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Bunting AC, Costi K, Chimutengwende-Gordon M, Callary SA, Pannach S, Nelson R, Howie DW, Solomon LB. Staged Revision Hip Arthroplasty With Femoral Impaction Bone Grafting for Prosthetic Joint Infections: Radiostereometric Analyses and Clinical Outcomes at Minimum 5-Year Follow-Up. J Arthroplasty 2023; 38:2716-2723.e1. [PMID: 37321515 DOI: 10.1016/j.arth.2023.06.003] [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: 12/11/2022] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND There are ongoing concerns regarding the use of bone graft following prosthetic joint infection and subsequent implant subsidence. The aim of this study was to determine whether the use of a cemented stem combined with femoral impaction bone grafting (FIBG) at second stage revision for infection results in stable femoral stem fixation, determined by accurate methods, and good clinical results. METHODS A prospective cohort of 29 patients underwent staged revision total hip arthroplasty for infection using an interval prosthesis followed by FIBG at the final reconstruction. The mean follow-up was 89 months (range, 8 to 167 months). Femoral implant subsidence was measured with radiostereometric analysis. Clinical outcomes included the Harris Hip Score, Harris Pain score and Société Internationale de Chirurgie Orthopédique et de Traumatologie activity scores. RESULTS At 2-years follow-up the median stem subsidence relative to femur was -1.36 mm (range, -0.31 to -4.98), while the cement subsidence relative to femur was -0.05 mm (range, 0.36 to -0.73). At 5-years follow-up, the median stem subsidence relative to femur was -1.89 mm (range, -0.27 to -6.35), while the cement subsidence relative to femur was -0.06 mm (range, 0.44 to -0.55). There were 25 patients who were confirmed infection-free after the second stage revision with FIBG. The median Harris Hip Score improved from 51 pre-operatively to 79 at 5 years (P = .0130), and Harris Pain score from 20 to 40 (P = .0038). CONCLUSIONS Stable femoral component fixation can be achieved with FIBG when reconstructing the femur after revision for infection without compromising infection cure rates and patient-reported outcomes.
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Affiliation(s)
- Alexandra C Bunting
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Kerry Costi
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia
| | | | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Susan Pannach
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Renjy Nelson
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, South Australia
| | - Donald W Howie
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Lucian Bogdan Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
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Jørgensen PB, Jakobsen SS, Vainorius D, Homilius M, Hansen TB, Stilling M. Less early subsidence of cemented Exeter short stems compared with cemented Exeter standard stems in Dorr type A femurs. Bone Jt Open 2023; 4:507-515. [PMID: 37407021 PMCID: PMC10322230 DOI: 10.1302/2633-1462.47.bjo-2023-0008.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Aims The Exeter short stem was designed for patients with Dorr type A femora and short-term results are promising. The aim of this study was to evaluate the minimum five-year stem migration pattern of Exeter short stems in comparison with Exeter standard stems. Methods In this case-control study, 25 patients (22 female) at mean age of 78 years (70 to 89) received cemented Exeter short stem (case group). Cases were selected based on Dorr type A femora and matched first by Dorr type A and then age to a control cohort of 21 patients (11 female) at mean age of 74 years (70 to 89) who received with cemented Exeter standard stems (control group). Preoperatively, all patients had primary hip osteoarthritis and no osteoporosis as confirmed by dual X-ray absorptiometry scanning. Patients were followed with radiostereometry for evaluation of stem migration (primary endpoint), evaluation of cement quality, and Oxford Hip Score. Measurements were taken preoperatively, and at three, 12, and 24 months and a minimum five-year follow-up. Results At three months, subsidence of the short stem -0.87 mm (95% confidence interval (CI) -1.07 to -0.67) was lower compared to the standard stem -1.59 mm (95% CI -1.82 to -1.36; p < 0.001). Both stems continued a similar pattern of subsidence until five-year follow-up. At five-year follow-up, the short stem had subsided mean -1.67 mm (95% CI -1.98 to -1.36) compared to mean -2.67 mm (95% CI -3.03 to -2.32) for the standard stem (p < 0.001). Subsidence was not influenced by preoperative bone quality (osteopenia vs normal) or cement mantle thickness. Conclusion The standard Exeter stem had more early subsidence compared with the short Exeter stem in patients with Dorr type A femora, but thereafter a similar migration pattern of subsidence until minimum five years follow-up. Both the standard and the short Exeter stems subside. The standard stem subsides more compared to the short stem in Dorr type A femurs. Subsidence of the Exeter stems was not affected by cement mantle thickness.
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Affiliation(s)
- Peter B. Jørgensen
- AutoRSA Reseach Group Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stig S. Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dovydas Vainorius
- Department of Orthopaedics, Gødstrup Regional Hospital, Herning, Denmark
| | - Morten Homilius
- Department of Orthopaedics, Gødstrup Regional Hospital, Herning, Denmark
| | - Torben B. Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopaedics, Gødstrup Regional Hospital, Herning, Denmark
| | - Maiken Stilling
- AutoRSA Reseach Group Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Vind TD, Jørgensen PB, Vainorius D, Jakobsen SS, Søballe K, Stilling M. Migration pattern of cemented Exeter short stem in Dorr type A femurs. A prospective radiostereometry study with 2-year follow-up. Arch Orthop Trauma Surg 2023; 143:1071-1080. [PMID: 35113240 DOI: 10.1007/s00402-021-04307-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Exeter short stem (ESS) is 25 mm shorter than the standard length v40 Exeter stem (Stryker) and intended for a narrow femoral diaphysis. The purpose of the study was to evaluate the migration pattern of the cemented ESS. MATERIAL AND METHOD In a prospective single-center cohort study, 23 patients (21 female) mean age 78 (range 70-89) with hip osteoarthritis and Dorr Type A femurs were included. Preoperative DXA was used to group patients into normal (> - 1) and low (< - 1) T-score. Components were the collarless polished double-tapered Exeter short stem type N°1 L125. Patients were followed for 2 years with model-based RSA (stem migration), regular hip radiographs (stem position and cementation quality), Oxford Hip Score (OHS) and VAS pain. RESULTS At 2-year follow-up, the stems subsided 1.48 mm (CI 95% 1.69; 1.26) and retroverted 0.45° (CI 95% 0.01; 0.88). From 12 to 24 months, stem subsidence was 0.18 mm (CI 95% 0.1; 0.25) (p = 0.001) and retroversion was - 0.04° (CI 95% - 0.27; 0.18) (p = 0.70). T-score and stem subsidence correlated (rho = 0.48; p = 0.025) and patients with normal T-score (n = 7) had 0.42 mm (CI 95% - 0.01; 0.85) less subsidence as compared to patients with low T-score (n = 15) (p = 0.054). Stems in varus position (n = 9) subsided 1.7 mm (CI 95% 1.35; 2.05) compared to 1.33 mm (CI 95% 1.05; 1.60) for stems in neutral position (n = 13) (p = 0.07). Postoperative cementation quality did not influence 2-year stem migration. OHS improved to 40.7 (CI 95% 36.8; 44.7) and VAS pain at rest and activity decreased to 5 mm and 10 mm, respectively (p < 0.001). CONCLUSION The 2-year migration pattern of the cemented ESS was similar to reports for the cemented standard length Exeter stem. Low preoperative T-score and varus stem-position showed a tendency for higher stem migration and should be studied as risk factors for failure in larger studies of cemented polished stems.
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Affiliation(s)
- Tobias Dahl Vind
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark.
- Aarhus University, Aarhus, Denmark.
| | - Peter Bo Jørgensen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark
| | - Dovydas Vainorius
- Hospital Unit West, University Clinic for Hand, Hip and Knee Surgery, Lægårdvej 12, 7500, Holstebro, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark
| | - Kjeld Søballe
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus, Denmark
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Khanuja HS, Mekkawy KL, MacMahon A, McDaniel CM, Allen DA, Moskal JT. Revisiting Cemented Femoral Fixation in Hip Arthroplasty. J Bone Joint Surg Am 2022; 104:1024-1033. [PMID: 35298444 PMCID: PMC9969348 DOI: 10.2106/jbjs.21.00853] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ The primary means of femoral fixation in North America is cementless, and its use is increasing worldwide, despite registry data and recent studies showing a higher risk of periprosthetic fracture and early revision in elderly patients managed with such fixation than in those who have cemented femoral fixation. ➤ Cemented femoral stems have excellent long-term outcomes and a continued role, particularly in elderly patients. ➤ Contrary to historical concerns, recent studies have not shown an increased risk of death with cemented femoral fixation. ➤ The choice of femoral fixation method should be determined by the patient's age, comorbidities, and bone quality. ➤ We recommend considering cemented femoral fixation in patients who are >70 years old (particularly women), in those with Dorr type-C bone or a history of osteoporosis or fragility fractures, or when intraoperative broach stability cannot be obtained.
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Affiliation(s)
- Harpal S. Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Kevin L. Mekkawy
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Aoife MacMahon
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Claire M. McDaniel
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Donald A. Allen
- Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia
| | - Joseph T. Moskal
- Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia
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5
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Ebert JR, Nivbrant NO, Petrov V, Yates P, Wood DJ. A 2-year prospective clinical and bone density evaluation, with a subset undergoing radiostereometric analysis, using the Absolut cemented stem. ANZ J Surg 2022; 92:830-836. [PMID: 35106881 PMCID: PMC9303330 DOI: 10.1111/ans.17519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/27/2022]
Abstract
Background Total hip arthroplasty (THA) is common though the investigation of new prostheses requires a practical, step‐wise introduction. This study reports the 2‐year clinical results and periprosthetic bone mineral density (BMD) changes, along with a subset undergoing Radiostereometric analysis (RSA), in patients undergoing primary cemented THA using a new highly polished, double tapered, collarless femoral stem (Absolut). Methods Between August 2013 and December 2016, 47 patients with a mean age of 74.2 years (range 36–89) underwent 51 THAs with the Absolut. All patients underwent clinical assessment pre‐surgery and at 6 weeks, 3, 12 and 24 months using the Oxford and Harris Hip Scores, as well as Dual Energy X‐ray Absorptiometry (DEXA) to assess BMD within 2–4 weeks post‐surgery, 12 and 24 months. RSA was undertaken in a patient subset (the first n = 30) early post‐surgery (1–2 days) and 3, 12 and 24 months. Results All clinical scores significantly improved (p < 0.05). RSA revealed a mean subsidence of 0.78 mm at 3 months, 1.23 mm at 12 months and 1.51 mm at 24 months. Anterior–posterior and medial‐lateral translation was negligible. A significant increase (p = 0.020) in BMD was observed in Gruen zone 1, though no significant changes were observed for any other zone up until 2 years. Two patients acquired an early post‐operative deep vein thrombosis that were treated accordingly and resolved, with no further complications or re‐operations. Conclusion The Absolut cemented femoral stem demonstrated good outcomes, BMD changes consistent with sound prosthesis integration and patterns of post‐operative micromotion observed in other successful cemented stems.
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia.,HFRC, Perth, Western Australia, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia
| | - Nils O Nivbrant
- Perth Orthopaedic Institute, Perth, Western Australia, Australia
| | | | - Piers Yates
- Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia.,Fremantle Hospital, Fremantle, Western Australia, Australia
| | - David J Wood
- Perth Orthopaedic Institute, Perth, Western Australia, Australia.,School of Surgery (Orthopaedics), University of Western Australia, Perth, Western Australia, Australia
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6
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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: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [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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7
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Mjöberg B. Hip prosthetic loosening: A very personal review. World J Orthop 2021; 12:629-639. [PMID: 34631447 PMCID: PMC8472441 DOI: 10.5312/wjo.v12.i9.629] [Citation(s) in RCA: 4] [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: 01/20/2021] [Revised: 05/03/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Hip prosthetic loosening is often difficult to detect at an early stage, and there has been uncertainty for a long time as to when the loosening occurs and thus to the basic causes. By comparing different diagnostic methods, we found that loosening is best defined as prosthetic migration and measured by radiostereometric analysis. Convincing evidence indicates that poor interlock, poor bone quality, and resorption of a necrotic bone bed may initiate loosening during or shortly after surgery; this forms the basis of the theory of early loosening. Biomechanical factors do affect the subsequent progression of loosening, which may increase subclinically during a long period of time. Eventually, the loosening may be detected on standard radiographs and may be interpreted as late loosening but should to be interpreted as late detection of loosening. The theory of early loosening explains the rapid early migration, the development of periprosthetic osteolysis and granulomas, the causality between wear and loosening, and largely the epidemiology of clinical failure of hip prostheses. Aspects discussed are definition of loosening, the pattern of early migration, the choice of migration threshold, the current understanding of loosening, a less exothermic bone cement, cemented taper-slip stems, a new exciting computed tomography-based technique for simpler implant migration studies, and research suggestions.
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Affiliation(s)
- Bengt Mjöberg
- Department of Orthopedics, Lund University, Lund SE-221 00, Sweden
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8
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Cemented Revision Hip Arthroplasty With Femoral Impaction Bone Grafting. J Am Acad Orthop Surg 2021; 29:591-595. [PMID: 34161958 DOI: 10.5435/jaaos-d-20-00481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 01/13/2021] [Indexed: 02/01/2023] Open
Abstract
Long-stemmed uncemented implants are commonly used during revision hip arthroplasty but may be difficult to re-revise. Impaction bone grafting allows for the use of a shorter cemented stem during revision hip arthroplasty and may restore bone stock in patients with substantial femoral defects. Femoral impaction bone grafting is particularly beneficial in younger patients, who are more likely to require additional revision procedures in the future. The surgical technique used at our institution includes improvements to previous methods including the use of modular tamps and nonirradiated, size-profiled bone graft.
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9
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Baryeh K, Mendis J, Sochart DH. Temporal subsidence patterns of cemented polished taper-slip stems: a systematic review. EFORT Open Rev 2021; 6:331-342. [PMID: 34150327 PMCID: PMC8183154 DOI: 10.1302/2058-5241.6.200086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The literature was reviewed to establish the levels of stem subsidence for both double and triple-tapered implants in order to determine whether there were any differences in subsidence levels with regard to the methods of measurement, the magnitude and rate of subsidence and clinical outcomes. All studies reporting subsidence of polished taper-slip stems were identified. Patient demographics, implant design, radiological findings, details of surgical technique, methods of measurement and levels of subsidence were collected to investigate which factors were related to increased subsidence. Following application of inclusion and exclusion criteria, 28 papers of relevance were identified. The studies initially recruited 3090 hips with 2099 being available for radiological analysis at final follow-up. Patient age averaged 68 years (42–70), 60.4% were female and the average body mass index (BMI) was 27.4 kg/m2 (24.1–29.2). Mean subsidence at one, two, five and 10 years was 0.97 mm, 1.07 mm, 1.47 mm and 1.61 mm respectively. Although double-tapered stems subsided more than triple-tapered stems at all time points this was not statistically significant (p > 0.05), nor was the method of measurement used (p > 0.05). We report the levels of subsidence at which clinical outcomes and survivorship remain excellent, but based on the literature it was not possible to determine a threshold of subsidence beyond which failure was more likely. There were relatively few studies of triple-tapered stems, but given that there were no statistically significant differences, the levels presented in this review can be applied to both double and triple-tapered designs. Cite this article: EFORT Open Rev 2021;6:331-342. DOI: 10.1302/2058-5241.6.200086
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Affiliation(s)
- Kwaku Baryeh
- The Academic Surgical Unit, South West London Elective Orthopaedic Centre, UK
| | | | - David H Sochart
- The Academic Surgical Unit, South West London Elective Orthopaedic Centre, UK
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10
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Steiner DK, Drivsholm NS, Buchardt STE, Laursen M. The influence of migration of the exeter V40 stem on patient reported outcome measures: a 2-year follow-up of 112 total hip arthroplasties using radiostereometric analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:167-174. [PMID: 33763771 DOI: 10.1007/s00590-021-02937-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The cemented Exeter V40 stem is known to migrate distally. Several previous studies have reported on the extent of stem migration and its influence on clinical outcome. However, no studies have investigated the influence of stem migration on Patient Reported Outcome Measures (PROM). METHODS One hundred and twelve total hip arthroplasties (THA) were included in a 2-year follow-up using Radiostereometric Analysis (RSA). Patients were evaluated using the Oxford Hip Score (OHS) and EQ-5D-3L PROMs. The purpose of this study was to assess the influence of stem migration, measured by Maximum Total Point Motion (MTPM), on the 2-year postoperative score (OHS and EQ-5D). Furthermore, the influence of pre-operative PROM, age, gender, acetabular component and BMI was associated with the 2-year postoperative OHS and EQ-5D scores. RESULTS MTPM was a non-significant predictor of the 2-year postoperative OHS (regression coefficient (B) = - 2.38 (CI - 5.44; .69)) and of the 2-year postoperative EQ-5D (B = - .01 (CI - .04; .02)). The only significant predictor of the 2-year postoperative OHS and 2-year postoperative EQ-5D was gender (B = 8.71 (CI 3.52; 13.90)) and (B = .13 (CI .07; .18)), respectively. CONCLUSION Stem migration did not significantly influence PROMs at 2 years post-operatively. Using a patient-focused approach, our results seem to corroborate results reported by previous studies, showing that slow migration of the Exeter V40 stem does not seem to influence the clinical outcome.
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Affiliation(s)
- Daniel K Steiner
- Department of Orthopaedic Surgery, Aalborg University Hospital, Farsoe, Denmark. .,Department of Orthopaedic Surgery, School of Medicine, Aalborg University, Aalborg, Denmark.
| | - Nikolaj S Drivsholm
- Department of Orthopaedic Surgery, Aalborg University Hospital, Farsoe, Denmark
| | | | - Mogens Laursen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Farsoe, Denmark
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11
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Richardson CG, Laende EK, Gross M, Dunbar MJ. Prospective clinical study using radiostereometric analysis (RSA) to evaluate fixation of a modular cemented polished femoral stem. Hip Int 2021; 31:191-195. [PMID: 31615281 DOI: 10.1177/1120700019881429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The long-term clinical success of cemented polished tapered femoral components has been demonstrated in prospective as well as registry studies. This stem design type has also been well studied with radiostereometric analysis (RSA) and provides a standard to evaluate alternative designs of polished tapered cemented femoral components. This prospective study evaluates the subsidence of a polished cemented stem with a modular neck design utilising RSA. METHODS 26 patients were prospectively enrolled in the study and 23 were available for RSA analysis at 2 years. RESULTS The average subsidence of the femoral implant was 1.1 mm (SD 0.4 mm) at 2 years post operation. There were no revisions in this group, specifically no failures of the modular stem-neck design as has been seen with other implants. CONCLUSIONS The RSA subsidence pattern at 2 years of this cemented femoral stem is similar to other successful designs with long-term follow-up. The implications over time of stem neck modularity for cemented polished tapered femoral components requires further evaluation.
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Affiliation(s)
- C Glen Richardson
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Elise K Laende
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Gross
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Michael J Dunbar
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
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Miyamoto S, Iida S, Suzuki C, Kawarai Y, Nakatani T, Nakamura J, Orita S, Ohtori S. Postoperative migration of the anatomical and functional anteversion angle following total hip arthroplasty with a well-fixed cemented femoral component with line-to-line implantation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1067-1074. [PMID: 32314066 DOI: 10.1007/s00590-020-02671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/07/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little is known about the association between well-fixed polished tapered cemented stems (PTCS) implanted by the line-to-line technique and changes of stem migration, or the change of functional anteversion of the femur after total hip arthroplasty (THA). MATERIALS AND METHODS This retrospective study included 422 two-stage bilateral primary THAs performed using PTCS implanted by the line-to-line technique. CT scans were made on both the target side (first postoperative CT) and on the contralateral side (second postoperative CT) 1 week postoperatively. The mean follow-up was 7.8 months. CT data for each scan were transferred to 3D template software (Zed hip, Lexi, Japan). The postoperative changes of anatomical stem anteversion (ASA), functional femoral anteversion (FFA), and stem subsidence were evaluated. RESULTS A total of 20 THAs with CT scans were available on 3D template software. The ASA and the FFA had migrated - 0.68° ± 0.62° and - 5.5° ± 9.7°, respectively, over the follow-up period. A significant positive correlation was observed between the change of subsidence and ASA (r2 = 0.34, p = 0.007), between the FFA on the second postoperative CT and ASA on the first postoperative CT (r2 = 0.26, p = 0.02) and between the FFA on the second postoperative CT and FFA on the first postoperative CT (r2 = 0.52, p = 0.0003). CONCLUSION This study indicates that the change in axial rotation of a PTCS implanted by the line-to-line technique was less than that reported by other studies and the preoperative external rotation contracture was substantially improved after THA.
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Affiliation(s)
- Shuichi Miyamoto
- Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan.
| | - Satoshi Iida
- Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Chiho Suzuki
- Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Yuya Kawarai
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Takushi Nakatani
- Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Junichi Nakamura
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Sumihisa Orita
- Center for Advanced Joint Function and Reconstructive Spine Surgery Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba, 260-8670, Japan
| | - Seiji Ohtori
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
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Critchley O, Callary S, Mercer G, Campbell D, Wilson C. Long-term migration characteristics of the Corail hydroxyapatite-coated femoral stem: a 14-year radiostereometric analysis follow-up study. Arch Orthop Trauma Surg 2020; 140:121-127. [PMID: 31655879 DOI: 10.1007/s00402-019-03291-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND The magnitude and pattern of acceptable long-term migration of cementless femoral stems are not well understood. The Corail hydroxyapatite-coated cementless stem is a clinically successful and commonly used femoral stem with a long-term migration pattern not previously described in the literature. The aim of this study was to assess the long-term migration of the Corail hydroxyapatite-coated cementless stem using radiostereometric analysis (RSA) at 14-year follow-up, thereby establishing a benchmark acceptable long-term migration pattern for hydroxyapatite-coated cementless prostheses. MATERIALS AND METHODS A prospective cohort of 29 patients (30 hips) undergoing primary total hip arthroplasty for primary hip osteoarthritis were enrolled into a study to characterise the migration of the Corail cementless stem. A total of 13 patients (4 males, 9 females) with mean age 82 (range 68-92) underwent repeat RSA radiographs at minimum 10 years post-operation (mean 13.9 years, range 13.3-14.4). Subsidence of the stem was measured and compared to prior measurements taken at 6 months and 1, 2, and 6 years. RESULTS None of the 13 patients have been revised. The migration at 6 months, 1 year, 2 years, and 6 years has been previously recorded. At mean 14-year follow-up, the cohort mean subsidence of the cementless stem was 0.70 mm (range - 0.06 to 3.61 mm). For each stem followed up at 6 months and 14 years, the mean subsidence over this period was 0.05 mm (range - 0.14 to 0.57 mm). There is no significant difference in mean subsidence at 6 months and 14 years (p = 0.43). CONCLUSIONS The long-term pattern of the subsidence of the Corail femoral stem has not previously been described. Subsidence occurs within the first 6 months, after which there is persistent stabilisation of the implant to 14 years. This study provides a description of a long-term acceptable migration pattern to which new hydroxyapatite-coated cementless prostheses may be compared. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Owain Critchley
- Department of Orthopaedics and Trauma Surgery, Flinders University, Adelaide, SA, Australia.,Department of Orthopaedics and Trauma, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia
| | - Stuart Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia.,Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, SA, Australia
| | - Graham Mercer
- Department of Orthopaedics, Repatriation General Hospital, Adelaide, SA, Australia
| | - David Campbell
- Wakefield Orthopaedic Clinic, 270 Wakefield Street, Adelaide, SA, Australia
| | - Christopher Wilson
- Department of Orthopaedics and Trauma Surgery, Flinders University, Adelaide, SA, Australia. .,Department of Orthopaedics and Trauma, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
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14
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Smitham PJ, Carbone TA, Bolam SM, Kim YS, Callary SA, Costi K, Howie DW, Munro JT, Solomon LB. Vancouver B2 Peri-Prosthetic Fractures in Cemented Femoral Implants can be Treated With Open Reduction and Internal Fixation Alone Without Revision. J Arthroplasty 2019; 34:1430-1434. [PMID: 30956048 DOI: 10.1016/j.arth.2019.03.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study is to assess the outcomes of 52 consecutive Vancouver B2 peri-prosthetic fractures around cemented polished double-tapered stems treated by open reduction and internal fixation in 2 trauma centers in 2 countries. METHODS Outcomes included modified Harris Hip Score (mHHS), Harris Pain Score, and return to pre-injury mobility. Fracture healing was assessed; implant subsidence measured and complications including re-operations reported. RESULTS No patient was lost to follow-up. Median patient age at operation was 82 years (range 43-98); Harris pain scores showed minimal pain (median 42, range 10-44) at latest follow-up. Median total subsidence at 1 year was 1.1 mm (range 0-5.4), the majority of which occurred within the cement mantle. No subsequent femoral stem revision was required (median 2.9 years, 0-10); however, there were 3 re-operations: 1 re-operation for pre-existing recurrent dislocation involving head liner exchange and 2 for repeat fixation due to metal fatigue. Two additional fractures occurred below the new plating, requiring further plating whilst still retaining the original stems. CONCLUSION Anatomical reduction and open reduction and internal fixation of Vancouver B2 peri-prosthetic fractures should be considered as an appropriate treatment solution for frail elderly patients with a peri-prosthetic fracture around cemented polished double-tapered stems.
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Affiliation(s)
- Peter J Smitham
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tania A Carbone
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Scott M Bolam
- Department of Orthopedic Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Young S Kim
- Department of Orthopedic Surgery, Dongguk University Hospital, Gyeongju, Gyeongsangbuk-do, Republic of Korea
| | - Stuart A Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kerry Costi
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Donald W Howie
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jacob T Munro
- Department of Orthopedic Surgery, Dongguk University Hospital, Gyeongju, Gyeongsangbuk-do, Republic of Korea
| | - Lucian B Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
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15
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Jørgensen PB, Lamm M, Søballe K, Stilling M. Equivalent hip stem fixation by Hi-Fatigue G and Palacos R + G bone cement: a randomized radiostereometric controlled trial of 52 patients with 2 years' follow-up. Acta Orthop 2019; 90:237-242. [PMID: 30931663 PMCID: PMC6534245 DOI: 10.1080/17453674.2019.1595390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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 - Long-term fixation of cemented femoral stems relies on several factors including cement adhesion and fatigue. Hi-Fatigue is a newer third-generation bone cement with low-viscosity properties at room temperature, good mechanical strength, and stable bone-cement interface in a laboratory testing environment. Palacos bone cement has excellent 10-year survival and is considered gold standard. We compared stem subsidence after fixation with Hi-Fatigue and Palacos bone cements using radiostereometry. Patients and methods - In a patient-blinded randomized controlled trial, 52 patients (30 women) at mean age 76 years (71-87) with osteoarthrosis and no osteoporosis received Hi-Fatigue G or Palacos R + G cement fixation of collarless, polished, double-tapered stems (CPT). Tantalum beads were inserted in the periprosthetic bone. Supine stereoradiographs were obtained postoperatively, 3 months, 6 months, 1 year, and 2 years after surgery. Oxford Hip Score (OHS) and VAS pain were recorded preoperatively and 1 and 2 years after surgery. Cement working times and properties were registered. Results - At 2 years, mean stem subsidence of 1.12 mm (95% CI 0.96-1.29) for Hi-Fatigue and 1.19 mm (CI 1.03-1.34) for Palacos was similar. Likewise, stem version was comparable between cement groups. Mean OHS and VAS pain were similar between cement groups. Cement working times were similar between cement groups, but the mean curing time was longer for Hi-Fatigue (13.7 min) than for Palacos (11.6 min). Interpretation - We found similar and generally low migration of CPT femoral stems inserted with Hi-Fatigue and Palacos bone cement until 2 years' follow-up, which indicates a good long-term survival of polished taper femoral stems inserted with both cement types.
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Affiliation(s)
- Peter B Jørgensen
- Department of Orthopedic Surgery, Aarhus University Hospital;; ,Department of Clinical Medicine, Aarhus University, Denmark,Correspondence:
| | - Martin Lamm
- Department of Orthopedic Surgery, Aarhus University Hospital;;
| | - Kjeld Søballe
- Department of Orthopedic Surgery, Aarhus University Hospital;; ,Department of Clinical Medicine, Aarhus University, Denmark
| | - Maiken Stilling
- Department of Orthopedic Surgery, Aarhus University Hospital;; ,Department of Clinical Medicine, Aarhus University, Denmark
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16
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Teeter MG, McCalden RW, Yuan X, MacDonald SJ, Naudie DD. Predictive accuracy of RSA migration thresholds for cemented total hip arthroplasty stem designs. Hip Int 2018; 28:363-368. [PMID: 29781291 DOI: 10.1177/1120700018762179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Radiostereometric analysis (RSA) migration thresholds for cemented total hip stems have been established beyond which an unacceptably high risk of revision is likely to occur. These thresholds are subsidence >0.23 mm or >1.2 mm after 2 years. The purpose of this study was to retrospectively examine after long-term follow-up the predictive accuracy of the two thresholds. METHODS Data from two previous prospective RSA trials with 2 year follow-up for which minimum 10 year survivorship data was available were used. Thirty-six patients received a Spectron stem, 17 patients received an Exeter stem, and 17 patients received a CPCS stem. Subsidence after 2 years was compared to the migration thresholds, and long-term survivorship and clinical outcome scores were obtained. RESULTS At 2 years, the Spectron stem subsided 0.046 ± 0.160 mm, the Exeter stem subsided 1.218 ± 0.320 mm, and the CPCS stem subsided 0.681 ± 0.246 mm ( p < 0.0001). The Spectron stem passed both thresholds, the Exeter stem failed both thresholds, and the CPCS stem passed 1 and failed 1 threshold. At 10 years, survivorship exceeded 90% for all stems. CONCLUSION All stems demonstrated strong 10 year survivorship and equivalent clinical outcome scores, but this success would not have been equally predicted across RSA migration thresholds. Although RSA is a useful predictive tool, care should be taken in applying migration thresholds only to those stem designs they are indicated for, with the threshold of 1.2 mm of subsidence at 2 years being most broadly applicable.
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Affiliation(s)
- Matthew G Teeter
- 1 Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada.,4 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Richard W McCalden
- 1 Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
| | - Xunhua Yuan
- 4 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Steven J MacDonald
- 1 Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
| | - Douglas D Naudie
- 1 Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada.,2 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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17
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Weber E, Olsson C, Kesteris U, Flivik G. Is a hollow centralizer necessary when using a polished, tapered, cemented femoral stem? Acta Orthop 2017; 88:377-382. [PMID: 28418269 PMCID: PMC5499327 DOI: 10.1080/17453674.2017.1315553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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 - A tapered, polished and collarless stem is normally equipped with a hollow centralizer to prevent the stem from becoming end-bearing in the cement as the stem subsides. In a randomized clinical trial, we evaluated such a stem (MS-30), which was initially introduced with a solid centralizer but was later recommended to be fitted with a hollow centralizer. We hypothesized that while the stem would sink more, it would become rotationally stable and have less retroversion with a hollow centralizer than with a solid centralizer. Patients and methods - We randomized 60 patients with primary hip arthritis to receive either a hollow centralizer or a solid centralizer with the stem. The effect was evaluated over a 10-year follow-up period with repeated RSA examinations, conventional radiographs, and clinical follow-ups using the WOMAC and SF-12 questionnaires. Results - At 10-year follow-up, the group with hollow centralizers had subsided more than the group with solid centralizers (1.99 mm (hollow) as opposed to 0.57 mm (solid); p < 0.001). However, rotation was similar at 10-year follow-up (mean retroversion 1.34° (hollow) and 1.30° (solid)). Both groups showed excellent 10-year results, with similar clinical outcome, and none of the stems were radiographically loose or had been revised. Interpretation - As expected, there was more subsidence in the group with hollow centralizers, and with similar magnitude to that reported in earlier RSA studies on conceptually similar prostheses. Interestingly, there was no difference in the rotational behavior of the prostheses. This stem type appears to have a design that, regardless of the type of centralizer and the possibility of subsidence, withstands the rotational forces it is subjected to very well. This study does not support the need for a hollow centralizer for these types of stems.
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Affiliation(s)
- Erik Weber
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund;,Correspondence:
| | - Christer Olsson
- Department of Orthopedics, Blekinge County Hospital, Karlshamn, Sweden
| | - Uldis Kesteris
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund
| | - Gunnar Flivik
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund
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18
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Desy NM, Johnson JD, Sierra RJ. Satisfactory Results of the Exeter Revision Femoral Stem Used for Primary Total Hip Arthroplasty. J Arthroplasty 2017; 32:494-498. [PMID: 27600303 DOI: 10.1016/j.arth.2016.07.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Exeter cemented femoral stem has demonstrated excellent clinical and radiographic outcomes as well as long-term survivorship free from aseptic loosening. A shorter revision stem (125 mm) with a 44 offset became available for the purpose of cement-in-cement revision situations. In certain cases, this shorter revision stem may be used for various primary total hip arthroplasties (THAs) where the standard length stem would require distally reaming the femoral canal. We sought to report on the early to midterm results of this specific stem when used for primary THA regarding (1) clinical and radiographic outcomes, (2) complications, and (3) survivorship. METHODS Twenty-nine patients (33 hips) underwent a hybrid THA using the smaller revision Exeter cemented femoral stem. Twenty-five patients (28 hips) had at least 2 years of follow-up and were assessed for clinical and radiographic outcomes. All 33 hips were included in the analysis of complications and survivorship. The Kaplan-Meier survivorship was performed using revision for all causes and for aseptic loosening as the end points. RESULTS The average clinical follow-up was 4 years (range, 2-7). Harris Hip Scores improved from a mean preoperative value of 56 (range, 23-96) to 90 (range, 51-100) at the latest follow-up. All patients demonstrated superior cement mantles with no signs of loosening. One patient suffered a B2 periprosthetic fracture and 1 patient experienced 2 episodes of instability. The 5-year Kaplan-Meier survivorship was 96.7% for all causes of revision and was 100% using aseptic loosening as the end point. CONCLUSION The shorter Exeter revision cemented femoral stem has favorable early to midterm clinical and radiographic outcomes when used for primary THA with a low complication rate and is a viable option in patients with narrow femoral canals where uncemented stem fixation is not desired.
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Affiliation(s)
- Nicholas M Desy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joshua D Johnson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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19
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van der Voort P, Pijls BG, Nieuwenhuijse MJ, Jasper J, Fiocco M, Plevier JWM, Middeldorp S, Valstar ER, Nelissen RGHH. Early subsidence of shape-closed hip arthroplasty stems is associated with late revision. A systematic review and meta-analysis of 24 RSA studies and 56 survival studies. Acta Orthop 2015; 86:575-85. [PMID: 25909455 PMCID: PMC4564780 DOI: 10.3109/17453674.2015.1043832] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Few studies have addressed the association between early migration of femoral stems and late aseptic revision in total hip arthroplasty. We performed a meta-regression analysis on 2 parallel systematic reviews and meta-analyses to determine the association between early migration and late aseptic revision of femoral stems. PATIENTS AND METHODS Of the 2 reviews, one covered early migration data obtained from radiostereometric analysis (RSA) studies and the other covered long-term aseptic revision rates obtained from survival studies with endpoint revision for aseptic loosening. Stems were stratified according to the design concept: cemented shape-closed, cemented force-closed, and uncemented. A weighted regression model was used to assess the association between early migration and late aseptic revision, and to correct for confounders. Thresholds for acceptable and unacceptable migration were determined in accordance with the national joint registries (≤ 5% revision at 10 years) and the NICE criteria (≤ 10% revision at 10 years). RESULTS 24 studies (731 stems) were included in the RSA review and 56 studies (20,599 stems) were included in the survival analysis review. Combining both reviews for the 3 design concepts showed that for every 0.1-mm increase in 2-year subsidence, as measured with RSA, there was a 4% increase in revision rate for the shape-closed stem designs. This association remained after correction for age, sex, diagnosis, hospital type, continent, and study quality. The threshold for acceptable migration of shape-closed designs was defined at 0.15 mm; stems subsiding less than 0.15 mm in 2 years had revision rates of less than 5% at 10 years, while stems exceeding 0.15 mm subsidence had revision rates of more than 5%. INTERPRETATION There was a clinically relevant association between early subsidence of shape-closed femoral stems and late revision for aseptic loosening. This association can be used to assess the safety of shape-closed stem designs. The published research is not sufficient to allow us to make any conclusions regarding such an association for the force-closed and uncemented stems.
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Affiliation(s)
- Paul van der Voort
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden
| | - Bart G Pijls
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden
| | - Marc J Nieuwenhuijse
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden
| | - Jorrit Jasper
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden
| | - Marta Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden
| | | | - Saskia Middeldorp
- Academic Medical Center, Department of Vascular Medicine, Amsterdam,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Edward R Valstar
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, University of Technology, Delft
| | - Rob G H H Nelissen
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden
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20
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Budde S, Seehaus F, Schwarze M, Hurschler C, Floerkemeier T, Windhagen H, Noll Y, Ettinger M, Thorey F. Analysis of migration of the Nanos® short-stem hip implant within two years after surgery. INTERNATIONAL ORTHOPAEDICS 2015; 40:1607-1614. [PMID: 26404094 DOI: 10.1007/s00264-015-2999-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/14/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Short-stem implants provide a bone-preserving alternative in total hip arthroplasty. However, some evidence exists that the smaller implant-bone contact surface may compromise primary stability and impair osseo-integration. The purpose of this study was to analyse the migration characteristics of the Nanos® short stem over two years by means of model-based roentgen stereophotogrammetric analysis (MBRSA). METHODS Eighteen patients aged 53.6 ± 7.2 years were included. After being treated with a Nanos implant, 14 patients were followed-up radiologically at three, six, 12 and 24 months by means of MBRSA. Early implant migration was calculated. Clinical data have been assessed in addition. RESULTS Highest translational migration was observed with a mean value of -0.22 ± 0.39 mm along the proximo-distal axis after three months and highest rotational migration with 0.8 ± 3.2° also around the y-axis after two years. The resulting total migration was 0.46 ± 0.31 mm, with the largest proportion occurring within three months after surgery (0.40 ± 0.34 mm). CONCLUSION The Nanos short-stem hip implant shows only a slight initial migration within three months after implantation, followed by secondary stabilisation. These results suggest both good primary stability and osseo-integration, suggesting a low risk of aseptic loosening.
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Affiliation(s)
- Stefan Budde
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
| | - Frank Seehaus
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, 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
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Yvonne Noll
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Max Ettinger
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Fritz Thorey
- Centre for Hip, Knee and Foot Surgery, Sports Traumatology, ATOS Hospital, Bismarckstr. 9-15, 69115, Heidelberg, Germany
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21
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Flatøy B, Röhrl SM, Rydinge J, Dahl J, Diep LM, Nordsletten L. Triple taper stem design shows promising fixation and bone remodelling characteristics: radiostereometric analysis in a randomised controlled trial. Bone Joint J 2015; 97-B:755-61. [PMID: 26033054 DOI: 10.1302/0301-620x.97b6.34736] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cemented femoral stems with force closed fixation designs have shown good clinical results despite high early subsidence. A new triple-tapered stem in this category (C-stem AMT) was introduced in 2005. This study compares this new stem with an established stem of similar design (Exeter) in terms of migration (as measured using radiostereometric analysis), peri-prosthetic bone remodelling (measured using dual energy x-ray densitometry, DXA), Oxford Hip Score, and plain radiographs. A total of 70 patients (70 hips) with a mean age of 66 years (53 to 78) were followed for two years. Owing to missing data of miscellaneous reasons, the final analysis represents data from 51 (RSA) and 65 (DXA) patients. Both stems showed a typical pattern of migration: Subsidence and retroversion that primarily occurred during the first three months. C-stem AMT subsided less during the first three months (p = 0.01), before stabilising at a subsidence rate similar to the Exeter stem from years one to two. The rate of migration into retroversion was slightly higher for C-stem AMT during the second year (p = 0.03). Whilst there were slight differences in movement patterns between the stems, the C-stem AMT exhibits good early clinical outcomes and displays a pattern of migration and bone remodelling that predicts good clinical performance.
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Affiliation(s)
- B Flatøy
- Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - S M Röhrl
- Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - J Rydinge
- Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - J Dahl
- Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - L M Diep
- Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
| | - L Nordsletten
- Oslo University Hospital, P. O. Box 4950 Nydalen, N-0424 Oslo, Norway
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22
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Comparison of Refobacin bone cement and palacos with gentamicin in total hip arthroplasty: an RSA study with two years follow-up. Hip Int 2014; 24:56-62. [PMID: 24062223 DOI: 10.5301/hipint.5000088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2013] [Indexed: 02/04/2023]
Abstract
Previous experience has demonstrated the importance of testing new bone cement in vivo before widespread clinical use. We performed a consecutive, radiostereometric (RSA) study comparing Refobacin Bone Cement (RBC) to the well proven Palacos with Gentamicin (PWG). According to the manufacturer of RBC it has the equivalent characteristics as PWG, and in vitro tests show good results. The purpose of this study was to evaluate whether RBC is safe to use in clinical practice for total hip arthroplasty (THA). Two consecutive series of patients with primary osteoarthritis received a THA using a highly polished, collarless, tapered stem with a hollow centralizer. The study comprises 21 hips with RBC and 30 with PWG. The patients were followed up for two years with repeated RSA examinations and clinical outcome questionnaires SF-12 and WOMAC. There were no statistically significant migratory differences between the groups. The mean subsidence after two years was 1.28 mm and 1.40 mm, and the mean retroversion was 1.03° and 0.99°, for the RBC and the PWG groups respectively. Almost all migration occurred in the interface between the stem and the cement. The WOMAC and SF12 clinical scores did not reveal any clinical differences between the groups. We conclude that, as previous in vitro tests indicate, RBC performs as well as PWG and seems to be safe to use in clinical practice for THA.
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23
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Weber E, Sundberg M, Flivik G. Design modifications of the uncemented Furlong hip stem result in minor early subsidence but do not affect further stability: a randomized controlled RSA study with 5-year follow-up. Acta Orthop 2014; 85:556-61. [PMID: 25175668 PMCID: PMC4259023 DOI: 10.3109/17453674.2014.958810] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Even small design modifications of uncemented hip stems may alter the postoperative 3-D migration pattern. The Furlong Active is an uncemented femoral stem which, in terms of design, is based on its precursor-the well-proven Furlong HAC-but has undergone several design changes. The collar has been removed on the Active stem along with the lateral fin; it is shorter and has more rounded edges in the proximal part. We compared the migration patterns of the uncemented Furlong HAC stem and the modified Furlong Active stem in a randomized, controlled trial over 5 years using radiostereometry (RSA). PATIENTS AND METHODS 50 patients with primary osteoarthritis were randomized to receive either the HAC stem or the Active stem. The patients underwent repeated RSA examinations (postoperatively, at 3 months, and after 1, 2, and 5 years) and conventional radiography, and they also filled out hip-specific questionnaires. RESULTS During the first 3 months, the collarless Active stem subsided to a greater extent than the collar-fitted HAC stem (0.99 mm vs. 0.31 mm, p=0.05). There were, however, no other differences in movement measured by RSA or in clinical outcome between the 2 stems. After 3 months, both stem types had stabilized and almost no further migration was seen. INTERPRETATION The Active stem showed no signs of unfavorable migration. Our results suggest that the osseointegration is not compromised by the new design features.
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Affiliation(s)
- Erik Weber
- Department of Orthopedics, Lund University and Skåne University Hospital, Lund, Sweden.
| | - Martin Sundberg
- Department of Orthopedics, Lund University and Skåne University Hospital, Lund, Sweden.
| | - Gunnar Flivik
- Department of Orthopedics, Lund University and Skåne University Hospital, Lund, Sweden.
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24
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Madanat R, Mäkinen TJ, Aro HT, Bragdon C, Malchau H. Adherence of hip and knee arthroplasty studies to RSA standardization guidelines. A systematic review. Acta Orthop 2014; 85:447-55. [PMID: 24954489 PMCID: PMC4164860 DOI: 10.3109/17453674.2014.934187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Guidelines for standardization of radiostereometry (RSA) of implants were published in 2005 to facilitate comparison of outcomes between various research groups. In this systematic review, we determined how well studies have adhered to these guidelines. METHODS We carried out a literature search to identify all articles published between January 2000 and December 2011 that used RSA in the evaluation of hip or knee prosthesis migration. 2 investigators independently evaluated each of the studies for adherence to the 13 individual guideline items. Since some of the 13 points included more than 1 criterion, studies were assessed on whether each point was fully met, partially met, or not met. RESULTS 153 studies that met our inclusion criteria were identified. 61 of these were published before the guidelines were introduced (2000-2005) and 92 after the guidelines were introduced (2006-2011). The methodological quality of RSA studies clearly improved from 2000 to 2011. None of the studies fully met all 13 guidelines. Nearly half (43) of the studies published after the guidelines demonstrated a high methodological quality and adhered at least partially to 10 of the 13 guidelines, whereas less than one-fifth (11) of the studies published before the guidelines had the same methodological quality. Commonly unaddressed guideline items were related to imaging methodology, determination of precision from double examinations, and also mean error of rigid-body fitting and condition number cutoff levels. INTERPRETATION The guidelines have improved methodological reporting in RSA studies, but adherence to these guidelines is still relatively low. There is a need to update and clarify the guidelines for clinical hip and knee arthroplasty RSA studies.
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Affiliation(s)
- Rami Madanat
- Helsinki University Central Hospital, Helsinki,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Hannu T Aro
- Turku University Hospital and University of Turku, Turku, Finland
| | - Charles Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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25
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von Schewelov T, Carlsson A, Sanzén L, Besjakov J. Continuous distal migration and internal rotation of the C-stem prosthesis without any adverse clinical effects: an RSA study of 33 primary total hip arthroplasties followed for up to ten years. Bone Joint J 2014; 96-B:604-8. [PMID: 24788493 DOI: 10.1302/0301-620x.96b5.33580] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2005, we demonstrated that the polished triple-tapered C-stem at two years had migrated distally and rotated internally. From that series, 33 patients have now been followed radiologically, clinically and by radiostereometric analysis (RSA) for up to ten years. The distal migration within the cement mantle had continued and reached a mean of 2 mm (0.5 to 4.0) at ten years. Internal rotation, also within the cement mantle, was a mean 3.8° (external 1.6° to internal 6.6°) The cement mantle did not show any sign of migration or loosening in relation to the femoral bone. There were no clinical or radiological signs indicating that the migration or rotation within the cement mantle had had any adverse effects for the patients.
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Affiliation(s)
- T von Schewelov
- Skane University Hospital, Department of Orthopaedics, S-205 02 Malmö, Sweden
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26
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27
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Kiernan S, Hermann KL, Wagner P, Ryd L, Flivik G. The importance of adequate stem anteversion for rotational stability in cemented total hip replacement. Bone Joint J 2013; 95-B:23-30. [DOI: 10.1302/0301-620x.95b1.30055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Progressive retroversion of a cemented stem is predictive of early loosening and failure. We assessed the relationship between direct post-operative stem anteversion, measured with CT, and the resulting rotational stability, measured with repeated radiostereometric analysis over ten years. The study comprised 60 cemented total hip replacements using one of two types of matt collared stem with a rounded cross-section. The patients were divided into three groups depending on their measured post-operative anteversion (< 10°, 10° to 25°, > 25°). There was a strong correlation between direct post-operative anteversion and later posterior rotation. At one year the < 10° group showed significantly more progressive retroversion together with distal migration, and this persisted to the ten-year follow-up. In the < 10° group four of ten stems (40%) had been revised at ten years, and an additional two stems (20%) were radiologically loose. In the ‘normal’ (10° to 25°) anteversion group there was one revised (3%) and one loose stem (3%) of a total of 30 stems, and in the > 25° group one stem (5%) was revised and another loose (5%) out of 20 stems. This poor outcome is partly dependent on the design of this prosthesis, but the results strongly suggest that the initial rotational position of cemented stems during surgery affects the subsequent progressive retroversion, subsidence and eventual loosening. The degree of retroversion may be sensitive to prosthetic design and stem size, but < 10° of anteversion appears deleterious to the long-term outcome for cemented hip prosthetic stems. Cite this article: Bone Joint J 2013;95-B:23–30.
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Affiliation(s)
- S. Kiernan
- Skane University Hospital, Department
of Orthopaedics, Clinical Sciences, Lund University, S-221
85 Lund, Sweden
| | - K. L. Hermann
- Copenhagen University Hospital Herlev, Department
of Radiology, DK-2730 Herlev, Denmark
| | - P. Wagner
- Skane University Hospital, RC
Syd, Clinical Sciences, Lund
University, S-221 85 Lund, Sweden
| | - L. Ryd
- Skane University Hospital, Department
of Orthopaedics, Clinical Sciences, Lund University, S-221
85 Lund, Sweden
| | - G. Flivik
- Skane University Hospital, Department
of Orthopaedics, Clinical Sciences, Lund University, S-221
85 Lund, Sweden
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28
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Haugan K, Husby OS, Klaksvik J, Foss OA. The migration pattern of the Charnley femoral stem: a five-year follow-up RSA study in a well-functioning patient group. J Orthop Traumatol 2012; 13:137-43. [PMID: 22576838 PMCID: PMC3427697 DOI: 10.1007/s10195-012-0187-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 03/10/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Implant stability is considered vital to long-time implant survival in total hip arthroplasty (THA), since loose implants are reported to be a major cause of hip revision. There is an association between early implant micromotion and increased risk of revision. More implant-specific data are needed to establish acceptable levels of early implant movement. MATERIALS AND METHODS Thirty-five patients (36 hips) undergoing Charnley THA were followed with repeated clinical, radiographic, and radiostereometric analysis (RSA) over 5 years. Twenty-three patients attended 5 years postoperatively. RESULTS The patient group was well functioning based on the radiological and clinical evaluations. The stems constantly moved up to 5 years postoperatively, with subsidence, retroversion, and varus tilt, based on the RSA. CONCLUSION Continuous movement of the Charnley stem was observed up to 5 years postoperatively in a well-functioning patient group. The migration data presented herein could be useful when defining acceptable migration limits for certain types of cemented femoral stems.
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Affiliation(s)
- Kristin Haugan
- Orthopaedic Research Centre, Trondheim University Hospital, 7006, Trondheim, Norway.
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29
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Bohm E, Petrak M, Gascoyne T, Turgeon T. The effect of adding tobramycin to Simplex P cement on femoral stem micromotion as measured by radiostereometric analysis: a 2-year randomized controlled trial. Acta Orthop 2012; 83:115-20. [PMID: 22248163 PMCID: PMC3339523 DOI: 10.3109/17453674.2011.652885] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Previous in vitro research on addition of antibiotics to bone cement has found no statistically significant deterioration in mechanical properties. However, no clinical studies have compared the performance of tobramycin-laden bone cement with that of standard bone cement (Simplex P). PATIENTS AND METHODS 23 patients (25 hips) were randomized to receive an Exeter (Stryker Orthopaedics) femoral stem cemented with either Simplex P (standard) or Simplex T (tobramycin-laden) cement. There were 2 years of follow-up, with scheduled radiostereometric (RSA) examinations. RESULTS All stems migrated distally and showed some degree of retroversion. No clinically significant differences in stem subsidence or retroversion were found between the Simplex T and Simplex P cement groups after 2 years. Overall subsidence was less than in previous studies, probably due to a postponed initial post-surgical examination. Rates of subsidence in both cement groups were consistent with those from previous studies of Exeter stems. INTERPRETATION Subsidence of the femoral stem after 2 years was similar in the Simplex T (tobramycin-laden) and Simplex P (standard) groups.
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Affiliation(s)
| | - Martin Petrak
- Concordia Joint Replacement Group, Concordia Hip and Knee Institute
| | - Trevor Gascoyne
- Concordia Joint Replacement Group, Concordia Hip and Knee Institute
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30
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Nieuwenhuijse MJ, Valstar ER, Kaptein BL, Nelissen RGHH. The Exeter femoral stem continues to migrate during its first decade after implantation: 10-12 years of follow-up with radiostereometric analysis (RSA). Acta Orthop 2012; 83:129-34. [PMID: 22401676 PMCID: PMC3339525 DOI: 10.3109/17453674.2012.672093] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Due to its collarless, double-tapered polished design, the Exeter femoral stem is known to migrate distally in the first 5 years after implantation. However, its long-term migration pattern has not been investigated. PATIENTS AND METHODS 39 consecutive patients (41 total hip arthroplasties) received a cemented Exeter stem and had prospective clinical and RSA follow-up. Patients were evaluated postoperatively at 6, 12, 26, and 52 weeks, and annually thereafter. Short-term results have been reported. In this study, the mean length of follow-up was 9.4 years (SD 3.2 years). No patients were lost to follow-up. 15 patients died during follow-up. RESULTS No stems were revised. In 4 stems, fractures of the cement mantle were noted within the first 3 postoperative years. In 3 stems, this resulted in a complete circumferential cement mantle discontinuity. For the 37 well-performing stems, continuous but small migration was measured between 2 and 12 years of follow-up. Continued subsidence of 0.08 mm/year (95% CI: 0.05-0.12, p < 0.001) was seen in combination with continued rotation in retroversion of 0.07°/year (95% CI: 0.02-0.12, p = 0.01). At 10 years of follow-up, mean subsidence was 2.1 (SD 1.2) mm and mean retroversion was 1.8° (SD 2.0). Two-thirds of this occurred during the first 2 postoperative years. In the 3 stems with a complete circumferential cement fracture, a sudden and disproportionately high increase in subsidence was measured in the time period of occurrence. INTERPRETATION The Exeter femoral stem continues to migrate during the first decade after implantation. Absolute stability is not required for good long-term survival if this is compatible with the design of the implant.
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Affiliation(s)
- Marc J Nieuwenhuijse
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden
| | | | - Bart L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden
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31
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Lamberton TD, Kenny PJ, Whitehouse SL, Timperley AJ, Gie GA. Femoral impaction grafting in revision total hip arthroplasty: a follow-up of 540 hips. J Arthroplasty 2011; 26:1154-60. [PMID: 21570802 DOI: 10.1016/j.arth.2011.03.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 12/31/2010] [Accepted: 03/02/2011] [Indexed: 02/01/2023] Open
Abstract
Between 1987 and 1999, 540 revision total hip arthroplasties in 487 patients were performed at our institution using the femoral impaction grafting technique with a cemented femoral stem. All patients were prospectively followed up for 2 to 15 years postoperatively with no loss to follow-up. A total of 494 hips remained successfully in situ at an average of 6.7 years. The 10-year survival rate was 98.0% (95% confidence interval, 96.2-99.8) with aseptic loosening as the end point and 84.2% (95% confidence interval, 78.5-89.9) for reoperation for any reason. Indication for surgery and the use of any kind of reinforcement significantly influenced outcome (P < .001). This is the largest known series of revision THA with femoral impaction grafting, and the results support continued use of this technique.
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32
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Howie DW, Callary SA, McGee MA, Russell NC, Solomon LB. Reduced femoral component subsidence with improved impaction grafting at revision hip arthroplasty. Clin Orthop Relat Res 2010; 468:3314-21. [PMID: 20680531 PMCID: PMC2974885 DOI: 10.1007/s11999-010-1484-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite stem subsidence being a major complication of femoral impaction bone grafting in cemented revision hip arthroplasty, few studies have distinguished subsidence at the prosthesis-cement interface from that at the cement-bone interface. It is unknown how technique developments intended to improve the procedure influence stability of the stem. QUESTIONS/PURPOSES We used a sensitive technique to measure subsidence of a cemented polished collarless double-taper stem at each interface after femoral impaction grafting and compared subsidence, radiographic loosening, complications, and reoperations over three series of hips defined by technique developments. PATIENTS AND METHODS Three series were defined: Series 1 (n = 23, irradiated allograft), Series 2 (n = 12, double-washed, size-profiled graft, nonirradiated bone, long stems as required), and Series 3 (n = 21, modular tamps). Stem subsidence was analyzed with Ein Bild Röntgen Analyse software. Radiographic loosening, complications, and reoperations were also determined. RESULTS The median subsidence at 12 months for Series 1, 2, and 3 were 2.1, 0.5, and 0.7 mm at the prosthesis-cement interface and 1.3, 0.1, and 0.1 mm at the cement-bone interface. There were two postoperative Vancouver B periprosthetic fractures in Series 1, four hips were revised for loosening in Series 1, and there were no fractures or loosening in Series 2 and 3 at minimum 2 years' followup. There were no surviving hips radiographically classified as possibly or probably loose. CONCLUSIONS Evolution in techniques of femoral impaction grafting in this study were associated with reduced subsidence of the stem at both the prosthesis-cement interface and cement-bone interface when compared to the original series. Concurrent with reduced stem subsidence was the absence of periprosthetic fracture, radiographic loosening, and complications requiring rerevision.
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Affiliation(s)
- D. W. Howie
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia ,Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA Australia
| | - S. A. Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia ,Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA Australia
| | - M. A. McGee
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia ,Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA Australia
| | - N. C. Russell
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
| | - L. B. Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia ,Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA Australia
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33
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McCalden RW, Charron KD, Yuan X, Bourne RB, Naudie DD, MacDonald SJ. Randomised controlled trial comparing early migration of two collarless polished cemented stems using radiostereometric analysis. ACTA ACUST UNITED AC 2010; 92:935-40. [DOI: 10.1302/0301-620x.92b7.24462] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This was a safety study where the hypothesis was that the newer-design CPCS femoral stem would demonstrate similar early clinical results and micromovement to the well-established Exeter stem. Both are collarless, tapered, polished cemented stems, the only difference being a slight lateral to medial taper with the CPCS stem. A total of 34 patients were enrolled in a single-blinded randomised controlled trial in which 17 patients received a dedicated radiostereometric CPCS stem and 17 a radiostereometric Exeter stem. No difference was found in any of the outcome measures pre-operatively or post-operatively between groups. At two years, the mean subsidence for the CPCS stem was nearly half that seen for the Exeter stem (0.77 mm (−0.943 to 1.77) and 1.25 mm (0.719 to 1.625), respectively; p = 0.032). In contrast, the mean internal rotation of the CPCS stem was approximately twice that of the Exeter (1.61° (−1.07° to 4.33°) and 0.59° (0.97° to 1.64°), respectively; p = 0.048). Other migration patterns were not significantly different between the stems. The subtle differences in designs may explain the different patterns of migration. Comparable migration with the Exeter stem suggests that the CPCS design will perform well in the long term.
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Affiliation(s)
- R. W. McCalden
- London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, Ontario, Canada N6A 5A5
| | - K. D. Charron
- London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, Ontario, Canada N6A 5A5
| | - X Yuan
- Robarts Research Institute, University of Western Ontario, P. O. Box 5015, 100 Perth Drive, London, Ontario, Canada N6A 5K8
| | - R. B. Bourne
- London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, Ontario, Canada N6A 5A5
| | - D. D. Naudie
- London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, Ontario, Canada N6A 5A5
| | - S. J. MacDonald
- London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, Ontario, Canada N6A 5A5
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34
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Thien TM, Thanner J, Kärrholm J. Randomized comparison between 3 surface treatments of a single anteverted stem design: 84 hips followed for 5 years. J Arthroplasty 2010; 25:437-444.e1. [PMID: 19232887 DOI: 10.1016/j.arth.2009.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 09/22/2008] [Accepted: 01/14/2009] [Indexed: 02/01/2023] Open
Abstract
Eighty patients (84 hips) randomly received an anteverted cobalt-chromium stem (Lubinus SP2; Waldemar Link, Hamburg, Germany) with matte, polymethyl methacrylate-coated, or polished surface (uncollared). Radiostereometry was used to study migration and wear; and the bone mineral density was studied with dual-energy x-ray absorptiometry at 6 months, 1 year, 2 years, and 5 years. The polished stems had subsided 0.1 to 0.2 mm more at 6 months and 0.3 to 0.4 mm more at 5 years than the matte and precoated versions (P < .0001) and subsided mainly inside the cement mantle. The rotations of the stem and the migration and wear of the cemented cup did not differ between the 3 groups. After 1 and 2 years, the polished stems had lost significantly less bone mineral in Gruen zones 1, 2, 6, and 7 (P = .004 to .03); but this difference had disappeared after 5 years. The period of improved bone remodeling around the polished version coincided with the early period of increased subsidence, suggesting that stem motions inside the mantle resulted in a favorable loading of the proximal femur. Our observations suggest that alternative shapes could be possible on future polished femoral stem designs.
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Affiliation(s)
- Truike M Thien
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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35
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A prospective randomised radiostereometric analysis trial of SmartSet HV and Palacos R bone cements in primary total hip arthroplasty. J Orthop Traumatol 2010; 11:29-35. [PMID: 20198403 PMCID: PMC2837815 DOI: 10.1007/s10195-010-0087-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 01/30/2010] [Indexed: 12/17/2022] Open
Abstract
Background Introduction of new bone cements into clinical practice should include radiostereometric studies. Materials and methods A prospective randomised radiostereometric study was performed, comparing SmartSet HV and Palacos R acrylic bone cements (without antibiotics) using third-generation cementing techniques in primary total hip arthroplasty. Thirty-five patients (36 hips) undergoing Charnley total hip arthroplasty were randomised to receive either of the two cements and were followed with repeated clinical, radiographic and radiostereometric examinations over 24 months. Twenty-seven patients (28 hips) attended 2 years postoperatively. Results The mean distal translation observed was −0.15 mm for SmartSet HV and −0.16 mm for Palacos R. The mean rotation around the longitudinal axis was 0.9° for SmartSet HV and 1.2° for Palacos R. The Merle d’Aubigne Postel score was the maximum of 18 points for all patients in both groups. Conclusions No statistically significant difference in stem fixation with use of SmartSet HV and Palacos R was found at 2-year follow-up.
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36
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Campbell D, Mercer G, Nilsson KG, Wells V, Field JR, Callary SA. Early migration characteristics of a hydroxyapatite-coated femoral stem: an RSA study. INTERNATIONAL ORTHOPAEDICS 2009; 35:483-8. [PMID: 20012862 DOI: 10.1007/s00264-009-0913-z] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 11/03/2009] [Accepted: 11/03/2009] [Indexed: 11/26/2022]
Abstract
Measurement of early stem subsidence can be used to predict the likelihood of long-term femoral component loosening and clinical failure. Data that examines the early migration pattern of clinically proven stems will provide clinicians with useful baseline data with which to compare new stem designs. This study was performed to evaluate the early migration pattern of a hydroxyapatite-coated press-fit femoral component that has been in use for over ten years. We enrolled 30 patients who underwent THA for osteoarthritis. The median age was 70 years (range, 55-80 years). Patients were clinically assessed using the Harris hip score. Radiostereometric analysis was used to evaluate stem migration at three to four days, six months, one year and two years. We observed a mean subsidence of 0.73 mm at six months, 0.62 mm at one year and 0.58 mm at two years and a mean retroversion of 1.82° at six months, 1.90° at one year and 1.59° at two years. This data suggests that subsidence is confined to the first six months after which there was no further subsidence. The results from this study can be compared with those from novel cementless stem designs to help predict the long-term outcome one may expect from new cementless stem designs.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/instrumentation
- Arthroplasty, Replacement, Hip/methods
- Coated Materials, Biocompatible
- Durapatite
- Female
- Health Status
- Hip Joint/diagnostic imaging
- Hip Joint/physiopathology
- Hip Joint/surgery
- Hip Prosthesis
- Humans
- Male
- Middle Aged
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/surgery
- Prospective Studies
- Prosthesis Design
- Prosthesis Failure
- Radiography
- Range of Motion, Articular
- Treatment Outcome
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Affiliation(s)
- David Campbell
- Orthopaedic Unit, Repatriation General Hospital, Adelaide, South Australia, Australia.
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37
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In vitro testing of femoral impaction grafting with porous titanium particles: a pilot study. Clin Orthop Relat Res 2009; 467:1538-45. [PMID: 19139968 PMCID: PMC2674165 DOI: 10.1007/s11999-008-0688-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 12/15/2008] [Indexed: 01/31/2023]
Abstract
The disadvantages of allografts to restore femoral bone defects during revision hip surgery have led to the search for alternative materials. We investigated the feasibility of using porous titanium particles and posed the following questions: (1) Is it possible to create a high-quality femoral graft of porous titanium particles in terms of graft thickness, cement thickness, and cement penetration? (2) Does this titanium particle graft layer provide initial stability when a femoral cemented stem is implanted in it? (3) What sizes of particles are released from the porous titanium particles during impaction and subsequent cyclic loading of the reconstruction? We simulated cemented revision reconstructions with titanium particles in seven composite femurs loaded for 300,000 cycles and measured stem subsidence. Particle release from the titanium particle grafts was analyzed during impaction and loading. Impacted titanium particles formed a highly interlocked graft layer. We observed limited cement penetration into the titanium particle graft. A total mean subsidence of 1.04 mm was observed after 300,000 cycles. Most particles released during impaction were in the phagocytable range (< 10 microm). There was no detectable particle release during loading. Based on the data, we believe titanium particles are a promising alternative for allografts. However, animal testing is warranted to investigate the biologic effect of small-particle release.
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38
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Yates PJ, Burston BJ, Whitley E, Bannister GC. Collarless polished tapered stem: clinical and radiological results at a minimum of ten years' follow-up. ACTA ACUST UNITED AC 2008; 90:16-22. [PMID: 18160493 DOI: 10.1302/0301-620x.90b1.19546] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We retrospectively reviewed 175 patients (191 hips) who had undergone primary cemented total hip replacement between November 1992 and November 1995 using a collarless polished double-tapered femoral component after a minimum of ten years (mean 11.08; 10 to 12.8). All stems were implanted using contemporary cementing techniques with a distal cement restrictor, pressurised lavage, retrograde cementing with a gun and proximal pressurisation. Clinical outcome was assessed using the Harris Hip score. Radiological analysis was performed on calibrated plain radiographs taken in two planes. Complete radiological data on 110 patients (120 hips) and clinical follow-up on all the surviving 111 patients (122 hips) was available. The fate of all the hips was known. At final follow-up, the mean Harris Hip score was 86 (47 to 100), and 87 of 116 patients (75%) had good or excellent scores. Survival with revision of the stem for aseptic loosening as the endpoint was 100%; and survival with revision of the stem for any reason was 95.9% (95% confidence interval 87.8 to 96.8) at ten years. All the stems subsided vertically at the stem-cement interface in a predictable pattern, at an overall mean rate of 0.18 mm per year (0.02 to 2.16), but with a mean rate of 0.80 mm (0.02 to 2.5) during the first year. The mean total subsidence was 1.95 mm (0.21 to 24). Only three stems loosened at the cement-bone interface. There was excellent preservation of proximal femoral bone stock. There was a high incidence of Brooker III and IV heterotopic ossification affecting 25 patients (22%). The collarless polished tapered stem has an excellent clinical and radiological outcome at a minimum of ten years' follow-up. The pattern and magnitude of subsidence of the stem within the cement mantle occurred in a predictable pattern, consistent with the design philosophy.
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Affiliation(s)
- P J Yates
- Department of Orthopaedics and Trauma Fremantle Hospital, Alma Road, Fremantle, Western Australia 6160, Australia.
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39
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Bell CGR, Weinrauch P, Pearcy M, Crawford R. In vitro analysis of exeter stem torsional stability. J Arthroplasty 2007; 22:1024-30. [PMID: 17920476 DOI: 10.1016/j.arth.2007.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 03/04/2007] [Indexed: 02/01/2023] Open
Abstract
The effect of cyclic loading on the torsional stiffness of a polished double-tapered femoral stem was investigated in vitro. Initial torsional stability was compared with torsional stability after cyclic loading. Stems were removed from the cement mantle and reinserted without the use of additional cement. Torsional stability was measured after reinsertion and after further cyclic loading. Subsidence of the stem was observed. No difference in torsional stiffness was observed during loading. No difference between the stiffness before extraction and after reinsertion was observed. Torsional stiffness of an Exeter stem does not decrease after axial subsidence under cyclic loading. Stability is retained after reinsertion into the original cement mantle. Debonding of the Exeter stem is not associated with rotational instability of the implant.
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Affiliation(s)
- Cameron Gordon Roodveldt Bell
- School of Engineering Systems and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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40
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Derbyshire B, Porter ML. A study of the Elite Plus femoral component using radiostereometric analysis. ACTA ACUST UNITED AC 2007; 89:730-5. [PMID: 17613495 DOI: 10.1302/0301-620x.89b6.18317] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We performed a three-year radiostereometric analysis (RSA) study of the Elite Plus femoral component on 25 patients undergoing primary total hip replacement. Additional assessments and measurements from standard radiographs were also made. Subsidence of the stem occurred at the cement-stem interface. At 36 months the subsidence of the stem centroid was a mean of 0.30 mm (0.02 to 1.28), and was continuing at a slow rate. At the same time point, internal rotation and posterior migration of the femoral head had ceased. One stem migrated excessively and additional assessments suggested that this was probably due to high patient demand. The failure rate of 4% in our study is consistent with data from arthroplasty registers but contrasts with poor results from another RSA study, and from some clinical studies. We believe that the surgical technique, particularly the use of high-viscosity cement, may have been an important factor contributing to our results.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/standards
- Bone Cements
- Female
- Hip Prosthesis/standards
- Humans
- Male
- Middle Aged
- Osteoarthritis, Hip/diagnostic imaging
- Osteoarthritis, Hip/surgery
- Postoperative Complications/diagnostic imaging
- Postoperative Complications/etiology
- Prosthesis Failure
- Radiographic Image Interpretation, Computer-Assisted/methods
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Affiliation(s)
- B Derbyshire
- Wrightington Wigan and Leigh NHS Trust, Centre for Hip Surgery Wrightington Hospital, Hall Lane, Appley Bridge WN6 9EP, UK.
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41
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Gheduzzi S, Miles AW. A review of pre-clinical testing of femoral stem subsidence and comparison with clinical data. Proc Inst Mech Eng H 2007; 221:39-46. [PMID: 17315767 DOI: 10.1243/09544119jeim129] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Immediate postoperative stability of femoral stems is one of the key factors for the long-term success of total hip replacement. The need to develop a reliable technique to assess in vitro implant stability under physiological loading conditions is widely recognized. A critical review of the in vitro techniques developed for the assessment of implant stability is presented. In vitro predictions of subsidence are compared to in vivo clinical data available from Roentgen stereophotogrammetric analysis (RSA) studies. Limited correlation between in vitro predictions of stability and clinical measurements of subsidence obtained through RSA data was found even though similar migration patterns could be distinguished.
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Affiliation(s)
- S Gheduzzi
- Department of Orthopaedic Surgery, University of Bristol, Bristol, UK
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42
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Abstract
We undertook a review of the literature relating to the two basic stem designs in use in cemented hip replacement, namely loaded tapers or force-closed femoral stems, and the composite beam or shape-closed designs. The associated stem fixation theory as understood from in vitro studies and finite element modelling were examined with reference to the survivorship results for each of the concepts of fixation. It is clear that both design principles are capable of producing successful long-term results, providing that their specific requirements of stem metallurgy, shape and surface finish, preparation of the bone and handling of the cement are observed.
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Affiliation(s)
- T Scheerlinck
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of the Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
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43
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Hallan G, Aamodt A, Furnes O, Skredderstuen A, Haugan K, Havelin LI. Palamed G compared with Palacos R with gentamicin in Charnley total hip replacement. A randomised, radiostereometric study of 60 HIPS. ACTA ACUST UNITED AC 2006; 88:1143-8. [PMID: 16943462 DOI: 10.1302/0301-620x.88b9.18008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We performed a randomised, radiostereometric study comparing two different bone cements, one of which has been sparsely clinically documented. Randomisation of 60 total hip replacements (57 patients) into two groups of 30 was undertaken. All the patients were operated on using a cemented Charnley total hip replacement, the only difference between groups being the bone cement used to secure the femoral component. The two cements used were Palamed G and Palacos R with gentamicin. The patients were followed up with repeated clinical and radiostereometric examinations for two years to assess the micromovement of the femoral component and the clinical outcome. The mean subsidence was 0.18 mm and 0.21 mm, and the mean internal rotation was 1.7 degrees and 2.0 degrees at two years for the Palamed G and Palacos R with gentamicin bone cements, respectively. We found no statistically significant differences between the groups. Micromovement occurred between the femoral component and the cement, while the cement mantle was stable inside the bone. The Harris hip score improved from a mean of 38 points (14 to 54) and 36 (10 to 57) pre-operatively to a mean of 92 (77 to 100) and 91 (63 to 100) at two years in the Palamed G and Palacos R groups, respectively. No differences were found between the groups. Both bone cements provided good initial fixation of the femoral component and good clinical results at two years.
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Affiliation(s)
- G Hallan
- Department of Orthopaedic Surgery, Haukeland University Hospital, University of Bergen, 5021 Bergen, Norway.
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44
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Derbyshire B, Porter ML. Movement patterns of the C-stem femoral components: an RSA study of 33 primary total hip arthroplasties followed for two years. ACTA ACUST UNITED AC 2006; 88:976; author reply 976-7. [PMID: 16799008 DOI: 10.1302/0301-620x.88b7.18139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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45
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Abstract
UNLABELLED The CFP stem represents a short collared neck-retaining stem with very proximal metaphyseal anchoring along the calcar combined with up-to-date metallurgy. Despite theoretical advantages, the stability and clinical outcome are unknown. We prospectively measured the migration pattern of this new stem and cup. Twenty-six patients (26 hips) with a mean age of 54 years (range, 40-66 years) underwent THA and were followed for 2 years with radiostereometry, radiographs, and clinical scores. The stem showed some early retroversion (mean, SEM 0.6 degrees, 0.3), but stabilized before 1 year. Subsidence (0.05 mm, 0.06) and varus-valgus tilting (0.03 degrees, 0.01) were low. We observed no bone loss in the calcar region. Factors related to patients, implant design, and implantation did not predict migration patterns. The two-dimensional wear of the ceramic/conventional articulation was 0.09 mm at 2-24 months. The low migration of this short neck preserving stem suggests a favorable long-term outcome but longer followup is needed to substantiate this prediction. This design might become an alternative to standard stems and hip resurfacing. LEVEL OF EVIDENCE Therapeutic Level IV. See The Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- S M Röhrl
- Department of Surgery and Perioperative Sciences, Umeå University Hospital, Sweden.
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46
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Glyn-Jones S, Alfaro-Adrian J, Murray DW, Gill HS. The influence of surgical approach on cemented stem stability: an RSA study. Clin Orthop Relat Res 2006; 448:87-91. [PMID: 16826101 DOI: 10.1097/01.blo.0000224006.25636.cc] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED The surgical approach used is an important aspect of hip arthroplasty and will have an effect on the loading of the implant. Our goal was to establish whether there was a difference in early stem migration between the posterior and the lateral surgical approaches. The migration patterns of 45 Exeter stems in 45 patients were measured using radiostereometric analysis during a 2-year period; 19 of the stems were implanted using the posterior approach and 26 were implanted using the lateral approach. From postoperative radiostereometric measurements it was established that there was no difference in initial stem position between the two approaches. The posterior approach group had greater internal rotation of the stem, approximately 2 degrees during the first 2 years. The lateral group had almost 1/2 this amount of internal rotation. Overall stem subsidence was similar between the groups. These differences suggest that the lateral approach may give a survival advantage, especially for less rotationally stable stem designs and suboptimal cementing technique. The posterior approach gives rise to greater degree of internal rotation during the first 2 years. LEVEL OF EVIDENCE Therapeutic Level II. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- S Glyn-Jones
- OOEC/Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, England
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47
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Seral-García B, Pérez-Ansón M, Seral-Iñigo F, García-Aznar J, Doblaré-Castellano M. Modelo de interfaz cemento-vástago en artroplastias totales de cadera. Estudio de la superficie con elementos finitos. Rev Esp Cir Ortop Traumatol (Engl Ed) 2006. [DOI: 10.1016/s1888-4415(06)76376-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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48
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Sundberg M, Besjakov J, von Schewelow T, Carlsson A. Movement patterns of the C-stem femoral component. ACTA ACUST UNITED AC 2005; 87:1352-6. [PMID: 16189306 DOI: 10.1302/0301-620x.87b10.16567] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We used roentgen stereophotogrammetric analysis to follow 33 C-stem femoral components for two years after primary total hip arthroplasty. All components migrated distally and posteriorly within the cement mantle. The mean distal migration was 1.35 mm (sd 0.62) at two years and the mean posterior migration was 1.35 mm (sd 0.69) at two years. All the femoral components rotated into retroversion with a mean rotation at two years of 1.9° (sd 1.1). For all other directions, the prosthesis was stable up to two years. Compared with other tapered prostheses, the distal migration of the C-stem is the same, but posterior rotation and posterior migration are greater.
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Affiliation(s)
- M Sundberg
- Malmö University Hospital, SE-205 02 Malmö, Sweden.
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49
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50
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Carlsson A, Markusson P, Sundberg M. Radiostereometric analysis of the double-coated STAR total ankle prosthesis: a 3-5 year follow-up of 5 cases with rheumatoid arthritis and 5 cases with osteoarthrosis. Acta Orthop 2005; 76:573-9. [PMID: 16195076 DOI: 10.1080/17453670510041583] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The designs of total ankle prostheses have changed in recent years in order to give better performance. Only a few studies of these ankle prostheses have been published, however, and none on micromotion. PATIENTS AND METHODS We evaluated 5 patients with rheumatoid arthritis and 5 with osteoarthrosis, 4 (3-5) years after arthroplasty with the double-coated STAR prosthesis. Clinical examination included AOFAS hindfoot score. Standardized a-p and lateral radiographs were taken and RSA analyses were done at regular intervals. RESULTS There was no difference in results between ankles operated on due to rheumatoid arthritis and due to osteoarthrosis. A rapid initial migration was observed for the tibial components at 6 weeks, but thereafter all but 1 implant seemed stable. The migration pattern for the talar component was similar. Rotation around the 3 axes was observed for the tibial components at 6 weeks, but not thereafter. The talar components became stable for rotation around the longitudinal and sagittal axes, but not around the transverse axis. 8 out of 10 ankles were painless. The median total AOFAS score was 83 and the median range of motion was 32 degrees. None of the 20 components had changed position and there were no signs of bone resorption. INTERPRETATION Provided the indication is adequate and the prosthesis has been implanted correctly, the double-coated STAR ankle prosthesis will have a satisfactory fixation to underlying bone.
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Affiliation(s)
- Ake Carlsson
- Department of Orthopedics, Malmö University Hospital, Sweden.
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