier
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Gabriela von Lewinski
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Yvonne Noll
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Michael Schwarze
- Hannover Medical School, Department of Orthopaedic Surgery, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany.
- Department for Medical Technology, Hochschule Bremerhaven, An Der Karlstraße 8, 27568, Bremerhaven, Germany.
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Suksathien Y, Chuvanichanon P, Tippimanchai T, Sueajui J. Insufficient lateral stem contact is an influencing factor for significant subsidence in cementless short stem total hip arthroplasty. World J Orthop 2022; 13:444-453. [PMID: 35633743 PMCID: PMC9124996 DOI: 10.5312/wjo.v13.i5.444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/25/2022] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Subsidence is one of the concerning early complications in cementless femoral stem. Few publications have studied the influencing factors for subsidence in short cementless stems, due to their metaphyseal anchoring without diaphyseal invasion, they might demonstrate different subsidence patterns than with the conventional stems.
AIM To analyze the factors associated with significant subsidence in short stems, including any radiographic parameters.
METHODS The digitized radiographs of 274 consecutive short stem total hip arthroplasties were retrospectively reviewed. Subsidence, neck-filling ratio (NFR), seating height and lateral stem contact were evaluated after a minimum of two years follow-up. A threshold of subsidence > 3 mm was considered a clinically significant migration.
RESULTS For the entire cohort, subsidence occurred in 75 cases (27.4%) with the mean stem subsidence of 0.5 mm. (0-12.7, 1.68). Twelve hips (4.4%) had significant subsidence (> 3 mm). The univariate regression analysis demonstrated that age, diagnosis, BMI, Dorr’s type B, NFR, and seating height had no significant influence on significant subsidence, whereas insufficient lateral stem contact (≥ 1 mm) did have a statistically significant influence [Odds ratio (OR) = 5.02; 95%CI: 1.3-18.9; P = 0.017]. The multivariate regression analysis also demonstrated that insufficient lateral stem contact was a statistically significant influencing factor (OR = 5.5; 95%CI: 1.4-21.4; P = 0.014). There was no femoral stem revision for aseptic loosening in our cohort.
CONCLUSION This study demonstrated that insufficient lateral stem contact was a statistically significant influencing factor on significant subsidence. Therefore, it is a particularly important step to create proper lateral cortical contact when performing the short stem total hip arthroplasty.
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Affiliation(s)
- Yingyong Suksathien
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Muang 30000, Nakhon Ratchasima Province, Thailand
| | - Pattawat Chuvanichanon
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Muang 30000, Nakhon Ratchasima Province, Thailand
| | - Thanut Tippimanchai
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Muang 30000, Nakhon Ratchasima Province, Thailand
| | - Jithayut Sueajui
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Muang 30000, Nakhon Ratchasima Province, Thailand
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Rilby K, Nauclér E, Mohaddes M, Kärrholm J. No difference in outcome or migration but greater loss of bone mineral density with the Collum Femoris Preserving stem compared with the Corail stem: a randomized controlled trial with five-year follow-up. Bone Joint J 2022; 104-B:581-588. [PMID: 35491578 DOI: 10.1302/0301-620x.104b5.bjj-2021-1539.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare the mid-term patient-reported outcome, bone remodelling, and migration of a short stem (Collum Femoris Preserving; CFP) with a conventional uncemented stem (Corail). METHODS Of 81 patients who were initially enrolled, 71 were available at five years' follow-up. The outcomes at two years have previously been reported. The primary outcome measure was the clinical result assessed using the Oxford Hip Score (OHS). Secondary outcomes were the migration of the stem, measured using radiostereometric analysis (RSA), change of bone mineral density (BMD) around the stem, the development of radiolucent lines, and additional patient-reported outcome measures (PROMs). RESULTS There were no statistically significant differences between the groups regarding PROMs (median OHS (CFP 45 (interquartile range (IQR) 35 to 48); Corail 45 (IQR 40 to 48); p = 0.568). RSA showed stable stems in both groups, with little or no further subsidence between two and five years. Resorption of the femoral neck was evident in nine patients in the CFP group and in none of the 15 Corail stems with a collar that could be studied. Dual X-ray absorbiometry showed a significantly higher loss of BMD in the proximal Gruen zones in the CFP group (mean changes in BMD: Gruen zone 1, CFP -9.5 (95% confidence interval (CI) -14.8 to -4.2), Corail 1.0 (95% CI 3.4 to 5.4); Gruen zone 7, CFP -23.0 (95% CI -29.4 to -16.6), Corail -7.2 (95% CI -15.9 to 1.4). Two CFP stems were revised before two years' follow-up due to loosening, and one Corail stem was revised after two years due to chronic infection. CONCLUSION The CFP stem has a similar clinical outcome and subsidence pattern when compared with the Corail stem. More pronounced proximal stress-shielding was seen with the CFP stem, suggesting diaphyseal fixation, and questioning its femoral neck-sparing properties in the long term. Cite this article: Bone Joint J 2022;104-B(5):581-588.
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Affiliation(s)
- Karin Rilby
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emma Nauclér
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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De Santis V, Bonfiglio N, Basilico M, Tanzi Germani G, Matrangolo MR, Carosini A, Malerba G, Maccauro G. Clinical and radiographic outcomes after total hip arthroplasty with the NANOS neck preserving hip stem: a 10 to 16-year follow-up study. BMC Musculoskelet Disord 2022; 22:1061. [PMID: 35012499 PMCID: PMC8750837 DOI: 10.1186/s12891-021-04953-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Short-stem Hip Arthroplasty (SHA) are increasingly implanted in recent years thanks to their potential advantage in preserving metaphyseal bone-stock. Among them, the NANOS® short-stem implant demonstrated satisfactory results to short and mid-term. The purpose of this retrospective study was to evaluate the clinical and radiographic outcome of the Nanos® short stem at a minimum follow-up of 10 years. METHODS Sixty-seven patients aged 53 ± 20 years were enlisted in the study, for a total of 72 hips. Primary outcomes were survivorship of the implant and clinical outcome measured using the Hip disability and Osteoarthritis Outcome scores (HOOS) and the Short Form Survey (SF12) questionnaire. The secondary outcome was a radiological evaluation calculating the inclination and the anteversion angle of the acetabular cup for each implant and investigating osteolysis, heterotopic ossifications and stem position. RESULTS We observed a 95.5% stem survivorship. The complication rate was 7.6% and three implants underwent revision because of an aseptic loosening, an infection and a periprosthetic fracture due to trauma. Among 58 patients (63 hips) evaluated in an outpatient visit 10-16 years after surgery, improvement in clinically relevant scores comparing with baseline was observed: HOOS score increased after surgery in all its subcategories (from 32.25 ± 14.07% up to 91.91 ± 9.13%) as well as SF12 which increased by more than 18 percentage points. On clinical assessment, the range of motion (ROM) was restored at follow-up, 1 patient (1.7%) showed a squeaking hip and 2 (3.4%) reported leg-length discrepancy. Neutral stem positioning was achieved in 58 hips and heterotopic ossifications occurred in 10 hips (16%). CONCLUSIONS The current study reports good clinical and radiological outcomes following NANOS® short-stem hip implant at minimum 10 years-follow-up. Since the high rate of stem survivorship, the low complication rate demonstrated and the overall patient satisfaction, our results suggest NANOS® neck-preserving prostheses should be considered as a valid alternative to standard implants.
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Affiliation(s)
- Vincenzo De Santis
- Department of Orthopaedics, Mater Olbia Hospital, Olbia, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nadia Bonfiglio
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Mattia Basilico
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | | | - Maria Rosaria Matrangolo
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Angelo Carosini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Giuseppe Malerba
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy.
| | - Giulio Maccauro
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, RM, Italy
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6
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RILBY K, MOHADDES M, NAUCLÉR E, KÄRRHOLM J. Similar outcome with a new anteverted or a straight standard stem: a randomized study of 72 total hip arthroplasties evaluated with clinical variables, radiostereometry, and DXA up to 2 years. Acta Orthop 2022; 93:59-67. [PMID: 34678118 PMCID: PMC8815675 DOI: 10.1080/17453674.2021.1993606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - The anatomical uncemented stem, SP-CL (Static Physiologicus - CementLess), designed to facilitate insertion and to avoid stress concentration at solitary contact points, has been on the market since 2014 but is not well documented. We studied its clinical performance, migration, and associated bone remodeling in a randomized controlled trial, with the Corail stem as control. Patients and methods - 79 patients (80 hips) were primarily recruited and 71 patients (72 hips, 36 SP-CL, 36 Corail) attended the last follow-up at 2 years. The Oxford Hip Score (OHS) was the primary outcome. In addition, we assessed stem migration, changes in bone mineral density, and development of radiolucencies by RSA, DXA, and conventional radiography. Results - At 2 years Oxford Hip Score was similar between the SP-CL and Corail stem. At 2 years the SP-CL stems showed a median distal migration of 0.23 mm (-0.1 to 5.2) and the Corail stems of 0.11 mm (-0.4 to 4.4). The SP-CL stems showed slightly more loss of bone mineral density in Gruen region 7 (p = 0.003). Interpretation - We found no difference in clinical results between the SP-CL and the well-documented Corail stem. The same stem stability was reached between 1 and 2 years postoperatively for both stems. As a next step we think that the SP-CL stem should be studied in a multi-center setting, before being accepted for general use.
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Affiliation(s)
- Karin RILBY
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
| | - Maziar MOHADDES
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg,Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Emma NAUCLÉR
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Johan KÄRRHOLM
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg,Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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7
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de Waard S, Sierevelt IN, Jonker R, Hoornenborg D, van der Vis HM, Kerkhoffs GMMJ, Haverkamp D. The migration pattern and initial stability of the Optimys short stem in total hip arthroplasty: a prospective 2-year follow-up study of 33 patients with RSA. Hip Int 2021; 31:507-515. [PMID: 31971010 DOI: 10.1177/1120700020901844] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The consensus that bone stock preservation and optimal restoration of offset and leg length is important in total hip arthroplasty is now widespread, especially for young and active patients. Short stems seem promising in this aspect, though implant stability is still of concern. This study looked at the migration pattern of the Optimys short stem through RSA analysis. PATIENTS AND METHODS 40 patients were included. RSA images were made directly postoperatively (within 5 days), at 6 weeks and at 3, 6, 12 and 24 months. Double examinations were made for precision measurement. HOOS and pain scores were obtained preoperatively and at 2 years. 4 patients were excluded due to protocol violation and 1 patient was excluded for RSA analysis with a CN number >110. 2 patients were lost to follow-up after 3 and 6 months (n = 1 lost, n = 1 deep infection, respectively). RESULTS Mean age was 60 years with a mean BMI of 27. RSA analysis of 34 patients showed a significant initial median proximodistal translation (subsidence) of 0.21 mm (IQR 0.64-0.06) and anteversion-retroversion rotation of 0.59° (IQR 0.01-1.34) at 6 weeks, after which the stem stabilises and showed no further significant movement. Median migration in other directions was small. 4 patients had an initial subsidence of >2 mm, all showed secondary stabilisation. HOOS outcomes were satisfactory, with the domain symptoms and pain showing a median score of 95/100 at 2 years. CONCLUSIONS After initial migration the Optimys achieves secondary stabilisation, suggesting low risk on long-term aseptic loosening. CLINICAL TRIALS REGISTRATION NL47055.048.13.
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Affiliation(s)
- Sheryl de Waard
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands.,Academic Medical Centre (AMC), Amsterdam, Netherlands
| | - Inger N Sierevelt
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
| | - Renee Jonker
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
| | - Daniel Hoornenborg
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
| | - Harm M van der Vis
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
| | | | - Daniël Haverkamp
- Specialized Centre of Othopedic Research & Education (SCORE) and Xpert Orthopedie, Amsterdam, Netherlands
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8
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Bostian PA, Grisez BT, Klein AE, Frye BM. Complex Primary Total Hip Arthroplasty: Small Stems for Big Challenges. Arthroplast Today 2021; 8:150-156. [PMID: 33786353 PMCID: PMC7994729 DOI: 10.1016/j.artd.2021.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/15/2022] Open
Abstract
Total hip arthroplasty is one of the most successful operations in all of medicine. Femoral deformities from malunion, prior osteotomy, and retained surgical implants all present unique challenges. Corrective osteotomy and hardware removal add significant morbidity to an operation that typically has a fast recovery. Short stems can be used in these cases to spare patients' increased morbidity. We present a case-based illustration and surgical technique for the use of short stems in complex primary total hip arthroplasty with femoral deformity and retained hardware. We discuss how these implants can spare significant morbidity, show radiographic examples of their use, and present short-term outcomes.
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Affiliation(s)
- Phillip A Bostian
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Brian T Grisez
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Adam E Klein
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Benjamin M Frye
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
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9
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Kutzner KP, Ried E, Donner S, Bieger R, Pfeil J, Freitag T. Mid-term migration pattern of a calcar-guided short stem: A five-year EBRA-FCA-study. J Orthop Sci 2020; 25:1015-1020. [PMID: 32057589 DOI: 10.1016/j.jos.2020.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/15/2019] [Accepted: 01/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Short-term results of several short-stem designs have indicated early axial migration. Mid- and long-term results for most designs are lacking. The objective of this study was to evaluate the mid-term migration pattern of a calcar-guided short stem five years postoperative. METHODS Implant migration of 191 calcar-guided short stems was assessed by Ein-Bild-Roentgen-Analysis Femoral-Component- Analysis (EBRA-FCA) 5 years after surgery. Migration pattern of the whole group was analyzed and compared to the migration pattern of implants potentially being "at hazard" with a subsidence of more than 1.5 mm at 2 years postoperatively. Influence of preoperative Dorr types (A vs. B vs. C), age (<70 vs. >70 years), gender (female vs. male), weight (<90 kg vs. >90 kg), BMI (<30 vs. >30) and uni-vs. bilateral procedures on mid-term migration pattern was analyzed. Additionally outcome of varus- and valgus stem alignment was assessed. RESULTS Mean axial subsidence was 1.5 mm (SD 1.48 mm) at final follow-up. Two years after surgery 73 short stems were classified "at hazard". Of these stems, 69 cases showed secondary stabilisation in the following period, whereas 4 cases presented unstable with more than 1 mm of further subsidence. Stem revision was not required neither in the group of implants with early stabilisation nor the group with pronounced early onset migration. Male gender and heavy-weight patients had a significant higher risk for axial migration, as well as extensive valgus stem alignment, whereas for Dorr type B, compared to A, no statistical difference could be observed. CONCLUSIONS In most cases, even in the group of stems being "at hazard", settling could be documented. While different Dorr types did not show a statistically significant impact on axial migration, particularly in male and heavy-weight patients the risk of continuous subsidence is increased. In those 4 cases with further migration, undersizing of the stem could be recognized. At present, clinical consequences are still uncertain.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20. 65189 Wiesbaden, Germany.
| | - Emanuel Ried
- Division of Trauma Surgery, University Hospital Zürich (USZ), University of Zürich, Rämistr. 100. 8091 Zürich, Switzerland.
| | - Stefanie Donner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20. 65189 Wiesbaden, Germany.
| | - Ralf Bieger
- Department of Orthopaedic Surgery, University of Ulm (RKU), Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Joachim Pfeil
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20. 65189 Wiesbaden, Germany.
| | - Tobias Freitag
- Department of Orthopaedic Surgery, University of Ulm (RKU), Oberer Eselsberg 45, 89081, Ulm, Germany.
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10
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[Early assessment of the risk of later implantloosening using Roentgen Sterophotogrammetric Analysis (RSA)]. DER ORTHOPADE 2020; 49:1042-1048. [PMID: 33108489 DOI: 10.1007/s00132-020-04027-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Aseptic implant loosening is the most common cause of implant revisions in total hip and total knee arthroplasty. Roentgen Stereophotogrammetric Analysis (RSA) represents the current gold standard for the in-vivo assessment of implant fixation. PRESENT SITUATION Long-term clinical trials have shown that continuous implant migration within the first two postoperative years correlates strongly with a later aseptic loosening. Thus, the implant migration measured with RSA can be regarded as a reliable surrogate marker for later implant loosening. Over the past 40 years, RSA has been continuously further developed, and the model-based RSA approach has reduced the effort involved since markers attached to implant are no longer needed. PERSPECTIVES The RSA method is gaining importance in the certification process of new orthopaedic implants-for example, the Dutch Orthopedic Society has recommended phased-introduction and RSA studies for new hip implants. Furthermore, in the context of the new EU Medical Device Regulation (MDR), which took effect in May 2017, RSA gained relevance for investigating clinically unproven implants. Critics who associate MDR with hindering innovation can be countered in that the RSA method provides a predictive assessment of implant fixation after only two years of follow-up, which is significantly shorter than standard long-term clinical trials.
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11
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Budde S, Schwarze M, Floerkemeier T, Plagge J, Wirries N, Windhagen H, Thorey F, Derksen A. Clinical and radiographic outcomes with the Nanos™ short-stem hip implant at 24 months: A prospective, single-center study. J Orthop 2020; 20:326-331. [PMID: 32641879 DOI: 10.1016/j.jor.2020.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/04/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022] Open
Abstract
Aim Short-stem total hip arthroplasty is designed to preserve proximal bone stock in case of eventual revision, potentially benefiting younger and more active patients. This prospective, single-center study assessed the safety and performance of the partially neck-sparing Nanos™ short-stem uncemented prosthesis at 24 months using clinical outcome scores and radiographic results. Methods Between April 2011 and February 2015, 52 subjects (mean age, 54.9 years) underwent total hip arthroplasty and were followed up at 3, 6, 12 and 24 months. The primary outcome was improvement in quality of life as measured by the Short-Form 36 Mental Component Score (SF-36 MCS). Secondary clinical outcomes included the Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, Postel Merle d'Aubigné-Score, Activity Level University of California, Los Angeles score, and Pain Visual Analogue Scale. Complications and radiographic images were also recorded at each follow-up. Results Mean SF-36 MCS score significantly improved from baseline to final follow up at 24 months (61.3 vs. 79.5, respectively; p < 0.001). All secondary clinical outcomes also showed significant improvement (p < 0.001) during this time period. Neutral stem positioning was achieved in 45 subjects (86.5%). Two subjects (3.8%) underwent revisions: one for a periprosthetic fracture unrelated to the study device and another due to a prosthetic joint infection. Intraoperatively, one fissure fracture of the acetabulum occurred. Conclusion Total hip arthroplasty with the Nanos short-stem led to significant clinical improvements and a high subjective satisfaction rate at 24 months. Further follow-up will determine whether these effects are sustained in the long term.
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Affiliation(s)
- Stefan Budde
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
| | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
| | - Thilo Floerkemeier
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
| | - Jochen Plagge
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
| | - Nils Wirries
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
| | - Fritz Thorey
- Center for Hip, Knee and Foot Surgery, Sports Traumatology, ATOS Hospital, Heidelberg, Germany
| | - Alexander Derksen
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, Hannover, Germany
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12
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Abstract
AIMS Short, bone-conserving femoral components are increasingly used in total hip arthroplasty (THA). They are expected to allow tissue-conserving implantation and to render future revision surgery more straightforward but the long-term data on such components is limited. One such component is the global tissue-sparing (GTS) stem. Following the model for stepwise introduction of new orthopaedic implants, we evaluated early implant fixation and clinical outcome of this novel short-stem THA and compared it to that of a component with established good long-term clinical outcome. METHODS In total, 50 consecutive patients ≤ 70 years old with end-stage symptomatic osteo-arthritis were randomized to receive THA with the GTS stem or the conventional Taperloc stem using the anterior supine intermuscular approach by two experienced hip surgeons in two hospitals in the Netherlands. Primary outcome was implant migration. Patients were followed using routine clinical examination, patient reported outcome using Harris Hip Score (HHS), Hip Disability And Osteoarthritis Outcome Score (HOOS), EuroQol five-dimension questionnaire (EQ5D), and Roentgen Stereophotogrammetric Analysis (RSA) at three, six, 12, and 24 months. This study evaluated the two-year follow-up results. RESULTS In addition to the initial migration pattern of distal migration (subsidence, Y-translation) and retroversion (Y-rotation) also exhibited by the Taperloc stem, the GTS stem showed an initial migration pattern of varization (X-translation combined with Z-rotation) and posterior translation (Z-translation). However, all components stabilized aside from one Taperloc stem which became loose secondary to malposition and was later revised. Clinical outcomes and complications were not statistically significantly different with the numbers available. CONCLUSION A substantially different and more extensive initial migration pattern was seen for the GTS stem compared to the Taperloc stem. Although implant stabilization was achieved, excellent long-term survival similar to that of the Taperloc stem should not be inferred. Especially in the absence of clinically proven relevant improvement, widespread usage should be postponed until long-term safety has been established. Cite this article: Bone Joint J 2020;102-B(6):699-708.
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Affiliation(s)
- Marc J Nieuwenhuijse
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Stephan B W Vehmeijer
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Nina M C Mathijsen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Stefan B Keizer
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
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13
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Floerkemeier T, Budde S, Lewinski GV, Windhagen H, HurSchler C, Schwarze M. Greater early migration of a short-stem total hip arthroplasty is not associated with an increased risk of osseointegration failure: 5th-year results from a prospective RSA study with 39 patients, a follow-up study. Acta Orthop 2020; 91:266-271. [PMID: 32106733 PMCID: PMC8023937 DOI: 10.1080/17453674.2020.1732749] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Short-stem hip arthroplasty has been a viable alternative to standard stems for the treatment of hip osteoarthritis for over 10 years. This study assessed whether a correlation existed between a greater initial increase in implant migration and inferior clinical outcomes at 5 years postoperatively. Results on these patients after 2 years have been published previously.Patients and methods - Radiostereometry and clinical scoring were undertaken after surgery and at 3, 6, 12, and 24 months, and 5 years postoperatively. The migration and the clinical outcomes data from the patients with initial migrations at 3 months above the 75th percentile (≥ 75% group) were compared with those with migrations at 3 months of less than the 75th percentile (< 75% group).Results - Between 3 months and 5 years after surgery, the mean resultant implant migrations were 0.40 mm (SD 0.32) in the ≥ 75% group and 0.39 mm (SD 0.25) in the < 75% group. The mean Harris Hip Scores and SF-36 physical scores at 5 years postoperatively were 100 (SD 0.4) and 44 (SD 12), respectively, for the ≥ 75% group and 99 (SD 2) and 50 (SD 10), respectively, for the < 75% group. The differences between the patient groups were not statistically significant.Interpretation - There was no correlation between a greater initial migration and inferior clinical outcomes at 5 years postoperatively. Despite a greater initial migration, there were no risks of early aseptic loosening and inferior midterm clinical outcomes associated with a short-stem implant with a primary metaphyseal anchorage.
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Affiliation(s)
| | - Stefan Budde
- Department of Orthopaedic Surgery, Hannover Medical School, Germany;; ,Correspondence:
| | | | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Germany;;
| | | | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School
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14
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New Implant Introduction in Total Hip Arthroplasty Using Radiostereometric Analysis: A Cautionary Note. J Arthroplasty 2020; 35:643-646. [PMID: 31678017 DOI: 10.1016/j.arth.2019.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [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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15
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Christiansen JD, Ejaz A, Nielsen PT, Laursen M. An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction. J Bone Joint Surg Am 2020; 102:128-136. [PMID: 31596796 DOI: 10.2106/jbjs.19.00104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) with a diaphyseal stem may risk bone loss. In order to save proximal bone stock in young patients with a high activity level and a long life expectancy, the interest in short stems has evolved. The purpose of this prospective observational cohort study was to evaluate the fixation of, and bone remodeling around, the Primoris femoral neck-preserving hip implant. METHODS Fifty younger patients with end-stage osteoarthritis were managed with the Primoris hip implant. We evaluated bone mineral density (BMD) using dual x-ray absorptiometry (DXA) and implant migration using radiostereometric analysis (RSA). A region-of-interest (ROI) protocol for 4 ROIs was applied to assess BMD. The association between BMD and migration was evaluated to determine the fixation of the Primoris implant and bone remodeling in the proximal part of the femur. Follow-up evaluation was performed at regular intervals from day 1 (baseline) until 24 months after surgery. RESULTS The major stem migrations were subsidence (Y axis; mean, 0.38 mm) at 6 weeks and varus tilt (rotation) (Z axis; mean, 0.93°) at 6 to 12 months. In ROI4 (the calcar area), a significant gain in bone was found with a mean difference of 4.1% (95% confidence interval [CI], 0.8% to 7.4%; p < 0.02) at 24 months postoperatively. Significant bone loss was found in ROI1 and ROI2, with a mean difference of -4.9% (95% CI, -7.4% to -2.4%; p = 0.0003) and -8.9% (95% CI, -11.5% to -6.2%; p = 0.0001), respectively. Linear regression and multivariate regression analysis showed a significant negative association between maximal total point motion and BMD (p = 0.02, R = 15%; and p < 0.05, R = 26%, respectively). CONCLUSIONS The Primoris component showed satisfactory primary stability with promising results at the 24-month follow-up. DXA scans showed limited stress-shielding with the proximal loading pattern of the Primoris. Better bone quality was associated with less implant migration. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Janus D Christiansen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ashir Ejaz
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul T Nielsen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark
| | - Mogens Laursen
- Department of Orthopaedic Surgery (J.D.C., A.E., P.T.N., and M.L.) and Orthopaedic Surgery Research Unit (J.D.C., A.E., and M.L.), Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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16
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Primary stability of calcar-guided short-stem total hip arthroplasty in the treatment of osteonecrosis of the femoral head: migration analysis using EBRA-FCA. Arch Orthop Trauma Surg 2020; 140:2091-2100. [PMID: 33011847 PMCID: PMC7674354 DOI: 10.1007/s00402-020-03610-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Osteonecrosis of the femoral head (ONFH) is a disabling condition that often results in secondary arthritis necessitating total hip arthroplasty (THA). Short-stem THA has constantly gained popularity. It remains controversial, whether ONFH represents a risk factor for failure after the implantation of short stems with pronounced metaphyseal anchorage. The potential spread of the osteonecrotic area and bone marrow edema into the metaphyseal bone might result in compromised stability. Early implant migration is considered predictive of subsequent aseptic loosening. The purpose of this study was a migration analysis of a modern, calcar-guided short-stem implant in patients with ONFH in a mid-term follow-up. MATERIALS AND METHODS This retrospective analysis investigated the migration pattern of 45 calcar-guided short stems in patients with ONFH, using Einzel-Bild-Roentgen-Analyse Femoral-Component-Analysis (EBRA-FCA). Influencing factors such as ARCO categories, age, gender, body weight and BMI were analyzed. Complications and adverse events were documented. RESULTS At mid-term [48.1 months (SD 20.7 months)], mean axial migration was 1.56 mm (SD 1.77 mm). Mean migration rate stabilized after 2 years. No influence of ARCO categories, age and BMI was found. A tendency of increased axial migration was observed in male patients and in overweight patients. No revision surgeries had to be performed during follow-up. CONCLUSION The results indicate a migration pattern comparable to that of primary osteoarthritis patients with slight initial migration under full load followed by subsequent stabilization in the metaphyseal femur. The 100% survival rate at mid-term supports the usage of this short-stem design in patients with ONFH.
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17
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Comparison of short-stem with conventional-stem prostheses in total hip arthroplasty: an 8-year follow-up study. Arch Orthop Trauma Surg 2020; 140:1285-1291. [PMID: 32572595 PMCID: PMC8211593 DOI: 10.1007/s00402-020-03519-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Coxarthrosis is a common disease of the adult hip joint. Elderly patients have mainly been treated with total hip arthroplasty (THA); however, younger patients are increasingly affected. Short-stem prostheses were developed for this special patient group. There have been few studies on the clinical outcomes of this type of prosthesis. This study compared the mid-term results of a short-stem prosthesis and a standard-stem prosthesis 8 years after implantation. METHODS According to our clinical registry, patients who received a short-stem prosthesis before 2011 were identified. Patients in the standard-stem prosthesis group were matched based on the sex, age, height, weight, and degree of arthrosis. At the follow-up time, the modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity score and visual analog scale (VAS) pain score were collected and compared with the preoperative values. RESULTS Fifty-five patients could be matched and analyzed for both groups. No patients needed revision surgery. In both groups, there were significant improvements at the follow-up time. The pre- and postoperative mHHSs, UCLA scores, and VAS scores were 41.9 and 95 (p < 0.0001), 3.75 and 7.9 (p < 0.0001), and 7.6 and 0.9 (p < 0.0001), respectively, in the short-stem group and 44.8 and 96.25 (p < 0.0001), 3.6 and 7.7 (p < 0.0001), and 7.7 and 0.9 (p < 0.0001), respectively, in the control group, with no significant differences between the groups at the follow-up time. CONCLUSION The short-stem prosthesis provides mid-term results comparable to those of a standard-stem prosthesis. In both groups, excellent patient-reported outcomes were achieved after an average of 8 years. LEVEL OF EVIDENCE IV.
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18
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Kutzner KP, Donner S, Loweg L, Rehbein P, Dargel J, Drees P, Pfeil J. Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases. J Orthop Traumatol 2019; 20:31. [PMID: 31673809 PMCID: PMC6823459 DOI: 10.1186/s10195-019-0537-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In recent years, a variety of short stems have been introduced. To date, mid- and long-term results of calcar-guided short-stem designs have been rarely available. MATERIALS AND METHODS Two hundred and sixteen calcar-guided short stems were included in combination with a cementless cup in a prospective study. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfaction on visual analogue scale (VAS) were assessed during a median follow-up of 61.7 months. Standardised radiographs were analysed at predefined time points regarding radiological alterations such as bone resorption and remodelling, radiolucency, osteolysis and cortical hypertrophy using modified Gruen zones. RESULTS At mid-term follow-up, no revision surgery of the stem had to be performed in the whole collective. At 5 years, HHS was 97.8 (SD 4.7), satisfaction on VAS was 9.7 (SD 0.7), rest pain on VAS was 0.1 (SD 0.5), and load pain on VAS was 0.6 (SD 1.2). Compared to the 2-year results, femoral bone resorption increased significantly at the 5-year follow-up (3.9% versus 42.3%). Rate of femoral cortical hypertrophy remained stable, occurring in a total of 9 hips (4.5%). At the 5-year follow-up, 2 stems (1.0%) showed non-progressive radiolucent lines with a maximum width of 2 mm. Signs of osteolysis were not observed. Compared to the 2-year follow-up, no further subsidence was observed. CONCLUSIONS The rate of stem revision (0%) at the mid-term follow-up was remarkable and indicates the principle of using a calcar-guided short stem as being a safe procedure. However, signs of bone-remodelling, indicating some amount of stress-shielding, must be acknowledged at 5 years depending on stem alignment and type of anchorage. LEVEL OF EVIDENCE IV, Prospective observational study Trial registration German Clinical Trials Register, DRKS00012634, 07/07/2017 (retrospectively registered).
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany. .,Department for Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Stefanie Donner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Lennard Loweg
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Jens Dargel
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department for Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Joachim Pfeil
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
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19
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Freitag T, Fuchs M, Woelfle-Roos JV, Reichel H, Bieger R. Mid-term migration analysis of a femoral short-stem prosthesis: a five-year EBRA-FCA-study. Hip Int 2019; 29:128-133. [PMID: 29739256 DOI: 10.1177/1120700018772277] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: The objective of this study was to evaluate the mid-term migration pattern of a femoral short stem. METHODS: Implant migration of 73 femoral short-stems was assessed by Ein-Bild-Roentgen-Analysis Femoral-Component-Analysis (EBRA-FCA) 5 years after surgery. Migration pattern of the whole group was analysed and compared to the migration pattern of implants "at risk" with a subsidence of more than 1.5 mm 2 years postoperative. RESULTS: Mean axial subsidence was 1.1 mm (-5.0 mm to 1.5 mm) after 60 months. There was a statistical significant axial migration until 2 years postoperative with settling thereafter. 2 years after surgery 18 of 73 Implants were classified "at risk." Nevertheless, all stems showed secondary stabilisation in the following period with no implant failure neither in the group of implants with early stabilisation nor the group with extensive early onset migration. CONCLUSION: In summary, even in the group of stems with more pronounced early subsidence, delayed settling occurred in all cases. The determination of a threshold of critical early femoral short stem subsidence is necessary because of the differing migration pattern described in this study with delayed settling of the Fitmore stem 2 years postoperatively compared to early settling within the first postoperative year described for conventional stems.
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Affiliation(s)
- Tobias Freitag
- 1 Department of Orthopaedic Surgery, University of Ulm, Germany
| | - Michael Fuchs
- 1 Department of Orthopaedic Surgery, University of Ulm, Germany.,2 Centre for Musculoskeletal Surgery, Orthopaedic Department Charite, Berlin, Germany
| | | | - Heiko Reichel
- 1 Department of Orthopaedic Surgery, University of Ulm, Germany
| | - Ralf Bieger
- 1 Department of Orthopaedic Surgery, University of Ulm, Germany
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20
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Rutherford M, Khan RJK, Fick DP, Haebich S, Nivbrant O, Kozak T. Randomised clinical trial assessing migration of uncemented primary total hip replacement stems, with and without autologous impaction bone grafting. INTERNATIONAL ORTHOPAEDICS 2019; 43:2715-2723. [PMID: 30706087 DOI: 10.1007/s00264-019-04290-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/02/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE Uncemented stems in primary total hip replacement (THR) are concerning in the elderly due to ectatic femoral canals and cortical thinning resulting in higher incidence of fracture and subsidence in this population. To obviate this concern, the authors developed a technique using autologous impaction bone grafting to achieve a better fitting femoral stem. The aim of this randomised clinical trial was to assess the efficacy of the technique. METHODS From 2013 to 2015, a total of 98 consecutive participants (100 primary THR procedures) were inducted into a single-institution, single-blinded, randomised clinical trial assessing, with radiostereometric analysis (RSA), the efficacy of autologous impaction bone grafting in uncemented primary THR compared with traditional uncemented primary THR technique. The primary outcome measure was femoral component migration using RSA. Secondary outcomes were post-operative proximal femoral bone density (using DEXA), hip function and quality of life using Oxford Hip Score (OHS) and Short Form-12 Health Survey (SF-12), hip pain and patient satisfaction. RESULTS There was no difference in femoral component stability (p > 0.5) or calcar resorption between the Graft and No Graft Groups at two years. There was also no difference in OHS, SF-12, pain or satisfaction between the Graft and No Graft Groups at two years (p > 0.39). CONCLUSIONS Autologous impaction bone grafting in uncemented primary THR has shown its short-term post-operative outcomes to be equivalent to standard uncemented technique, whilst offering a better fit in patients who are between femoral stem sizes. AUSTRALIAN CLINICAL TRIAL REGISTRATION NUMBER ACTRN12618000652279.
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Affiliation(s)
- Michael Rutherford
- Hollywood Private Hospital, Monash Avenue, Perth, WA, 6009, Australia. .,The Joint Studio, Suite 1/85 Monash Avenue, Perth, WA, 6009, Australia.
| | - Riaz J K Khan
- Hollywood Private Hospital, Monash Avenue, Perth, WA, 6009, Australia.,The Joint Studio, Suite 1/85 Monash Avenue, Perth, WA, 6009, Australia.,School of Medicine, University of Notre Dame Fremantle, Fremantle, WA, 6160, Australia
| | - Daniel P Fick
- Hollywood Private Hospital, Monash Avenue, Perth, WA, 6009, Australia.,The Joint Studio, Suite 1/85 Monash Avenue, Perth, WA, 6009, Australia
| | - Samantha Haebich
- The Joint Studio, Suite 1/85 Monash Avenue, Perth, WA, 6009, Australia
| | - Oscar Nivbrant
- Department of Orthopaedics, Umeå University, Umeå, Sweden
| | - Thomas Kozak
- Royal Perth Hospital, 197 Wellington St., Perth, WA, 6000, Australia
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21
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Femoral neck preservation with a short hip stem produced with powder manufacturing: mid-term results of a consecutive case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:801-806. [PMID: 30689043 DOI: 10.1007/s00590-019-02381-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Abstract
Stress shielding and thigh pain are not uncommon after cementless total hip arthroplasty (THA) using conventional hip stems. It has been postulated that short, neck-preserving stems may overcome these disadvantages of standard stems and, hence, further improve clinical outcome. The purpose of our retrospective study was to assess the mid-term performance of a neck-preserving hip stem for which, as of yet, no clinical results have been published. A population of 146 consecutive patients who received 152 neck-preserving stems over a 1.6-year period was retrospectively reviewed. Harris Hip Score (HHS) and the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) were collected, along with radiographic data. One hundred and forty-four THAs implanted in 136 patients were available for analysis. After a mean follow-up of 56 months, mean HHS and WOMAC improved significantly versus preoperative values. Aseptic loosening was not observed. Five-year survival with revision of any component for any reason as the endpoint was 99.3% (95% confidence interval, 95.2-99.9%). Excellent mid-term clinical and radiographic outcomes were observed with the study device. We attribute this to the metaphyseal fit in combination with retention of the femoral neck. However, our findings need to be confirmed by multicentre studies with larger patient samples.
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22
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Jacobsen A, Seehaus F, Hong Y, Cao H, Schuh A, Forst R, Sesselmann S. Model-based roentgen stereophotogrammetric analysis using elementary geometrical shape models: 10 years results of an uncemented acetabular cup component. BMC Musculoskelet Disord 2018; 19:335. [PMID: 30223820 PMCID: PMC6142331 DOI: 10.1186/s12891-018-2259-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/12/2018] [Indexed: 11/16/2022] Open
Abstract
Background Non-cemented acetabular cup components demonstrated different clinical performance depending on their surface texture or bearing couple. However, clinical osseointegration needs to be proved for each total joint arthroplasty (TJA) design. Aim of this study was to detect the in vivo migration pattern of a non-cemented cup design, using model-based roentgen stereophotogrammetric analysis with elementary geometrical shape models (EGS-RSA) to calculate early cup migration. Methods Interchangeable applicability of the model-based EGS-RSA method next to gold standard marker-based RSA method was assessed by clinical radiographs. Afterwards, in vivo acetabular cup migration for 39 patients in a maximum follow up of 120 months (10 years) was calculated using model-based EGS-RSA. Results For the axes with the best predictive capability for acetabular cup loosening, mean (±SD) values were calculated for migration and rotation of the cup. The cup migrated 0.16 (±0.22) mm along the cranio-caudal axis after 24 months and 0.36 (±0.72) mm after 120 months, respectively. It rotated − 0.61 (±0.57) deg. about the medio-lateral axis after 24 months and − 0.53 (±0.67) deg. after 120 months, respectively. Conclusions Interchangeable applicability of model-based EGS-RSA next to gold standard marker-based RSA method could be shown. Model-based EGS-RSA enables an in vivo migration measurement without the necessity of TJA specific surface models. Migration of the investigated acetabular cup component indicates significant migration values along all the three axes. However, migration values after the second postoperative year were within the thresholds reported in literature, indicating no risk for later aseptic component loosening of this TJA design.
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Affiliation(s)
- Anne Jacobsen
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Frank Seehaus
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Yutong Hong
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Han Cao
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Alexander Schuh
- Muskuloskelettales Zentrum, Klinikum Neumarkt, Nürnberger Str. 12, 92318, Neumarkt i. d. OPf, Germany
| | - Raimund Forst
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Stefan Sesselmann
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany. .,Institute for Medical Technology, Ostbayerische Technische Hochschule Amberg-Weiden, Hetzenrichter Weg 15, 92637, Weiden, Germany.
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Ferguson RJ, Broomfield JA, Malak TT, Palmer AJR, Whitwell D, Kendrick B, Taylor A, Glyn-Jones S. Primary stability of a short bone-conserving femoral stem. Bone Joint J 2018; 100-B:1148-1156. [DOI: 10.1302/0301-620x.100b9.bjj-2017-1403.r1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aims The aim of this study was to determine the stability of a new short femoral stem compared with a conventional femoral stem in patients undergoing cementless total hip arthroplasty (THA), in a prospective randomized controlled trial using radiostereometric analysis (RSA). Patients and Methods A total of 53 patients were randomized to receive cementless THA with either a short femoral stem (MiniHip, 26 patients, mean age: 52 years, nine male) or a conventional length femoral stem (MetaFix, 23 patients, mean age: 53 years, 11 male). All patients received the same cementless acetabular component. Two-year follow-up was available on 38 patients. Stability was assessed through migration and dynamically inducible micromotion. Radiographs for RSA were taken postoperatively and at three, six, 12, 18, and 24 months. Results At two years, there was significantly less subsidence (inferior migration) of the short femoral stem (head, 0.26 mm, 95% confidence interval (CI) 0.08 to 0.43, sd 0.38; tip, 0.11 mm, 95% CI -0.08 to 0.31, sd 0.42) compared with the conventional stem (head, 0.62 mm, 95% CI 0.34 to 0.90, sd 0.56, p = 0.02; tip, 0.43 mm, 95% CI 0.21 to 0.65, sd 0.44, p = 0.03). There was no significant difference in dynamically inducible micromotion, rate of complications or functional outcome. Conclusion This study demonstrates that the short femoral stem has a stable and predictable migration. However, longer-term survival analysis still needs to be determined. Cite this article: Bone Joint J 2018;100-B:1148–56.
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Affiliation(s)
- R. J. Ferguson
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - J. A. Broomfield
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - T. T. Malak
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - A. J. R. Palmer
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - D. Whitwell
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - B. Kendrick
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - A. Taylor
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
| | - S. Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Botnar Research
Centre, Oxford, UK
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Abstract
Over the last two decades, several conservative femoral prostheses have been designed. The goals of conservative stems include: the spearing of the trochanteric bone stock; a more physiological loading in the proximal femur reducing the risk of stress shielding; and to avoid a long stem into the diaphysis preventing impingement with the femoral cortex and thigh pain. All stems designed to be less invasive than conventional uncemented stems are commonly named ‘short stems’. However, this term is misleading because it refers to a heterogeneous group of stems deeply different in terms of design, biomechanics and bearing. In the short-term follow-up, all conservative stems provided excellent survivorship. However, variable rates of complications were reported, including stem malalignment, incorrect stem sizing and intra-operative fracture. Radiostereometric analysis (RSA) studies demonstrated that some conservative stems were affected by an early slight migration and rotation within the first months after surgery, followed by a secondary stable fixation. Dual-energy x-ray absorptiometry (DEXA) studies demonstrated an implant-specific pattern of bone remodelling. Although the vast majority of stems demonstrated a good osseointegration, some prostheses transferred loads particularly to the lateral and distal-medial regions, favouring proximal stress shielding and bone atrophy in the great trochanter and calcar regions. Cite this article: EFORT Open Rev 2018;3:149-159. DOI: 10.1302/2058-5241.3.170052
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Italy; Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Italy
| | - Guido Grappiolo
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Italy
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25
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Schwarze M, Budde S, von Lewinski G, Windhagen H, Keller MC, Seehaus F, Hurschler C, Floerkemeier T. No effect of conventional vs. minimally invasive surgical approach on clinical outcome and migration of a short stem total hip prosthesis at 2-year follow-up: A randomized controlled study. Clin Biomech (Bristol, Avon) 2018; 51:105-112. [PMID: 29287171 DOI: 10.1016/j.clinbiomech.2017.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/30/2017] [Accepted: 12/08/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
| | - Stefan Budde
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Gabriela von Lewinski
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Marie Christina Keller
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Frank Seehaus
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
| | - Thilo Floerkemeier
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
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26
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Yan SG, Weber P, Steinbrück A, Hua X, Jansson V, Schmidutz F. Periprosthetic bone remodelling of short-stem total hip arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2017; 42:2077-2086. [DOI: 10.1007/s00264-017-3691-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 11/09/2017] [Indexed: 01/26/2023]
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27
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Mahmoud AN, Kesteris U, Flivik G. Stable migration pattern of an ultra-short anatomical uncemented hip stem: a prospective study with 2 years radiostereometric analysis follow-up. Hip Int 2017; 27:259-266. [PMID: 28165591 DOI: 10.5301/hipint.5000458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Shorter, anatomically shaped and proximally loading stems have been developed to achieve better stress distribution and be more bone preserving. The purpose of this prospective study was to evaluate the migration pattern of the Proxima™ ultra-short uncemented stem using radiostereometric analysis (RSA), and to review the literature regarding the migration of short stemmed hip arthroplasty. METHODS 25 patients (28 hips) with hip osteoarthritis received a Proxima stem during total hip arthroplasty (THA). To measure stem migration, repeated RSA examinations were done during a 2 year follow up period. The patients were evaluated with the hip specific (HOOS) and the generic health (EQ5D) scores up to 1 year, and clinically for 6 years postoperatively. RESULTS Almost all migration occurred within the first 3 months, with mean subsidence of 0.22 mm and varus rotation of 1.04°, being the primary effect variables. After the third postoperative month and up to the 2 year RSA follow up no further significant migration occurred. The outcome scores showed substantial improvement after 1 year. No revisions were performed or indicated for any stem after a mean clinical follow up of 72.1 months. CONCLUSIONS Like many other uncemented stems, the Proxima showed early migration up to 3 months hereafter osseointegration seems to have occurred. The achieved stability and clinical outcomes indicate favorable early results for this stem in younger patients who have good bone quality and average BMI. We found, however, the surgical technique to be slightly more demanding compared to conventional stems owing to the unique implant design that necessitates specific adjusted femoral cutting and broaching procedures.
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Affiliation(s)
- Ahmed Nageeb Mahmoud
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund - Sweden
| | - Uldis Kesteris
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund - Sweden
| | - Gunnar Flivik
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund - Sweden
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28
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Can the metaphyseal anchored Metha short stem safely be revised with a standard CLS stem? A biomechanical analysis. INTERNATIONAL ORTHOPAEDICS 2017; 41:2471-2477. [DOI: 10.1007/s00264-017-3497-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023]
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The Influence of Tribological Pairings and Other Factors on Migration Patterns of Short Stems in Total Hip Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8756432. [PMID: 28497067 PMCID: PMC5406728 DOI: 10.1155/2017/8756432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/11/2017] [Accepted: 03/28/2017] [Indexed: 01/13/2023]
Abstract
Over the last decade, the number of short stem total hip arthroplasty procedures has increased. Along with the possible benefits associated with short stems is a smaller implant-bone contact surface, which may have a negative influence on primary stability and impair osseointegration. Previous studies observed migration of short stems, especially within the first three months. The variables that influence migration in short stem hip implants remain unknown. Therefore, the purpose of this study was to associate the migration of short stems with its possible influencing variables. Migration data from two different short stem studies were retrospectively analyzed. Migration within the first two postoperative years was determined by model-based Roentgen stereophotogrammetric analysis. Migration was correlated to bearing couple, type and size of stem, size of acetabular cup, and age, gender, weight, and height of patients using a multiple factor analysis. Eigenvalue analysis explained 80.7% of the overall variance for the first three dimensions. The four most dominant variables in the first dimension were weight, stem size, acetabular cup size, and patient height (correlations of 0.81, 0.80, 0.71, and 0.70, resp.). None of the analyzed parameters (bearing couple, type and size of stem, size of acetabular cup, and age, gender, weight, and height of patients) affected the migration pattern of short stem THA with primary metaphyseal fixation.
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30
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One-stage bilateral versus unilateral short-stem total hip arthroplasty: comparison of migration patterns using "Ein-Bild-Roentgen-Analysis Femoral-Component-Analysis". INTERNATIONAL ORTHOPAEDICS 2016; 41:61-66. [PMID: 27075867 DOI: 10.1007/s00264-016-3184-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/27/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE The hypothesis of this study was that femoral implant migration would not differ between simultaneous bilateral or unilateral short-stem THA. METHOD Implant migration of 202 femoral short-stems (100 unilateral and 102 one-stage bilateral cases) in 151 patients was assessed by "Ein-Bild-Roentgen-Analysis Femoral-Component-Analysis" in a two years follow-up (2.0-3.0 years). Migration patterns of unilateral and simultaneous cases were analysed and compared. RESULTS There was no difference between the two groups regarding age, body mass index and gender. After two years mean subsidence of all 202 implants was 1.43 mm (-6.5 mm to 2.0 mm). After initial subsidence of 0.37 mm per month within the first six weeks, the mean monthly migration was reduced to 0.02 mm between one and two years post-operative. There was no statistical difference in mean migration between unilateral (1.34 mm) and simultaneous bilateral (1.51 mm) THA (p = 0.33). CONCLUSION In summary, two years post-operative there was no difference in the amount of mean implant subsidence between unilateral compared to simultaneous bilateral short-stem THA. This suggests that regarding implant fixation simultaneous bilateral short-stem THA is as safe and successful as a solely unilateral intervention.
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