Trevisan C, Lombardo AS, Gallinari G, Zeppieri M, Klumpp R. Taper-wedge stem suitable for anterior approach total hip arthroplasty: Adequate biomechanical reconstruction parameters and excellent clinical outcome at mid-term follow-up. World J Orthop 2022; 13(12): 1047-1055 [PMID: 36567862 DOI: 10.5312/wjo.v13.i12.1047]
Corresponding Author of This Article
Marco Zeppieri, BSc, MD, PhD, Doctor, Department of Ophthalmology, University Hospital of Udine, p.le S. Maria della Misericordia 15, Udine 33100, Italy. markzeppieri@hotmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Dec 18, 2022; 13(12): 1047-1055 Published online Dec 18, 2022. doi: 10.5312/wjo.v13.i12.1047
Taper-wedge stem suitable for anterior approach total hip arthroplasty: Adequate biomechanical reconstruction parameters and excellent clinical outcome at mid-term follow-up
Carlo Trevisan, Antonino Salvatore Lombardo, Gianluca Gallinari, Marco Zeppieri, Raymond Klumpp
Carlo Trevisan, Antonino Salvatore Lombardo, Gianluca Gallinari, UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST, Bergamo Est 24068, Italy
Marco Zeppieri, Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
Raymond Klumpp, UOC Ortopedia e Traumatologia, Ospedale Treviglio-Caravaggio ASST, Bergamo Ovest 24047, Italy
Author contributions: Trevisan C designed the research study, performed data acquisition, and wrote the manuscript; Lombardo AS, Gallinari G, and Klumpp R designed the research study and performed data acquisition; Trevisan C, Lombardo AS, Gallinari G, Zeppieri M and Klumpp R contributed towards conception of the study and final editing; All authors revised the article critically for important intellectual content, and provided final approval for the paper to be published.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Bergamo, Italy (No. 144/19, August 5, 2019).
Informed consent statement: Patients were not required to give informed consent to the study because the data was collected retrospectively and anonymized. Clinical data were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Zeppieri, BSc, MD, PhD, Doctor, Department of Ophthalmology, University Hospital of Udine, p.le S. Maria della Misericordia 15, Udine 33100, Italy. markzeppieri@hotmail.com
Received: September 13, 2022 Peer-review started: September 13, 2022 First decision: October 28, 2022 Revised: November 9, 2022 Accepted: December 6, 2022 Article in press: December 6, 2022 Published online: December 18, 2022 Processing time: 94 Days and 2.1 Hours
Abstract
BACKGROUND
The direct anterior approach (DAA) for total hip arthroplasty (THA) is a less invasive and muscle-sparing approach that seems to improve early function and patient satisfaction. Several studies, however, have reported high complication and revision rates due to the technical difficulties related to the femoral preparation.
AIM
To evaluate the usefulness and safety of a new stem equipped with a morphometric design and a size-specific medial curvature in DAA for THA.
METHODS
This retrospective study was based on 130 patients that underwent mini-invasive DAA procedures for THA using the Accolade II stem. A total of 144 procedures were included in the assessment, which was based on postoperative complications, survival rates, functional parameters, and patient related outcomes.
RESULTS
Overall complications were recorded in 6 procedures (4.2%). There were no complications related to the stem implantation and no intraoperative fractures. Only one patient was revised for deep infection. On radiographs, biomechanical hip reconstruction was satisfactory and no stem showed any subsidence greater than 2 mm. Full osseointegration based on Engh scores was seen in all of the implanted stems. Median Harris hip score at final follow-up was 99 points (range 44-100 points), which resulted excellent in 91.3% of patients. The median values of the osteaorthritis outcome score ranged from 87.5 to 95.
CONCLUSION
The mid-term positive outcomes and low complication rate in our consecutive series of patients support the safety and suitability of this new stem design in DAA for THA.
Core Tip: The direct anterior approach can provide a less invasive and muscle-sparing technique for total hip arthroplasty. New stems used in the direct anterior approach have been designed to reduce complication rates, and enhance postoperative morphologic and functional outcomes. The Accolade II stem is equipped with a morphometric design and a size-specific medial curvature, which can be advantageous for this type of surgery.
