scholarly journals The impact of reducing the femoral stem length in total hip arthroplasty during gait

2021 ◽  
Author(s):  
Anatole Vilhelm Wiik ◽  
Adeel Aqil ◽  
Bilal Al-Obaidi ◽  
Mads Brevadt ◽  
Justin Peter Cobb
Keyword(s):  
Total Hip Arthroplasty ◽  
Gait Analysis ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Short Stem ◽  
Stem Length ◽  
Practical Consideration ◽  
Total Hip ◽  
Long Stem ◽  
The Impact

Abstract Aim The length of the femoral stem in total hip arthroplasty (THA) is a practical consideration to prevent gait impairment. The aim of this study was to determine if reducing the femoral stem length in THA would lead to impaired gait biomechanics. Methods Patients uniformly with the same brand implant of differing lengths (100 mm vs 140–166 mm) were taken retrospectively from a prospective trial introducing a new short stem. Twelve patients without any other disorder to alter gait besides contralateral differing length stem THA were tested at differing gradients and speed on a validated instrumented treadmill measuring ground reaction forces. An anthropometrically similar group of healthy controls were analysed to compare. Results With the same posterior surgical approach, the offset and length of both hips were reconstructed within 5 mm of each other with an identical mean head size of 36 mm. The short stem was the last procedure for all the hips with gait analysis occurring at a mean of 31 and 79 months postoperatively for the short and long stem THA, respectively. Gait analysis between limbs of both stem lengths demonstrated no statistical difference during any walking condition. In the 90 gait assessments with three loading variables, the short stem was the favoured side 51% of the time compared 49% for the long stem. Conclusion By testing a range of practical walking activities, no lower limb loading differences can be observed by reducing the femoral stem length. A shorter stem demonstrates equivalence in preference during gait when compared to a reputable conventional stem in total hip arthroplasty.

1-stage bilateral total hip arthroplasty operation in 22 patients with use of short and standard stem length on either side: gait analysis 1 and 2 years after bilateral THA

2017 ◽  
Vol 28 (4) ◽  
pp. 391-399 ◽  
Author(s):  
Roland Zügner ◽  
Roy Tranberg ◽  
Goran Puretic ◽  
Johan Kärrholm
Keyword(s):  
Total Hip Arthroplasty ◽  
Gait Analysis ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Optical Tracking ◽  
Stem Length ◽  
Total Hip ◽  
Flexion Extension ◽  
Hip Extension

Background: According to previous gait analyses, insertion of a total hip arthroplasty (THA) will improve the range of hip flexion-extension but not to normal. Use of short stems could have a potential to improve the motion by preservation of more bone and muscular attachments. We evaluated whether a short femoral stem resulted in improved hip motion compared to a conventional stem in patients who underwent 1-stage bilateral THA. The most painful hip was randomised to either design and the 2nd hip was operated with the design not used on the 1st side. Methods: Gait analysis was performed with an optical tracking system in 22 patients. The follow-up was performed 1 and 2 years after the operation. The mean age was 59 (SD 7.7) years and body mass index was 27.7 (SD 4.3). 66 subjects without hip pathology served as controls. Results: Minimal differences were observed, between or within the 2 different stem designs during gait at the 2 follow-up occasions. Comparison between each of the 2 stem designs and controls at 2 years revealed reduced stride length (p = 0.009), cadence, hip extension (p<0.001) and hip extension-flexion range (p = 0.021) for both designs. Furthermore, the range of hip adduction-abduction (p = 0.046) and hip abduction moment for both designs in the frontal plane was also reduced bilaterally (p<0.001). Conclusions: We found no difference in gait parameters between the short and the conventional stem after 1-stage bilateral THA. Although both hip joints were operated at the same time motions and moments did not normalise after bilateral 1-stage operations.

scholarly journals Massive Femoral Osteolysis Secondary to Loosening of a Cemented Roughened Long Stem: A Case Report

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Yasuaki Tamaki ◽  
Tomohiro Goto ◽  
Daisuke Hamada ◽  
Toshihiko Nishisho ◽  
Kiminori Yukata ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Muscular Weakness ◽  
Total Hip ◽  
Roughened Surface ◽  
Long Stem ◽  
Component Revision ◽  
Cemented Total Hip Arthroplasty ◽  
Dislocation Of The Hip

The surface finish of a femoral stem plays an important role in the longevity of cemented total hip arthroplasty. In efforts to decrease the rate of aseptic loosening, some prostheses have been designed to have a roughened surface that enhances bonding between the prosthesis and cement, but clinical outcomes remain controversial. We present a rare case of massive osteolysis with extreme femoral expansion that developed after cemented revision total hip arthroplasty. The destructive changes in the femur were attributable to abnormal motion of the stem and were aggravated by the roughened precoated surface of the long femoral component. Revision surgery using a total femur prosthesis was performed because there was insufficient remaining bone to fix the new prosthesis. The surgical technique involved wrapping polypropylene meshes around the prosthesis to create an insertion for the soft tissue, which proved useful for preventing muscular weakness and subsequent dislocation of the hip.

Biomechanical Evaluation of the Accuracy in Radiographic Assessment of Femoral Component Migration Measurement after Total Hip Arthroplasty

2020 ◽  
Vol 13 (1) ◽  
pp. 65-70
Author(s):  
Mikayla Forness ◽  
Zachary Podoll ◽  
Benjamin Noonan ◽  
Alexander Chong
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Stem Length ◽  
Head Diameter ◽  
Plain Radiographs ◽  
Total Hip ◽  
Image Magnification ◽  
Magnification Factors ◽  
Radiographic Measurements

Introduction: Implant subsidence is one criteria utilized to monitor for prosthesis loosening after total hip arthroplasty (THA) with initial implant subsidence assessment often done utilizing plain radiographs. The specific aim of this study was to identify the most reliable references when using plain radiographs to establish an image magnification with the goals being easy to use, inexpensive, reliable, and accurate. Methods: Two femoral stem implants (stem lengths: 127mm, 207mm) were utilized to simulate hemiarthroplasty of the hip with composite femurs. Different combinations of femoral stem distances from the radiographic film (ODD), source-detector differences (SDD), hip rotation, and hip flexion were elected. Standardized anterior-posterior pelvis for each parameter combination setup were taken. Radiographic measurements (head diameter, stem length, stem seating length) were undertaken five times by three examiners. Radiographic image magnification factors were generated from two references (head diameter and stem length). Radiograph measurement reproducibility and stem seating length errors using these magnification factors were evaluated. Results: High level of repeated measurements reliability was found for head diameter (99 ± 0%) and stem length (90 ± 7%) measurements, whereas seating length measurements were less reliable (76 ± 6%). Stem length error using the femoral head magnification factor yielded 11% accuracy. Stem seating length error using both magnification factors were not reliable (< 7% accuracy). All parameters, except SDD, showed significant effect on calibrated measurement error. Conclusions: Current methods of assessing implant subsidence after THA using plain radiographs are inaccurate or reliable. Clinicians should recognize these limitations and be cautious when diagnosing implant stability using plain radiographs alone.

Long-Stem versus Short-Stem Preformed Antibiotic-Loaded Cement Spacers for Two-Stage Revision of Infected Total Hip Arthroplasty

2010 ◽  
Vol 20 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Carlo L. Romanò ◽  
Delia Romanò ◽  
Nicola Logoluso ◽  
Enzo Meani
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Two Stage ◽  
Total Hip ◽  
Long Stem

scholarly journals Impact of Femoral Stem Prosthesis Tip On Femoral Cortex After Primary Total Hip Arthroplasty (THA)

2021 ◽  
Author(s):  
Yang Zhang ◽  
Qiang Wang ◽  
Qi Cheng ◽  
Dasai Wang ◽  
Jian Cheng ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Thigh Pain ◽  
Harris Hip Score ◽  
Total Hip ◽  
Femoral Cortex ◽  
Increased Risk ◽  
The Impact ◽  
Primary Total Hip Arthroplasty

Abstract Background: The mechanisms of pain after total hip arthroplasty (THA) is not clear, which may be related to its impact on the femoral cortex caused by improper prosthesis placement. This study was to explore the the impact of the femoral stem prosthesis on the femoral cortex after implantation, and its relationship with postoperative thigh pain. Methods: Totally 172 patients who underwent primary THA were retrospectively analyzed, who were divided into the impact (n=25) and non-impact (n=147) groups. Contact or penetration of the femoral stem prosthesis tip with the distal femoral cortex was defined as impingement. Patients were followed up and recorded.Results: In the patients undergoing primary THA, 25 patients (14.5%) had impact, including 7 males and 18 females. Most of the patients in the impact group were women of small stature. In the impact group, the postoperative thigh pain was more obvious, and the Harris Hip score (HHS) was lower, compared with the non-impact group (P < 0.05). The regression analysis showed that height (OR=1.196; 95%CI: 1.059-1.351; P=0.004) and prosthesis implant angle (PIA) (OR=0.208; 95%CI: 0.074-0.584; P=0.003) were important risk factors for distal femoral cortical impingement in patients who underwent THA. Conclusions: Patients with short stature should have adequate preoperative planning for primary THA, to prevent increased risk of postoperative thigh pain due to impinging femoral stem implants.

Short-term outcomes with the REDAPT monolithic, tapered, fluted, grit-blasted, forged titanium revision femoral stem

2020 ◽  
Vol 102-B (2) ◽  
pp. 191-197 ◽  
Author(s):  
Jonathan A. Gabor ◽  
Jorge A. Padilla ◽  
James E. Feng ◽  
Erik Schnaser ◽  
William B. Lutes ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Intraoperative Complications ◽  
Femoral Stem ◽  
Stem Length ◽  
Total Hip ◽  
Early Results ◽  
One Year

Aims Although good clinical outcomes have been reported for monolithic tapered, fluted, titanium stems (TFTS), early results showed high rates of subsidence. Advances in stem design may mitigate these concerns. This study reports on the use of a current monolithic TFTS for a variety of indications. Methods A multi-institutional retrospective study of all consecutive total hip arthroplasty (THA) and revision total hip arthroplasty (rTHA) patients who received the monolithic TFTS was conducted. Surgery was performed by eight fellowship-trained arthroplasty surgeons at four institutions. A total of 157 hips in 153 patients at a mean follow-up of 11.6 months (SD7.8) were included. Mean patient age at the time of surgery was 67.4 years (SD 13.3) and mean body mass index (BMI) was 28.9 kg/m2 (SD 6.5). Outcomes included intraoperative complications, one-year all-cause re-revisions, and subsidence at postoperative time intervals (two weeks, six weeks, six months, nine months, and one year). Results There were eight intraoperative complications (4.9%), six of which were intraoperative fractures; none occurred during stem insertion. Six hips (3.7%) underwent re-revision within one year; only one procedure involved removal of the prosthesis due to infection. Mean total subsidence at latest follow-up was 1.64 mm (SD 2.47). Overall, 17 of 144 stems (11.8%) on which measurements could be performed had >5 mm of subsidence, and 3/144 (2.1%) had >10 mm of subsidence within one year. A univariate regression analysis found that additional subsidence after three months was minimal. A multivariate regression analysis found that subsidence was not significantly associated with periprosthetic fracture as an indication for surgery, the presence of an extended trochanteric osteotomy (ETO), Paprosky classification of femoral bone loss, stem length, or type of procedure performed (i.e. full revision vs conversion/primary). Conclusion Advances in implant design, improved trials, a range of stem lengths and diameters, and high offset options mitigate concerns of early subsidence and dislocation with monolithic TFTS, making them a valuable option for femoral revision. Cite this article: Bone Joint J 2020;102-B(2):191–197.

Short Femoral Stem in Total Hip Arthroplasty: Stable Fixation and Low Complication Rates in Elderly Patients

2017 ◽  
Vol 27 (4) ◽  
pp. 311-316 ◽  
Author(s):  
Jaime J. Morales de Cano ◽  
Christian Gordo ◽  
Jordi Canosa Areste
Keyword(s):  
Total Hip Arthroplasty ◽  
Elderly Patients ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Short Stem ◽  
Control Group ◽  
Complication Rates ◽  
Total Hip ◽  
Short Femoral Stem

Background We present the result of our experience in using a short femoral stem in elderly patients (>70 years of age) compared to patients younger than 70 years. Methods Data were prospectively collected on 138 patients who underwent 148 primary total hip arthroplasty (THA), with a conservative short stem between November 2010 and June 2014. The cohort was divided into 2 groups: the study group (group 1) comprised 57 patients (60 THA) over 70 years of age at the time of surgery, with a mean age of 75.4 years (range 70-87 years) and a mean follow-up of 26.7 months (range 9-48 months). The control group (group 2) comprised 81patients (88 THA) less than 70 years of age with a mean age of 57.4 years (range 33-69 years) and a mean follow-up of 27.3 months (range 9-54 months). Hip function in the 2 groups was compared preoperatively and postoperatively using the Merle D'Aubigne hip score (MD) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. Results At the latest follow-up, 1 calcar fracture was reported in a 54-year-old patient in the control group, which required fixation with a screw and had a favourable outcome. No cases of clinical or radiographic loosening were reported. Clinical results showed no statistically significant differences between the 2 groups. Conclusions The use of the GTS conservative short stem in patients over 70 years old has shown very good results and low complication rates, comparable to those for patients younger than 70 years.

scholarly journals Value of 3D Preoperative Planning for Primary Total Hip Arthroplasty Based on Biplanar Weightbearing Radiographs

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Y. Knafo ◽  
F. Houfani ◽  
B. Zaharia ◽  
F. Egrise ◽  
I. Clerc-Urmès ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Preoperative Planning ◽  
Femoral Stem ◽  
Leg Length ◽  
Femoral Offset ◽  
Postoperative Result ◽  
Total Hip ◽  
Planning Software ◽  
Navigated Surgery

Two-dimensional (2D) planning on standard radiographs for total hip arthroplasty may not be sufficiently accurate to predict implant sizing or restore leg length and femoral offset, whereas 3D planning avoids magnification and projection errors. Furthermore, weightbearing measures are not available with computed tomography (CT) and leg length and offset are rarely checked postoperatively using any imaging modality. Navigation can usually achieve a surgical plan precisely, but the choice of that plan remains key, which is best guided by preoperative planning. The study objectives were therefore to (1) evaluate the accuracy of stem/cup size prediction using dedicated 3D planning software based on biplanar radiographic imaging under weightbearing and (2) compare the preplanned leg length and femoral offset with the postoperative result. This single-centre, single-surgeon prospective study consisted of a cohort of 33 patients operated on over 24 months. The routine clinical workflow consisted of preoperative biplanar weightbearing imaging, 3D surgical planning, navigated surgery to execute the plan, and postoperative biplanar imaging to verify the radiological outcomes in 3D weightbearing. 3D planning was performed with the dedicated hipEOS® planning software to determine stem and cup size and position, plus 3D anatomical and functional parameters, in particular variations in leg length and femoral offset. Component size planning accuracy was 94% (31/33) within one size for the femoral stem and 100% (33/33) within one size for the acetabular cup. There were no significant differences between planned versus implanted femoral stem size or planned versus measured changes in leg length or offset. Cup size did differ significantly, tending towards implanting one size larger when there was a difference. Biplanar radiographs plus hipEOS planning software showed good reliability for predicting implant size, leg length, and femoral offset and postoperatively provided a check on the navigated surgery. Compared to previous studies, the predictive results were better than 2D planning on conventional radiography and equal to 3D planning on CT images, with lower radiation dose, and in the weightbearing position.

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