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Suksathien Y, Suarjui J, Tippimanchai T, Suksathien R, Lajuntuk B, Khamphaeng S. Long-term results of short stem total hip arthroplasty in patients with osteonecrosis of the femoral head. Arch Orthop Trauma Surg 2024; 145:9. [PMID: 39666077 DOI: 10.1007/s00402-024-05680-0] [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: 05/11/2024] [Accepted: 10/07/2024] [Indexed: 12/13/2024]
Abstract
INTRODUCTION Short stem total hip arthroplasty (THA) is an alternative to conventional stem, designed to facilitate minimal-invasive surgery, physiological loading and preserve bone stock. However, there is insufficient evidence of the long-term outcomes in patients with osteonecrosis of the femoral head (ONFH). This study aims to analyze the clinical and radiographic results with a minimum follow-up of 10 years. Furthermore, the survival rate of the short stem was calculated. MATERIALS AND METHODS There were 81 patients (101 hips) with the mean age of 45 years (range, 21 to 68) in this study. The Harris Hip Scores (HHS) and Forgotten Joint Scores (FJS) were recorded to evaluate the clinical results. The appearance of osteointegration and radiolucent line were reviewed. The mean follow-up period was 129.3 months (range, 120-154). RESULTS At the latest follow-up, the mean HHS and FJS were 96.9 ± 5.7 (range, 69-100) and 95 ± 7 (range, 75-100) points respectively. The radiographic changes around the stem showed osteointegration mainly in the proximal part, zones 1 (94.1%), 2 (84.2%), 6 (99%) and 7 (92.1%). One stem underwent revision due to periprosthetic fracture, using conventional stem with plate and screws. Survivorship of the stem with the endpoint for any reason was 99.01% (95% confidence interval [CI], 93.18-99.86%) and for aseptic loosening was 100% at 10 years. CONCLUSION Short stem showed promising long-term clinical outcomes in patients with ONFH. The radiographic results demonstrated physiological proximal load transfer.
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Affiliation(s)
- Yingyong Suksathien
- Department of Orthopaedic Surgery, Maharat Nakhon Ratchasima Hospital, Chang Phueak Rd, Mueang District, Nakhon Ratchasima Province, Ratchasima Province, 30000, Thailand.
| | - Jithayut Suarjui
- Department of Orthopaedic Surgery, Maharat Nakhon Ratchasima Hospital, Chang Phueak Rd, Mueang District, Nakhon Ratchasima Province, Ratchasima Province, 30000, Thailand
| | - Thanut Tippimanchai
- Department of Orthopaedic Surgery, Maharat Nakhon Ratchasima Hospital, Chang Phueak Rd, Mueang District, Nakhon Ratchasima Province, Ratchasima Province, 30000, Thailand
| | - Rachawan Suksathien
- Department of Rehabilitation Medicine, Maharat Nakhon Ratchasima Hospital, Chang Phueak Rd, Muang District, Nakhon, Ratchasima Province, 30000, Thailand
| | - Bankchart Lajuntuk
- Department of Orthopaedic Surgery, Buayai Hospital, Buayai District, Nakhon Ratchasima Province, 30000, Thailand
| | - Sirawitz Khamphaeng
- Department of Orthopaedic Surgery, Uthumphon Phisai Hospital, Uthumphon Phisai District, Sisaket Province, 33120, Thailand
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Stauss R, Becker NT, Savov P, Ettinger M, Seeber GH. Analysis of Postoperative Complication and Revision Rates and Mid- to Long-Term Implant Survival in Primary Short-Stem Total Hip Arthroplasty. J Clin Med 2024; 13:3779. [PMID: 38999347 PMCID: PMC11242722 DOI: 10.3390/jcm13133779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/18/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Short-stem prostheses were introduced as an alternative to conventional straight-stem prostheses. Despite their benefits, including minimally invasive approaches, soft-tissue- and bone-sparing implantation, and physiological load transfer to the metaphysis, data on postoperative complication and revision rates as well as on implant survival are scarce. Methods: A retrospective analysis of 1327 patients who underwent primary total hip arthroplasty (THA) using the Metha® short stem between 2006 and 2023 was conducted. Complication and revision rates were analysed for the intraoperative, direct postoperative, and follow-up episodes. Implant survival was analysed with the endpoint of all-cause stem revision. Results: Intraoperative complications were observed in 3.77% of the cases and included 44 hairline cracks and 6 fractures. In 15 cases (30.0%), conversion to a straight-stem or revision implant was necessary. The direct postoperative complication rate was 2.44%, and 11 revision procedures were performed during inpatient stay (0.84%). Mean follow-up was 7 years (range 1-17). During follow-up, femoral component revision was performed in 60 cases. Aseptic loosening and stem subsidence accounted for a combined percentage of 80% of all indications. Implant survival rate was 95.66% after 5 years, 95.58% after 10 years, and 95.50% after 15 years. Conclusions: Our study provides a comprehensive analysis of postoperative complication and revision rates in a large sample undergoing primary short-stem THA. Postoperative complication rates were favourable, and the long-term implant survival rates were comparable to conventional straight-stem prostheses. Therefore, short-stem THA may be considered an alternative for younger patients.
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Affiliation(s)
- Ricarda Stauss
- Division of Orthopaedics at Campus Pius-Hospital, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26121 Oldenburg, Germany
| | - Nils T. Becker
- Division of Orthopaedics at Campus Pius-Hospital, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26121 Oldenburg, Germany
| | - Peter Savov
- Division of Orthopaedics at Campus Pius-Hospital, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26121 Oldenburg, Germany
| | - Max Ettinger
- Division of Orthopaedics at Campus Pius-Hospital, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26121 Oldenburg, Germany
| | - Gesine H. Seeber
- Division of Orthopaedics at Campus Pius-Hospital, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26121 Oldenburg, Germany
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Mihalko WM, Jove M, Jove N, Calkins TE, Gehlert RJ. United States Experience With a Femoral Neck Retaining Total Hip Arthroplasty Stem: A Retrospective Study With Control Comparison From the Literature. J Arthroplasty 2024; 39:750-753. [PMID: 37640246 DOI: 10.1016/j.arth.2023.08.074] [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: 04/25/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Femoral neck retaining prostheses have gained popularity in Europe, but the United States has not seen the same trends occurring. Previous reports demonstrate high survivorship for these implants, but to our knowledge, there are no reports examining US data. METHODS After institutional review board approval, 824 primary total hip arthroplasties utilizing a femoral neck-retaining prosthesis were examined for femoral component survivorship rates. European studies were systematically reviewed to determine survivorship rates. The data were used to formulate a Kaplan-Meier survivorship curve and compare US data to that of the European studies. RESULTS European studies demonstrated survivorship rates for all causes of 97.7 and 99.0% for aseptic loosening at an average of 6 years (range, 4.5 to 10). The current study demonstrated an all-cause 94% Kaplan-Meier survivorship estimate at 5 years and when aseptic loosening only was considered, survivorship increased to 99.4% at 5 years and 98.4% at 11 years. CONCLUSION This femoral neck-retaining prosthesis demonstrated excellent survivorship that is comparable to the rates seen in European studies as well as the rates of standard and mid-stem prostheses in the United States.
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Affiliation(s)
- William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Maurice Jove
- Atlanta Bone and Joint Specialists, Atlanta, Georgia
| | - Nathan Jove
- Atlanta Bone and Joint Specialists, Atlanta, Georgia
| | - Tyler E Calkins
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rick J Gehlert
- Department of Orthopaedic Surgery, University of New Mexico, Albuquerque, New Mexico
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Weenders SGM, Merfort R, Eschweiler J, Hildebrand F, Gruner A, Heller KD. Ten-year follow-up and clinical outcome of a metaphyseal anchoring short hip stem prosthesis: a retrospective single-centre analysis. INTERNATIONAL ORTHOPAEDICS 2024; 48:419-426. [PMID: 37672119 DOI: 10.1007/s00264-023-05958-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE Short stems for total hip arthroplasty are an alternative to traditional conventional long stems. Short stems are designed to facilitate minimal-invasive surgery, improve bone-stock preservation, and mimic a physiological load distribution. However, there is little evidence of the long-term outcome of short stems. This study aims to analyze the ten year survival rates and clinical outcome of one specific metaphyseal short hip stem implant. METHODS We retrospectively analyzed the patient records of the patients who underwent a total hip arthroplasty with a monoblock partial collum sparing metaphyseal short hip stem prosthesis in 2008 and 2009 in our clinic. Patients were contacted, and clinical follow-up was recorded using the German version of the modified Harris Hip Score. Furthermore, complications, revision surgery, and post-operative radiographs were analyzed. RESULTS Data from 339 primary implantations in 322 patients were retrieved. The mean follow-up was 10.6 years. Seven patients underwent a revision. The ten year survival rate with any revision surgery as the endpoint was 97.5%. The mean modified Harris Hip Score was 86 points (range 30 to 91 points). Five patients had an intraoperative fracture of the femur (1.6%). Two patients (0.6%) had a dislocation of the hip. The stem tip-to-cortex distance, measured in the anterior posterior view, was 2.6 mm (range 0 to 8.3 mm). CONCLUSION The ten year survival rate of our used monoblock partial collum sparing metaphyseal short hip stem implant is comparable to traditional stems for total hip arthroplasty.
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Affiliation(s)
- S G M Weenders
- Clinic for Orthopaedic Surgery, Herzogin Elisabeth Hospital, Leipzigerstraße 24, 38124, Braunschweig, Germany.
| | - R Merfort
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - J Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - F Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - A Gruner
- Clinic for Orthopaedic Surgery, Herzogin Elisabeth Hospital, Leipzigerstraße 24, 38124, Braunschweig, Germany
| | - K D Heller
- Clinic for Orthopaedic Surgery, Herzogin Elisabeth Hospital, Leipzigerstraße 24, 38124, Braunschweig, Germany
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Nakai T, Takeda Y, Niitsu S, Fujihara Y, Okahisa S, Tachibana T, Fukunishi S. Comparative Study for Postoperative Initial Fixation Patterns of Two Different Types of Cementless Short Stem Using Three-Dimensional Templating Software. Clin Orthop Surg 2024; 16:23-33. [PMID: 38304207 PMCID: PMC10825261 DOI: 10.4055/cios23100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 02/03/2024] Open
Abstract
Background While cementless short stems have become popular in total hip arthroplasty (THA), Metha is a relatively recent development that differs from other short stems in its initial fixation concept of partial collum-sparing metaphyseal anchorage. The purpose of this study was to quantify the contact state between Metha and the femur. Additionally, we investigated the difference in contact points between Meta and Fitmore, which is one of the more popular curved short stems. Methods We conducted a retrospective review of 42 hips that underwent THA using Metha and 41 hips using Fitmore. Stem-to-femur contact was evaluated by density mapping using a three-dimensional digital template system to quantify the contact condition according to the modified Gruen zone. The criterion for the stem-to-bone contact boundary was defined as a computed tomography value of 543 Hounsfield. Results Quantitative evaluation of Metha according to the modified Gruen zones showed the ratio of surface area with high cortical contact in each zone. The results were 4.6% ± 5.7% in zone 1, 0.9% ± 2.3% in zone 2, 19.1% ± 12.9% in zone 3, 1.4% ± 3.2% in zone 5, 29.6% ± 16.4% in zone 6, and 25.1% ± 17.7% in zones 7. Evaluation of Fitmore for the same zones was as follows: 1.6% ± 2.4%, 18.5% ± 16.9%, 20.8% ± 17.4%, 12.7% ± 12.8%, 3.7% ± 5.8%, and 13.3% ± 10.3%. Comparing the two groups, the contact area was significantly greater for Metha in zones 1, 6 and 7 and Fitmore in zones 2 and 5 (p < 0.05). Conclusions It is possible for Metha to achieve metaphyseal anchoring by contacting the cortical bone at the proximal femur, thus avoiding proximal offloading. To the best of our knowledge, no previous studies have quantitatively reported stem-to-cortical bone contact conditions in curved short stems.
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Affiliation(s)
- Takuya Nakai
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan
| | - Yu Takeda
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Saori Niitsu
- Department of Orthopedic Surgery, Goshi Hospital, Hyogo, Japan
| | - Yuki Fujihara
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Shohei Okahisa
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Shigeo Fukunishi
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan
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Grappiolo G, Gambaro FM, Spera M, Chiappetta K, Morenghi E, Loppini M. Clinical and radiological outcomes of an uncemented metaphyseal short stem at minimum 10 years of follow-up: a prospective observational study. Arch Orthop Trauma Surg 2024; 144:425-431. [PMID: 37526737 DOI: 10.1007/s00402-023-05012-8] [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: 03/05/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE There is growing interest around short stems as they provide a less invasive approach for total hip arthroplasty preserving bone stock for a possible revision surgery if required. The main purpose of this work was to assess the long-term performance of an uncemented metaphyseal short stem in terms of survival rate and in addition its clinical and radiological outcomes. MATERIALS AND METHODS From January to December 2010, we prospectively enrolled all consecutive patients undergoing primary total hip arthroplasty with an uncemented metaphyseal short stem in our institution with a minimum follow-up of 10 years. The radiographic features investigated were the varus-valgus stem orientation, areas of osteolysis and radiolucencies, stress shielding, and heterotopic calcifications. The clinical outcomes were measured using the HHS. RESULTS A total of 163 patients (172 hips) were finally included and the measured survival rate at 10 years was 99.6%. The average HHS increased from 55.0 preoperatively to 97.8 at the last follow-up (p < 0.0001). Among them, 137 patients (164 hips) were also available for radiographic assessment. Mild varus malalignment was observed in 40% of cases and remained stable in the serial X-rays and was not associated with step loosening. Mild stress shielding was observed around 13 stems (9%) and moderate only around 3 implants. CONCLUSION In conclusion, the uncemented metaphyseal short stems showed excellent survival and clinical results at 10 years and at a radiographical level very low stress shielding was observed; moreover, besides the high frequency of varus alignment the implanted stems was not associated with revision surgery or with worse clinical outcomes.
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Affiliation(s)
- Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona-Università degli Studi di Genova, Via Magliotto 2, 17100, Savona, Italy
| | - Francesco Manlio Gambaro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Marco Spera
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Katia Chiappetta
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona-Università degli Studi di Genova, Via Magliotto 2, 17100, Savona, Italy
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
- Fondazione Livio Sciutto Onlus, Campus Savona-Università degli Studi di Genova, Via Magliotto 2, 17100, Savona, Italy.
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Yabusaki Y, Asai K, Hisakado H, Takano N. Effect of short stem alignment on initial fixation, stress transfer, and failure risk. Technol Health Care 2024; 32:117-130. [PMID: 37302047 DOI: 10.3233/thc-220591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Short stems are advantageous for revision as they preserve autogenous bone. At present, the method of short-stem installation is determined based on the surgeon's experience. OBJECTIVE To provide the guideline for installing a short stem, we aimed to investigate the alignment effect on the initial fixation of the stem, stress transfer, and the risk of failure numerically. METHODS Models in which the caput-collum-diaphyseal (CCD) angle and flexion angle were hypothetically changed based on the two clinical cases of hip osteoarthritis were analyzed using the non-linear finite element method. RESULTS The medial settlement of the stem increased in the varus model and decreased in the valgus model. With varus alignment, the stresses acting on the femur were high in the distal to the femoral neck. In contrast, the stresses in the proximal to the femoral neck tend to be higher with valgus alignment, although the difference in the femur stress between varus and valgus alignment was slight. CONCLUSION Both initial fixation and stress transmission are lower when the device was placed in the valgus model than in the actual surgical case. In order to obtain initial fixation and suppress stress shielding, it is essential to extend the contact area between the medial portion of the stem and the femur along the bone axis, and to ensure adequate contact between the lateral portion of the stem tip and the femur.
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Affiliation(s)
- Yumie Yabusaki
- Department of Mechanical Engineering, Kanazawa Institute of Technology, Hakusan, Japan
| | - Kenji Asai
- Department of Mechanical Engineering, Kanazawa Institute of Technology, Hakusan, Japan
| | | | - Noriyuki Takano
- Integrated Technology Research Center of Medical Science and Engineering, Kanazawa Institute of Technology, Hakusan, Japan
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Afghanyar Y, Kutzner KP, Pfeil J, Drees P, Rehbein P, Dargel J. Cementless Short Stems in Total Hip Arthroplasty: Chances and Limits. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:396-404. [PMID: 35104904 DOI: 10.1055/a-1678-7684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In recent decades, a large number of cementless short stems have been introduced to the market. The concept aims at saving soft tissue using minimally invasive surgery and at the same time preserving as much bone as possible. In particular, the latest generation of short stems, which are implanted using a calcar-guided round-the-corner technique, are attracting increasing attention. An individualised resection level allows individual stem alignment and thus an ideal reconstruction of the hip anatomy. The early clinical results of short-stem total hip arthroplasty (THA) are promising and have led to an expansion of the indications and limitations for the use of short stems. In particular, the individual positioning in valgus or varus and the resulting individual metaphyseal or metadiaphyseal anchorage offers various possibilities to reconstruct even abnormal joint morphologies. Consequently, short stems are increasingly used in patients with complex anatomical variations or in cases of osteonecrosis of the femoral head. In some various cases, they can also be used in revision or conversion arthroplasty. In some patients, short stems can also be used after femoral neck fracture. Currently, scientific data on those areas of indication of short-stem THA is scarce.
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Affiliation(s)
- Yama Afghanyar
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Karl Philipp Kutzner
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
- Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Joachim Pfeil
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Philipp Drees
- Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Philipp Rehbein
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Jens Dargel
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
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Castagnini F, Bordini B, Cosentino M, Tassinari E, Guizzardi G, Traina F. Comparison of single taper and dual taper versions of the same stem design in total hip arthroplasty for primary osteoarthritis. J Orthop Traumatol 2023; 24:5. [PMID: 36725766 PMCID: PMC9892395 DOI: 10.1186/s10195-023-00687-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/21/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In total hip arthroplasty (THA), the outcomes of single taper (ST) and dual taper (DT) versions of the same stem design have been scarcely studied. A registry study comparing ST and DT versions of the same stem design was designed, aiming to assess: (1) the survival rates and the hazard ratios for failure; (2) the survival rates and the hazard ratios for failure using stem-focused endpoints. MATERIAL AND METHODS A regional arthroplasty registry was interrogated about stem designs with ST and DT versions in cementless THAs performed for primary osteoarthritis. Only the same cup and ceramic-on-ceramic bearings were included: the DT stems had a titanium-on-titanium modularity. Demographic and implant features were recorded. Survival rates and hazard ratios were evaluated and compared. Stem-focused endpoints were also investigated. RESULTS A total of 5359 THAs were included, with three stem designs. The two versions of every stem showed different demographics and implant-related features: ST versions were preferentially implanted in heavier young men. For each stem, the two versions had similar survival rates at 5 years (p = 0.076; p = 0.319; p = 0.616) and similar adjusted hazard ratios for failures (p = 0.084; p = 0.308; p = 0.729). When stem-focused endpoints were adopted, the ST and DT versions of the three stems achieved similar survival rates (p = 0.710; p = 0.784; p = 0.983) and similar adjusted hazard ratios (p = 0.647; p = 0.858; p = 0.787). Three neck breakages occurred (0.0007% of all the modular implants). CONCLUSIONS ST and DT versions of the same stem design did not show any differences in terms of survival rates and hazard ratios for failures at 5 years. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d'anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Barbara Bordini
- Laboratorio Di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, Italy
| | - Monica Cosentino
- Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d'anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Enrico Tassinari
- Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d'anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Giulia Guizzardi
- Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d'anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d'anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- DIBINEM, Università Di Bologna, Bologna, Italy
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Reinbacher P, Hecker A, Friesenbichler J, Smolle M, Leitner L, Klim S, Draschl A, Colovic D, Brunnader K, Leithner A, Maurer-Ertl W. Simultaneous Bilateral Total Hip Arthroplasty with Straight-Stems and Short-Stems: Does the Short One Do a Better Job? J Clin Med 2023; 12:1028. [PMID: 36769676 PMCID: PMC9918178 DOI: 10.3390/jcm12031028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/22/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is known to be the most successful orthopaedic surgery of the last century, but it is still struggling with controversies concerning one-stage bilateral THA. The current study aimed to compare the clinical outcome of patients with unilateral or simultaneous bilateral THA by using short-stem and straight-stem designs and focusing on operation time, blood loss, and length of hospital stay (LOS). MATERIAL AND METHODS Between 2006 and 2018, 92 patients were enrolled in this study. Forty-six patients underwent a bilateral THA in one session, and forty-six matched patients underwent a unilateral THA. In each of the two groups (unilateral vs. bilateral), 23 patients received either a straight (unilateral: 10 females, 13 males, mean age 63; bilateral: 12 females, 11 males, mean age 53 years) or short stem (unilateral: 11 females, 12 males, mean age 60 years; bilateral: 12 females, 11 males, 53 mean age 62 years). The blood count was checked preoperatively as well as one and three days after surgery. Furthermore, the operation time and LOS were investigated. RESULTS Compared to THA with straight-stems, short-stem THA showed significantly less blood loss; there was no difference in the LOS of both groups. A significantly shorter operative time was only observed in the bilateral THA. CONCLUSION The current study showed that simultaneous bilateral THA appears to be safe and reliable in patients without multiple comorbidities. In addition, short-stem THA appears to be beneficial in terms of clinical performance and outcome, and it appears to be superior to straight-stem THA, regardless of whether the patient underwent unilateral or simultaneous bilateral THA.
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Affiliation(s)
- Patrick Reinbacher
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Joerg Friesenbichler
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Maria Smolle
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Sebastian Klim
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Alexander Draschl
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Danijel Colovic
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Kevin Brunnader
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics & Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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11
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[Strategies for stem revision : Surgery planning, implant removal and reimplantation]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:21-34. [PMID: 35802156 PMCID: PMC9842594 DOI: 10.1007/s00132-022-04277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PLANNING Femoral revision represents a challenging procedure in its surgical planning and technical execution. The results are mainly dependent on the bone loss present, the quality of the implant removal and the choice of revision system. Patient-specific factors such as age, comorbidities, bone quality or even the localization of the cement have a decisive influence on the surgical strategy. Appropriate preoperative preparation, including the presence of the necessary special instruments, which are essential for gentle implant removal, is indispensable to achieve the best possible result. THERAPY A bone-sparing implant removal can be particularly challenging, especially in the case of well-fixed stems and cement residues, which may extend far beyond the isthmus. In such situations, a transfemoral approach should be considered. Cementless reimplantation using modular or non-modular titanium stems is currently the preferred treatment of choice for most revisions. In elderly, low-demand patients or with poor bone quality, cemented revision remains a good alternative treatment option.
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Luger M, Stiftinger J, Allerstorfer J, Hochgatterer R, Gotterbarm T, Pisecky L. High varus stem alignment in short-stem total hip arthroplasty: a risk for reconstruction of femoro-acetabular offset, leg length discrepancy and stem undersizing? Arch Orthop Trauma Surg 2022; 142:2935-2944. [PMID: 34554313 PMCID: PMC9474344 DOI: 10.1007/s00402-021-04176-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/09/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE Short stems are increasingly used in in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Short stems can be inserted in a more varus position compared to conventional straight stems. This poses the risk of final varus misplacement of the femoral component, which is not intended in all femoral short stems. METHODS We wanted to evaluate the effect of a high varus stem positioning in MIS THA on hip offset, leg length and femoral canal fill index. A series of 1052 consecutive THAs with a singular cementless femoral short stem and press-fit cup was retrospectively screened for inclusion. One hundred six patients with unilateral THA and a contralateral healthy hip met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior-posterior postoperative radiographs. Patients were divided into Group A (varus stem alignment ≤ 3°) and Group B (varus stem alignment > 3°). RESULTS Hip offset (HO) increased significantly in Group B by 4 mm (p = 0.013). No influence on leg length difference was detected in both groups. Preoperative CCD angle was significantly lower in Group B (p < 0.001). Canal Fill Indices (CFI) were significantly lower in Group B (CFI I: p < 0.001; CFI II p = 0.003; CF III p = 0.002). CONCLUSION High varus stem alignment > 3° leads to a statistically significant but minor increase in HO and poses the risk of stem undersizing. A preoperatively low genuine CCD angle pose a risk for varus stem positioning.
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Affiliation(s)
- Matthias Luger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria. .,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria. .,Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria.
| | - Julian Stiftinger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Jakob Allerstorfer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Rainer Hochgatterer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Lorenz Pisecky
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
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Ezechieli M, Windhagen H, Matsubara M, Budde S, Wirries N, Sungu M. A neck-preserving short stem better reconstructs the centre of rotation than straight stems: a computed tomography-based cadaver study. Arch Orthop Trauma Surg 2022; 142:1669-1680. [PMID: 34231044 DOI: 10.1007/s00402-021-03957-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/10/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Short femoral hip stems with a metaphyseal anchoring concept have been designed to treat younger patients with good bone quality. The aim of this study was to reconstruct the centre of rotation and soft tissue balancing and preserve bone in the long-term perspective. MATERIALS AND METHODS Eighteen human femurs were randomised into three groups: (1) metaphyseal anchoring short stem, (2) shortened straight stem, (3) straight stem). Prior to the implantation of the hip stems, a computed tomography (CT) of the bones was performed and the femoral ante-torsion and ante-tilt was measured and compared to the results of the post-implantation CT. This could be calculated based on the 3D coordinates taken from the pre- and post-op CT scans, which were transformed into the same coordinate systems. RESULTS The mean preoperative caput-collum-diaphyseal (CCD) angle for the three groups was 126.87° ± 3.50° (Group 3: 129.64° ± 3.53°, Group 1: 123.76° ± 5.56°, Group 2: 127.53° ± 1.42°) and was consistent with published reports. The postoperative CCD angles with 126.85° ± 3.43° were within a very good reconstruction range for all three groups. The anterior offset comparison among these three groups showed significant difference in reconstruction. The smallest difference between the anatomical (preoperative) and postoperative condition was seen in Group 1 (1.47° ± 0.60°), followed by Group 2 (3.60° ± 0.23°) and Group 3 (8.00° ± 0.70°) groups. The horizontal offset showed no significant difference among the groups and was within the window of ± 5 mm. CONCLUSION In this cadaver study, we found that the metaphyseal anchoring, partially neck-preserving short hip stem best reconstructs the ante-torsion and the ante-tilt of the femoral neck. Therefore, it can be a useful stem in younger or active middle-aged patients.
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Affiliation(s)
- M Ezechieli
- Vincenz Krankenhaus Paderborn, Standort Salzkotten, Dr.-Krismann-Strasse 12, 33154, Salzkotten, Germany. .,Orthopaedic Clinic Medical School Hannover, Hannover, Germany.
| | - H Windhagen
- Orthopaedic Clinic Medical School Hannover, Hannover, Germany
| | | | - S Budde
- Orthopaedic Clinic Medical School Hannover, Hannover, Germany
| | - N Wirries
- Orthopaedic Clinic Medical School Hannover, Hannover, Germany
| | - M Sungu
- Expert and Product Management Department, BBraun Aesculap, Tuttlingen, Germany
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Ishaque BA. Short Stem for Total Hip Arthroplasty (THA) - Overview, Patient Selection and Perspectives by Using the Metha ® Hip Stem System. Orthop Res Rev 2022; 14:77-89. [PMID: 35387255 PMCID: PMC8977779 DOI: 10.2147/orr.s233054] [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: 09/06/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Short stem hip replacement has not only gained attention but also significance over the past decades. However, there still remains uncertainty regarding the correct indications for these stems. Even companies, producing implants, have varying recommendations that are more likely based on a well-meant advice than on statistically evaluated data. Thus, it is important to evaluate the advantages and disadvantages of a short stem prosthesis. The goal of this paper is to reveal some of the existing uncertainty in this field, by analyzing the Metha® short hip stem system. This paper does not only focus on general aspects but also discusses some more specific problems, such as avascular necrosis and post-rheumatic diseases, as well as hip dysplasia and coxarthrosis. The aim is also to convey the opportunity to indicate this type of implant for elderly and obese patients as well as for femoral misalignments following post-Perthes disease, post-traumatic deformities or other malpositions of the hip.
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Affiliation(s)
- Bernd Alexander Ishaque
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Giessen, 35392, Germany
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15
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Drobniewski M, Synder M, Synder MA, Krasińska M, Olewnik L, Borowski A. Future of total hip arthroplasty with the Metha short stem in modern surgeries. Sci Rep 2021; 11:21763. [PMID: 34741121 PMCID: PMC8571394 DOI: 10.1038/s41598-021-01367-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 10/25/2021] [Indexed: 12/02/2022] Open
Abstract
The aim of the study was to analyse the results of uncemented total hip replacement, using the Metha (metaphyseal) stem. A total of 158 patients (70 females and 88 males) were qualified to the study and submitted to total hip arthroplasty (183 procedures altogether), using the Metha stem. The mean age of the patients on the day of surgery was 51.7 years (the range from 17 to 69 years). The mean follow up period was 9.2 years (the range from 5 to 13.5 years). Preoperative assessments gave poor scores, according to the Merle d’Aubigne and Postel classification, modified by Charnley. The average improvement after surgery, according to the used scale, was 6.9 points. A very good outcome was recorded in 154 cases (84.2%), a good outcome was achieved in 20 cases (10.9%) and a poor outcome was confirmed in 9 cases, while no satisfactory case was observed. Poor outcomes were associated with implant loosening. Extraskeletal ossification was noted in 10 cases (5.5%). According to the Kaplan–Meier estimator, the 10-year survival was 93.2% and 97.3% for the whole implant and the stem alone, respectively. 1. Our follow-up period of more than 9 years on the average, indicates that Metha stems produce excellent clinical and functional results in operated young patients with advanced degenerative changes of the hip joint. 2. Assuming a proper qualification for the procedure, the absence of complications and a correct surgical technique, which is slightly more difficult, when compared to standard stem implantation, the risk of aseptic loosening is fairly negligible.
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Affiliation(s)
- Marek Drobniewski
- Orthopaedics and Paediatric Orthopaedics Department, Medical University of Lodz, ul. Pomorska 251, 92-213, Lodz, Poland
| | - Marek Synder
- Orthopaedics and Paediatric Orthopaedics Department, Medical University of Lodz, ul. Pomorska 251, 92-213, Lodz, Poland
| | - Marek Aleksander Synder
- Orthopaedics and Paediatric Orthopaedics Department, Medical University of Lodz, ul. Pomorska 251, 92-213, Lodz, Poland
| | - Magdalena Krasińska
- Orthopaedics and Paediatric Orthopaedics Department, Medical University of Lodz, ul. Pomorska 251, 92-213, Lodz, Poland
| | - Lukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Andrzej Borowski
- Orthopaedics and Paediatric Orthopaedics Department, Medical University of Lodz, ul. Pomorska 251, 92-213, Lodz, Poland.
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16
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Azari F, Sas A, Kutzner KP, Klockow A, Scheerlinck T, van Lenthe GH. Cemented short-stem total hip arthroplasty: Characteristics of line-to-line versus undersized cementing techniques using a validated CT-based finite element analysis. J Orthop Res 2021; 39:1681-1690. [PMID: 33095461 DOI: 10.1002/jor.24887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/03/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
Short stems are becoming increasingly popular in total hip arthroplasty as they preserve the bone stock and simplify the implantation process. Short stems are advised mainly for patients with good bone stock. The clinical use of short stems could be enlarged to patients with poor bone stock if a cemented alternative would be available. Therefore, this study aimed to quantify the mechanical performance of a cemented short stem and to compare the "undersized" cementing strategy (stem one size smaller than the rasp) with the "line-to-line" technique (stem and rasp with identical size). A prototype cemented short stem was implanted in eight pairs of human cadaveric femora using the two cementing strategies. Four pairs were experimentally tested in a single-legged stance condition; stiffness, strength, and bone surface displacements were measured. Subject-specific nonlinear finite element models of all the implanted femora were developed, validated against the experimental data, and used to evaluate the behavior of cemented short stems under physiological loading conditions resembling level walking. The two cementing techniques resulted in nonsignificant differences in stiffness and strength. Strength and stiffness as calculated from finite element were 8.7 ± 16% and 9.9 ± 15.0% higher than experimentally measured. Displacements as calculated from finite element analyses corresponded strongly (R 2 ≥ .97) with those measured by digital image correlation. Stresses during level walking were far below the fatigue limit for bone and bone cement. The present study suggests that cemented short stems are a promising solution in osteoporotic bone, and that the line-to-line and undersized cementing techniques provide similar outcomes.
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Affiliation(s)
| | - Amelie Sas
- Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Karl P Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
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Pardo F, Bordini B, Castagnini F, Giardina F, Faldini C, Traina F. Are powder-technology-built stems safe? A midterm follow-up registry study. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:10. [PMID: 33471238 PMCID: PMC7817598 DOI: 10.1007/s10856-020-06481-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Powder technology was developed to bring together the mechanical features and high porosity of titanium. However, the high porosity may theoretically compromise mechanical resistance. Literature is deficient about the use and safety profile of cementless femoral implants built using additive manufacturing (in particular electron beam melting technology, EBM). The purpose of this study was to evaluate the survival rates and the reason for revisions (especially implant breakage) of the first two EBM-built stems at a mid-term follow-up, using a joint arthroplasty registry. METHODS The registry of Prosthetic Orthopedic Implant (RIPO) was investigated about cementless stems implanted from 2010 to 2017. Stems built with EBM technology (Parva and Pulchra stems; Adler Ortho, Milan, Italy) were compared to all the other cementless stems implanted during the same period, acting as control group. The survival rates and reasons for revision were assessed. RESULTS No stem breakage occurred. At 5-year follow-up, the survival rates of the two cohorts were not statistically different (96.8% EBM stems, 98.0% standard cementless stems; p > 0.05). In the EBM stems, aseptic loosening occurred in 1.7% of the cases at the latest follow-up. CONCLUSIONS This large cohort showed that mechanical resistance is not a concern in EBM stems at mid-term follow-up. However, larger populations and longer follow-ups are needed to further validate these results.
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Affiliation(s)
- Francesco Pardo
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
| | - Federico Giardina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
| | - Cesare Faldini
- Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
- DIBINEM, University of Bologna, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, 40136, Italy
- DIBINEM, University of Bologna, Bologna, Italy
- University of Messina, Messina, Italy
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18
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Malahias MA, Tejaswi P, Chytas D, Kadu V, Karanikas D, Thorey F. The clinical outcome of the Metha short hip stem: a systematic scoping review. Hip Int 2021; 31:24-33. [PMID: 32019377 DOI: 10.1177/1120700020903719] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Short femoral stems were designed to bridge the gap between conventional straight design stems and hip resurfacing prostheses in total hip arthroplasty (THA). A number of clinical trials have been recently conducted to assess the clinical and safety profile of the cementless, colarless, tapered Metha short hip stem in young or active middle-aged individuals. METHODS A systematic scoping review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. 4 reviewers independently conducted the search using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms "short" AND "hip" AND "stem". RESULTS From the initial 773 studies we finally chose 12 studies after applying our inclusion-exclusion criteria. The number of operated hips that were included in these studies was 5048 (mean BMI range: 22.7-35.2, mean age range: 44.4-60.4 years, mean follow-up range: 2-9 years). The mean modified Coleman methodology score was 52.3/100, while it ranged from 31/100 to 63/100. All mean clinical outcome scores that were used in the studies illustrated significant postoperative improvement when compared with the respective initial values. The revision rate of the Metha stem for component-related reasons was 2.5%, while the rate of major complications not requiring revision of the Metha stem was 2.8%. CONCLUSIONS The Metha stem performs well in young or active middle-aged THA patients. Further studies are required for the assessment of the long-term results.
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Affiliation(s)
- Michael-Alexander Malahias
- International Centre for Hip, Knee and Foot Surgery, Sports Traumatology, ATOS Hospital, Heidelberg, Germany
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Purnachandra Tejaswi
- International Centre for Hip, Knee and Foot Surgery, Sports Traumatology, ATOS Hospital, Heidelberg, Germany
| | - Dimitrios Chytas
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vikram Kadu
- Department of Orthopaedic, ACPM Medical College, Maharashtra, India
| | - Dimitrios Karanikas
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fritz Thorey
- International Centre for Hip, Knee and Foot Surgery, Sports Traumatology, ATOS Hospital, Heidelberg, Germany
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19
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Kheir MM, Drayer NJ, Chen AF. An Update on Cementless Femoral Fixation in Total Hip Arthroplasty. J Bone Joint Surg Am 2020; 102:1646-1661. [PMID: 32740265 DOI: 10.2106/jbjs.19.01397] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael M Kheir
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nicholas J Drayer
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Gombár C, Janositz G, Friebert G, Sisák K. The DePuy Proxima™ short stem for total hip arthroplasty - Excellent outcome at a minimum of 7 years. J Orthop Surg (Hong Kong) 2020; 27:2309499019838668. [PMID: 30939986 DOI: 10.1177/2309499019838668] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Metaphyseal, proximally anchored uncemented stems for total hip arthroplasty provide bone preservation and decrease the incidence of proximal stress shielding and thigh pain. Our study investigated the clinical and radiological outcome of the DePuy Proxima™ short stem at a minimum of 7 years. METHODS Eighty-one consecutive patients (86 procedures) under the age of 70 undergoing primary total hip replacement at two arthroplasty centres were enrolled. Follow-up was clinical (Harris Hip Score (HHS), thigh pain and satisfaction) and radiological (subsidence, malalignment and loosening) at 6 months and yearly thereafter. RESULTS Average age was 50 (range 32-65) with 79% (68 of 86) being male. Preoperative diagnosis included primary osteoarthritis (OA) 36%, avascular necrosis of femoral head 51%, dysplasia 9% and post-traumatic OA 4%. HHS improved 51 points at latest follow-up (from 40 to 91). We had 3.5% (3 of 86) periprosthetic fractures, one requiring revision. We had one dislocation, no infections and no thigh pain. Malalignment rate (≥5° off neutral) was 12% (10 of 86), not affecting clinical results. CONCLUSION Overall stem survival was over 97% at 7 years. The DePuy Proxima provides excellent clinical results at a minimum of 7 years post-operatively.
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Affiliation(s)
- Csaba Gombár
- 1 Department of Orthopaedics, University of Szeged, Szeged, Hungary
| | - Gábor Janositz
- 2 Department of Orthopaedics, Bacs-Kiskun District General Hospital, Kecskemét, Hungary
| | - Gábor Friebert
- 1 Department of Orthopaedics, University of Szeged, Szeged, Hungary
| | - Krisztián Sisák
- 1 Department of Orthopaedics, University of Szeged, Szeged, Hungary
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21
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Bone remodelling and integration of two different types of short stem: a dual-energy X-ray - absorptiometry study. INTERNATIONAL ORTHOPAEDICS 2020; 44:839-846. [PMID: 32219497 DOI: 10.1007/s00264-020-04545-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Different kinds of bone preserving hip stems have been created to assure a more physiological distribution of the strengths on the femur. The aim of this research is to evaluate the density reaction of the periprosthetic bone while changing the conformation of the prosthetic implant on dual-energy X-ray - absorptiometry (DXA). METHODS This is a prospective, single-centre study assessing bone remodelling changes after implantation of two short hip stems, dividing the patients in two groups according to the implant used: 20 in group A, Metha (B-Braun), and 16 in group B, SMF (Smith and Nephew). All participants had a pre-operative and a post-operative (24 months) DXA evaluating the changes in bone mass density (BMD) occurred in the five Gruen's zones. RESULTS Compared to the pre-operative value, differences in BMD percentage were statistically significant only in ROI 4 (p < 0.05), with an increase in both groups (9 and 18%, respectively). The average increase in BMD was of 7.3% and 7.2% in the 2 groups. CONCLUSION According to our study, both stems have proved able to provide good load distribution across the metaphyseal region favouring proper system integration. Nonetheless, is certainly needed to perform other studies with longer follow-up and bigger populations to give strength to these conclusions.
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22
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Grupp TM, Baxmann M, Jansson V, Windhagen H, Heller KD, Morlock MM, Knaebel HP. How to proceed with asymptomatic modular dual taper hip stems in the case of acetabular revision. MATERIALS 2020; 13:ma13051098. [PMID: 32121627 PMCID: PMC7084958 DOI: 10.3390/ma13051098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
How to proceed with a clinically asymptomatic modular Metha® Ti alloy stem with dual taper CoCr neck adapter in case of acetabular revision? To systematically answer this question the status of research and appropriate diagnostic methods in context to clinically symptomatic and asymptomatic dual taper stem-neck couplings has been evaluated based on a systematic literature review. A retrieval analysis of thirteen Metha® modular dual taper CoCr/Ti alloy hip stems has been performed and a rational decision making model as basis for a clinical recommendation was developed. From our observations we propose that in cases of acetabular revision, that for patients with a serum cobalt level of > 4 µg/L and a Co/Cr ratio > 3.6, the revision of the modular dual taper stem may be considered. Prior to acetabular revision surgery a systematic diagnostic evaluation should be executed, using specific tests such as serum metal (Co, Cr) ion analysis, plain antero-posterior and lateral radiographs and cross-sectional imaging modalities (Metal Artefact Reduction Sequence Magnetic Resonance Imaging). For an asymptomatic Metha® dual taper Ti alloy/CoCr stem-neck coupling at the stage of acetabular revision careful clinical decision making according to the proposed model should be followed and overreliance on any single examination should be avoided, considering the complete individual differential diagnosis and patient situation.
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Affiliation(s)
- Thomas M. Grupp
- Aesculap AG Research & Development, 78532 Tuttlingen, Germany;
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern Ludwig Maximilians University Munich, 81377 Munich, Germany;
- Correspondence: ; Tel.: +49-7461-95-2667; Fax: +49-7461-95-382667
| | - Marc Baxmann
- Aesculap AG Research & Development, 78532 Tuttlingen, Germany;
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern Ludwig Maximilians University Munich, 81377 Munich, Germany;
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, 30625 Hannover, Germany;
| | - Karl-Dieter Heller
- Department of Orthopaedic Surgery, Herzogin-Elisabeth-Hospital, 38124 Braunschweig, Germany;
| | - Michael M. Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, 21073 Hamburg, Germany;
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Thalmann C, Horn Lang T, Bereiter H, Clauss M, Acklin YP, Stoffel K. An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem. Hip Int 2020; 30:152-159. [PMID: 31010329 DOI: 10.1177/1120700019834336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although reported results on short stems sound very promising, the occurrence of distal femoral cortical hypertrophy is often observed. The aim of the present study was to report 5-year survival data of a commercially available trochanter sparing short stem and investigate the clinical impact of distal femoral cortical hypertrophy on the outcome. METHODS 123 total hip arthroplasties were performed on 120 patients from April 2008 to May 2010 (mean age 62, range 29-89 years; 71 hips from male patients, 58%). Clinical and radiological data were collected preoperative, at 6 weeks, 1, 2, 3, and 5 years postoperative to assess the outcome. Radiographs taken immediately postoperative as well as 1 and 5 years postoperative were used to identify and assess cortical hypertrophy. RESULTS 1 stem had to be revised due to aseptic loosening, resulting in a Kaplan-Meier survival analysis with endpoint for stem revision of 99.2% (95% Confidence Interval 94.1-99.9) at 5 years. 96 radiological and 95 clinical follow-ups were analysed 5 years postoperative. 68 (71%) hips showed distal femoral cortical hypertrophy after 5 years. The average Harris Hip Score and Oxford Hip Score improved 33 (standard deviation (SD) 15.1, range 2-70), 18 (SD 12.1, range -10-43) points, respectively. Overall 16% of the patients reported thigh pain, unrelated to the presence of cortical hypertrophy. DISCUSSION This short stem shows an excellent 5-year survival rate and good clinical outcome despite a high incidence of cortical hypertrophy. However, the question of the mechanism of load transfer arises.
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Affiliation(s)
| | - Tamara Horn Lang
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Heinz Bereiter
- Orthopaedic Surgery, Kantonsspital Graubünden, Chur, Switzerland
| | - Martin Clauss
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Yves P Acklin
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Karl Stoffel
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
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Donner S, Rehbein P, Schneider M, Pfeil J, Drees P, Kutzner KP. Return to Sports and Recreational Activity After Single-Stage Bilateral Short-Stem Total Hip Arthroplasty: 5-Year Results of a Prospective Observational Study. Orthop J Sports Med 2019; 7:2325967119872746. [PMID: 31632996 PMCID: PMC6767735 DOI: 10.1177/2325967119872746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Single-stage bilateral total hip arthroplasty (THA) is an alternative to
staged unilateral THA in patients suffering from bilateral hip arthritis;
however, there is still broad concern regarding the safety and reliability
of this procedure. Short-stem THA has emerged in recent years. To date, no
data are available on sports and recreational activity levels after
single-stage bilateral short-stem THA in the general patient population. Hypothesis: Patients who have undergone single-stage bilateral short-stem THA return to a
satisfying level of sports and recreational activity at midterm
follow-up. Study Design: Case series; Level of evidence, 4. Methods: A total of 54 consecutive patients (108 hips) were prospectively included.
Midterm follow-up was performed in 51 patients (94.4%). The Western Ontario
and McMaster Universities Osteoarthritis Index (WOMAC) score and the Harris
Hip Score (HHS) were assessed clinically after a mean of 5.2 years. After a
mean of 4.9 years, activity levels were assessed using the University of
California, Los Angeles (UCLA) activity scale via a questionnaire.
Additionally, a detailed evaluation of sports behavior was conducted using
an additional questionnaire. Pain and satisfaction with sporting ability
were assessed using a visual analog scale (VAS). Complications and revisions
were documented. Results: Patients had a mean WOMAC score of 98.0 (range, 60.0-100.0) and HHS score of
97.8 (range, 65.0-100.0) at final follow-up. The mean UCLA activity score
was 4.7 (range, 2.0-10.0). An increasing number of patients were active in
sports at follow-up compared with before surgery (76.5% vs 60.8%,
respectively); 2 patients (3.9%) stopped participating in sports on a
regular basis, and 10 (19.6%) commenced with sports after surgery. The most
popular activities before surgery were cycling (31.4%), hiking (29.4%),
swimming (21.6%), and fitness/weight training (15.7%). At follow-up, most
patients were engaged in cycling (35.3%) and fitness/weight training
(33.3%), followed by swimming (25.5%) and hiking (19.6%). The duration
(hours per week) and frequency (times per week) of sporting activities
remained stable. The mean VAS pain level during sports was 1.3 (range,
0.0-7.0). No revision surgery had to be performed. Conclusion: After single-stage bilateral short-stem THA, the study patients returned to
satisfying levels of activity at midterm follow-up. Postoperatively, few
patients were engaged in high-impact sports; however, more patients
commenced with lower impact activities. Satisfaction with sporting abilities
was high, and the complication rate in total was low.
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Affiliation(s)
- Stefanie Donner
- Department of Orthopaedic Surgery and Traumatology, St Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedic Surgery and Traumatology, St Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Michael Schneider
- Department of Orthopaedic Surgery and Traumatology, St Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Joachim Pfeil
- Department of Orthopaedic Surgery and Traumatology, St Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St Josefs Hospital Wiesbaden, Wiesbaden, Germany.,Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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Kutzner KP. Short-Stem Total Hip Arthroplasty. GENERAL PRINCIPLES OF ORTHOPEDICS AND TRAUMA 2019:717-737. [DOI: 10.1007/978-3-030-15089-1_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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von Engelhardt LV, Breil-Wirth A, Kothny C, Seeger JB, Grasselli C, Jerosch J. Long-term results of an anatomically implanted hip arthroplasty with a short stem prosthesis (MiniHip TM). World J Orthop 2018; 9:210-219. [PMID: 30364820 PMCID: PMC6198291 DOI: 10.5312/wjo.v9.i10.210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/17/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the clinical and radiological outcome nine and ten years after short-stemmed, bone preserving and anatomical hip arthroplasty with the MiniHipTM system.
METHODS In a prospective study, 186 patients underwent hip arthroplasty with a partial neck preserving short stem (MiniHipTM, Corin). Elderly patients were not excluded from this study, thus the mean age at the time of surgery was 59.3 years (range 32 to 82 years). Surgery and the follow-up assessments were performed at two Centers. Up until now, the mean follow-up was 112.5 ± 8.2 mo. The Oxford Hip Score (OHS) and the Hip Dysfunction Osteoarthritis and Outcome Score (HOOS) was assessed pre- and each year after surgery. The clinical follow-up was accompanied by standardized a.p. and axial radiological examinations. Periprosthetic lucencies, hypertrophies within the Gruen zones one to fourteen were assessed. A subsidence of the stem was investigated according to Morray and heterotopic ossifications were assessed according to Brooker.
RESULTS The OHS and HOOS improved from 18 ± 3.3 to 46 ± 2.0 and from 30 ± 8.3 to 95 ± 4.6 points, P < 0.001 respectively. There were no differences regarding age, etiology, friction pairings, etc., (P > 0.05). Two stems were revised due to a symptomatic subsidence four and twelve months postoperatively. Thus, the survivorship for aseptic loosening at nine to ten years was 98.66%. Including one stem revision due to a symptomatic exostosis, bursitis and thigh pain as well as one revision because of a septic stem loosening, the overall survival for the stem with revision for any reason was 97.32%. Besides one asymptomatic patient, radiological signs of a proximal stress-shielding, such as bone resorptions within the proximal Gruen zones, were not noticed. Findings suggesting a distal loading, e.g., bony hypertrophies or bone appositions of more than 2 mm, were also not detected.
CONCLUSION Regarding these first long-term results on the MiniHipTM, the implant performed exceedingly well with a high rate of survivorship for aseptic loosening. Our radiological results within the Gruen zones support the design rationale of the Minihip to provide a reliable metaphyseal anchoring with the expected proximal, more physiological load transfer. This might minimize or exclude a stress shielding which might be associated with thigh pain, proximal bone loss and an increased risk of aseptic loosening. The MiniHipTM is a reliable partial-neck retaining prosthesis with good a clinical long-term outcome in younger as well as elderly patients.
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Affiliation(s)
- Lars V von Engelhardt
- Faculty of Health, University of Witten/Herdecke, Witten 58448, Germany
- Department of Trauma Surgery Orthopedics and Sports Medicine, Katholisches Karl-Leisner Klinikum, Kleve 47533, Germany
| | - Andreas Breil-Wirth
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
| | | | - Jörn Bengt Seeger
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, Giessen 35392, Germany
| | - Christian Grasselli
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
- Department of Orthopaedics and Traumatology, Waldburg-Zeil Clinic Tettnang, Tettnang 88069, Germany
| | - Joerg Jerosch
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
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Morellato K, Grupp TM, Bader U, Sungu M, Fink B, Cristofolini L. Standard and line-to-line cementation of a polished short hip stem: Long-term in vitro implant stability. J Orthop Res 2018; 36:2736-2744. [PMID: 29727032 DOI: 10.1002/jor.24036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/27/2018] [Indexed: 02/04/2023]
Abstract
The current trend is toward shorter hip stems. While there is a general agreement on the need for a cement mantle thicker than 2 mm, some surgeons prefer line-to-line cementation, where the mantle has only the thickness provided by the cement-bone interdigitation. The aim of this study was to assess if a relatively short, polished hip stem designed for a standard cementation can also be cemented line-to-line without increasing the risk of long-term loosening. Composite femurs with specific open-cell foam to allow cement-bone interdigitation were used. A validated in-vitro biomechanical cyclic test replicating long-term physiological loading was applied to femurs where the same stem was implanted with the Standard-mantle (optimal stem size) and Line-to-line (same rasp, one-size larger stem). Implant-bone motions were measured during the test. Inducible micromotions never exceeded 10 μm for both implant types (differences statistically not-significant). Permanent migrations ranged 50-300 μm for both implant types (differences statistically not-significant). While in the standard-mantle specimens there was a pronounced trend toward stabilization, line-to-line had less tendency to stabilize. The cement cracks were observed after the test by means of dye penetrants: The line-to-line specimens included the same cracks of the standard-mantle (but in the line-to-line specimens they were longer), and some additional cracks. The micromotions and cement damage were consistent with those observed in-vitro and clinically for stable stems, confirming that none of the specimens became dramatically loose. However, it seems that for this relatively short polished stem, standard-mantle cementation is preferable, as it results in less micromotion and less cement cracking. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2736-2744, 2018.
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Affiliation(s)
- Kavin Morellato
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Thomas M Grupp
- Aesculap AG Research and Development, Am Aesculap-Platz, Tuttlingen, Germany.,Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig Maximilian University, Campus Grosshadern, Munich, Germany
| | - Uwe Bader
- Aesculap AG Research and Development, Am Aesculap-Platz, Tuttlingen, Germany
| | - Mevluet Sungu
- Aesculap AG Research and Development, Am Aesculap-Platz, Tuttlingen, Germany
| | - Bernd Fink
- Orthopädische Klinik Markgröningen, Clinic for Joint Replacement, General and Rheumatic Orthopaedics, Ludwigsburg, Germany
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
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Hauer G, Vielgut I, Amerstorfer F, Maurer-Ertl W, Leithner A, Sadoghi P. Survival Rate of Short-Stem Hip Prostheses: A Comparative Analysis of Clinical Studies and National Arthroplasty Registers. J Arthroplasty 2018; 33:1800-1805. [PMID: 29428465 DOI: 10.1016/j.arth.2018.01.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The primary aim was to evaluate the outcome of short-stem hip prostheses in terms of overall revision rates. Data were taken from published literature and national arthroplasty registers. The second study aim was to evaluate a potentially superior outcome of dependent compared to independent clinical studies. METHODS All clinical studies on short-stem hip prostheses between 2006 and 2016 were reviewed and evaluated with a special interest on revision rates. Revision rate was calculated as "revision per 100 component years." Short stems were divided into femoral neck retaining (NR), neck sparing (NS), and neck harming (NH) prostheses. Published literature was further classified into dependent and independent studies, and data were compared to the Australian National Arthroplasty Register. RESULTS Fifty-two studies with 56 cohorts met the inclusion criteria and were therefore included in our study. All clinical studies showed a median revision rate of 4.8% after 10 years. NS and NH stems performed equally, whereas neck retaining prostheses were significantly inferior. Independent showed higher revision rates compared to dependent data without being statistically significant. The Australian register revealed a revision rate of 6.6% after one decade. CONCLUSION Similar low revision rates for NS and NH short-stem prostheses were found in the included data. Dependent studies seem not to be biased with regard to the longevity of short-stem hip replacement. Longer follow-up periods in clinical studies and more detailed information in arthroplasty registers would be desirable for future studies.
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Affiliation(s)
- Georg Hauer
- Department of Orthopaedic Surgery and Traumatology, Medical University of Graz, Graz, Austria
| | - Ines Vielgut
- Department of Orthopaedic Surgery and Traumatology, Medical University of Graz, Graz, Austria
| | - Florian Amerstorfer
- Department of Orthopaedic Surgery and Traumatology, Medical University of Graz, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedic Surgery and Traumatology, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedic Surgery and Traumatology, Medical University of Graz, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedic Surgery and Traumatology, Medical University of Graz, Graz, Austria
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Giardina F, Castagnini F, Stea S, Bordini B, Montalti M, Toni A. Short Stems Versus Conventional Stems in Cementless Total Hip Arthroplasty: A Long-Term Registry Study. J Arthroplasty 2018; 33:1794-1799. [PMID: 29395723 DOI: 10.1016/j.arth.2018.01.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/26/2017] [Accepted: 01/05/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Short stems in total hip arthroplasty (THA) have recently gained increasing popularity, allowing mini-invasive exposures and bone-sparing approaches. However, long-term studies and recommendations for the routine use are not available. The aim of this report was to compare the survival rates and the reasons for revision of short stems versus conventional stems in cementless THAs, in a registry-based population. METHODS The Registry of Prosthetic Orthopedic Implants (RIPO) was inquired about cementless THAs performed since 2000 to 2016. The stems were divided into short (<12 cm) and conventional ones, and then, classified according to the classification by Feyen and Shimmin: short stems with neck-retaining osteotomy (group A: 1684 hips), short stems with standard osteotomy (group B: 2727 THAs), and conventional stems (group C: 57,359 cases). Demographics, survivorships, and reasons for revision were investigated and compared. RESULTS Short stems were preferentially implanted in younger patients and normal morphologies. Short and conventional stems showed comparable survival rates at long-term follow-up (>90% at 15 years). The rates of stem aseptic loosening, intraoperative fractures, and periprosthetic fractures were similar in the 3 groups. Group B had higher rates of revisions due to primary instability (early dislocations and impingement-related events; P < .05). Revisions due to pain were nonsignificantly higher in group B. CONCLUSION Short stems are reliable implants at long-term follow-up. The comparison with conventional stems showed no additional risk of premature aseptic loosening and intraoperative and periprosthetic fractures. However, the high rate of revisions due to pain and, mostly, primary instability should be investigated in clinical trials.
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Affiliation(s)
- Federico Giardina
- Hip and Knee Surgery Department, Rizzoli Orthopedic Institute, Bologna, Italy
| | | | - Susanna Stea
- Medical Technology Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Maurizio Montalti
- Hip and Knee Surgery Department, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Aldo Toni
- Hip and Knee Surgery Department, Rizzoli Orthopedic Institute, Bologna, Italy
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Abstract
Over the last two decades, several conservative femoral prostheses have been designed. The goals of conservative stems include: the spearing of the trochanteric bone stock; a more physiological loading in the proximal femur reducing the risk of stress shielding; and to avoid a long stem into the diaphysis preventing impingement with the femoral cortex and thigh pain. All stems designed to be less invasive than conventional uncemented stems are commonly named ‘short stems’. However, this term is misleading because it refers to a heterogeneous group of stems deeply different in terms of design, biomechanics and bearing. In the short-term follow-up, all conservative stems provided excellent survivorship. However, variable rates of complications were reported, including stem malalignment, incorrect stem sizing and intra-operative fracture. Radiostereometric analysis (RSA) studies demonstrated that some conservative stems were affected by an early slight migration and rotation within the first months after surgery, followed by a secondary stable fixation. Dual-energy x-ray absorptiometry (DEXA) studies demonstrated an implant-specific pattern of bone remodelling. Although the vast majority of stems demonstrated a good osseointegration, some prostheses transferred loads particularly to the lateral and distal-medial regions, favouring proximal stress shielding and bone atrophy in the great trochanter and calcar regions. Cite this article: EFORT Open Rev 2018;3:149-159. DOI: 10.1302/2058-5241.3.170052
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Italy; Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Italy
| | - Guido Grappiolo
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Italy
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Schnurr C, Loucif A, Patzer T, Schellen B, Beckmann J, Eysel P. Short stem survival after osteonecrosis of the femoral head. Arch Orthop Trauma Surg 2018; 138:573-579. [PMID: 29396635 DOI: 10.1007/s00402-018-2892-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Short stems were developed as a bone-conserving alternative especially for the young hip arthroplasty patient. Patients suffering from osteonecrosis of the femoral head are frequently younger than primary arthritis patients. The outcome of short stems in these patients remains unclear. The aim of our study was to compare mid-term survival of short stems after osteonecrosis of the femoral head (ONFH) and primary arthritis. MATERIALS AND METHODS Data on short stem implantations over a 10-year period were collected. Demographic data and X-ray measurements before and after surgery were recorded. Indication for operation was determined from medical records and X-rays. Patients were asked by post about any revision. Reason for revision was identified by analysis of operation protocols. Short stem revision rates were analyzed using Kaplan-Meier charts, comparing 212 ONFH patients (231 operations) and 1284 primary arthritis patients (1455 operations). RESULTS Follow-up time averaged 5.3 and 6 years and was complete for 92% (ONFH) and 94% (primary arthritis) of the patients. ONFH patients were significantly younger (53 years vs. 59 years, p < 0.001) and more frequently male (55 vs. 42%, p < 0.001). The total revision rate did not differ between the two groups (8 years: 4.2 vs. 5.6%, p = ns). A trend towards more stem revisions was detected for ONFH patients (3 vs. 1.8%, p = ns). The aseptic stem loosening rate was significantly elevated for osteonecrosis patients (8 years: 2.6 vs. 0.7%, p = 0.013). CONCLUSIONS Our study showed elevated short stem loosening rates after ONFH. Similar results are published for classic cementless stems. The question of which stem is best for the young osteonecrosis patient cannot be answered yet. Consecutive studies directly comparing loosening rates of short and classic cementless stems in young osteonecrosis patients are required.
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Affiliation(s)
- Christoph Schnurr
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Schloßstr. 85, 40477, Düsseldorf, Germany.
| | - Anissa Loucif
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Schloßstr. 85, 40477, Düsseldorf, Germany
| | - Theresa Patzer
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Schloßstr. 85, 40477, Düsseldorf, Germany
| | - Bernd Schellen
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Schloßstr. 85, 40477, Düsseldorf, Germany
| | - Johannes Beckmann
- Department for Endoprosthetics Lower extremity, Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Germany
| | - Peer Eysel
- Clinic for Orthopedic Surgery and Traumatology, University of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany
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Yan SG, Weber P, Steinbrück A, Hua X, Jansson V, Schmidutz F. Periprosthetic bone remodelling of short-stem total hip arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2017; 42:2077-2086. [DOI: 10.1007/s00264-017-3691-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 11/09/2017] [Indexed: 01/26/2023]
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Epinette JA, Brax M, Chammaï Y. A predictive radiological analysis of short stems versus both shortened and long stems in primary hip replacement: A case-control study of 100 cases of Metha versus ABG II and Omnifit HA at 2-8years' follow-up. Orthop Traumatol Surg Res 2017; 103:981-986. [PMID: 28899823 DOI: 10.1016/j.otsr.2017.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/21/2017] [Accepted: 07/31/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Short hip stems, intended to conserve bone stock and ensure a more physiological distribution of stress in the femur under loading, are meeting with renewed interest. Radiologic semiology is not known exactly, particularly in relation to conventional implants; we therefore conducted a case-control study of 3 types of implant differing only in stem length: short, shortened or long. The aim was: (1) to compare radiographic aspects, (2) to attempt to systematize medium-term radiologic status for the 3 types, and (3) to assess the impact of radiographic aspect on loosening and revision rates. HYPOTHESIS The short Metha stem is better adapted to the recipient bone than longer stems, without sacrificing stability. MATERIAL AND METHODS A prospective series comprising the first 100 selected cases of hip replacement using the short Metha stem was compared to two other series of 100 "long" (Omnifit HA) and 100 "shortened" (ABG II) stems at comparable follow-up: 4.05±1.44years (range: 2-8years) for Metha, 4.48±0.97years (range: 2-8years) for Omnifit, and 4.75±2.07years (range: 2-8years) for ABG II. Selection criteria in this initial phase were very strict: young age and/or high activity level, with good bone stock and femoral morphology suited to fitting a Metha stem (no "stovepipe" or "champagne-flute" femurs), for which 12.8% of primary hip replacements were selected. Matching was performed by sampling on criteria of age, gender, body-mass index and etiology. Radiographic parameters were compared between the short stem group and the two control groups and classified according to Engh-Massin score (10 points for fixation and 17 for stability). RESULTS The short Metha stem provided excellent fixation scores: 7.65/10, versus 7.16 (P=0.003) and 5.92 (P=0.0001) for ABG II and Omnifit, respectively. Likewise, stability was scored 14.23/17 for Metha, vs. 14.51 (NS) and 11.83 (P=0.0001) respectively, and the total score was higher for Metha (21.88/27) than ABG II (21.67; P=0.03) or, more particularly, Omnifit (17.83; P=0.0001). The Metha stem was never associated with thigh pain or periprosthetic fracture. 8-year survival was 100%, without significant difference with respect to ABG II (100%; NS) or Omnifit (98.8%; 95% CI: 0.964-1; NS). DISCUSSION The apparent radiologic superiority of the short Metha stem requires long-term confirmation in non-selected series. Meanwhile, Metha can be asserted to have demonstrated optimal compromise between lasting bone anchorage and respect of bone physiology under loading at medium term. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- J-A Epinette
- Clinique Médico-Chirurgicale, 200, rue d'Auvergne, 62700 Bruay-La-Buissière, France.
| | - M Brax
- Centre Hospitalier, 64, avenue du Professeur-Leriche, 67500 Haguenau, France
| | - Y Chammaï
- Centre Hospitalier, 64, avenue du Professeur-Leriche, 67500 Haguenau, France
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Can the metaphyseal anchored Metha short stem safely be revised with a standard CLS stem? A biomechanical analysis. INTERNATIONAL ORTHOPAEDICS 2017; 41:2471-2477. [DOI: 10.1007/s00264-017-3497-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023]
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