Radiographic Evaluation of Proximal Femoral Nutrient Arteries After Total Hip Arthroplasty with a Short Femoral Stem

AbstractThe cementless, tapered wedge, short femoral stem implant is commonly used in direct anterior approach (DAA) total hip arthroplasty (THA). The lack of access and visualization, however, may increase the risk of perioperative fracture and early failure. Therefore, the current study examined perioperative complications and 2-year implant survivorship following DAA THA performed using a fracture table and short, tapered wedge femoral stem. A retrospective analysis was conducted on patients having undergone DAA THA with a cementless, tapered wedge, short femoral stem. Perioperative fractures were noted and survivorship was determined by the incidence of revision surgery within a minimum 2-year follow-up period. A total 366 consecutive patients (441 hips) were identified in the cohort. Four patients (6 hips; 1.4%) were lost to follow-up and three patients died from unrelated causes. Average follow-up time for the remaining 359 patients (435 hips) was 32.9 ± 10.2 months. There were no intraoperative factures but three perioperative fractures within two weeks. Aseptic loosening occurred in one stem at 13 months, resulting in a 99.1% survival rate with a mean survival time of 23.8 ± 0.1 months (95% confidence interval: 23.6–24.0 months). The use of a short, tapered wedge femoral stem and a fracture table for DAA THA resulted in 0.7% periprosthetic fractures and only one aseptic loosening within 2 years. These results suggest that proper femoral exposure with the use of a fracture table and a short, tapered wedge femoral stem does not appear to increase the risk of periprosthetic femoral fracture.

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A Tapered Titanium Femoral Stem Inserted without Cement in a Total Hip Arthroplasty. Radiographic Evaluation and Stability*

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-199608000-00012 ◽

1996 ◽

Vol 78 (8) ◽

pp. 1214-25 ◽

Cited By ~ 81

Author(s):

B. D. MULLIKEN ◽

R. B. BOURNE ◽

C. H. RORABECK ◽

N. NAYAK

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Radiographic Evaluation ◽

Total Hip

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RADIOGRAPHIC EVALUATION OF EARLY OUTCOME AFTER TWO TYPES OF CEMENTLESS HIP ARTHROPLASTY

Issues of Rehabilitation, Orthopaedics, Neurophysiology and Sport Promotion – IRONS ◽

10.19271/irons-000143-2021-36 ◽

2019 ◽

Vol 36 ◽

pp. 41-49

Author(s):

Jędrzej Roman Tschurl ◽

Maciej Kasprzyk ◽

Patryk Kasongo ◽

Tomasz Jopek

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Hip Replacement ◽

Femoral Stem ◽

Position Angle ◽

Radiographic Evaluation ◽

Good Reliability ◽

Total Hip ◽

Medical Histories ◽

Stem Position

Introduction Total Hip Arthroplasty is one of the most common orthopaedic procedures. Its outcome is assessed by radiographic evaluation. Two principal radiographic parameters are cup inclination and stem position angle. Aim The study aimed to compare radiological outcomes of two total hip arthroplasty techniques: Alloclassic Zweymüller versus Corail Pinnacle endoprostheses. Material and methods Medical histories of 345 patients who had a hip replacement between 2007 and 2017 were reviewed. Patients with primary total hip arthroplasty with both of mentioned systems were included in the research. Seven observers individually evaluated the radiological images of the 67 endoprostheses (39 Alloclassic Zweymüller and 26 Corail Pinnacle). The cup inclination and the stem position angle were measured using MB-Ruler programme. Results There was no statistical difference (p > 0.338) in cup inclination angle between Alloclassic Zweymüller and Pinnacle cups, with the angle ranging from 31.01° to 58.80° (45.20° on average) and from 30.61° to 59.1° (43.60° on average), respectively. Femoral stem position did not differ between both types of endoprosthesis (p > 0.932), ranging from −1.05° to 7.87° (3.09° on average) for Alloclassic Zweymüller and 0.35° to 7.79° (3.06° on average) for Corail Pinnacle stem. ICC (Intraclass Coefficient Correlation) was estimated and their 95% confident intervals were calculated for cup inclination and stem position showing good reliability of cup inclination measurements. Conclusions Both types of endoprostheses presented similar radiological outcomes. Cup inclination can be used by non-experienced medical staff to reliably assess the postoperative radiograms. Keywords: cementless hip replacement, radiological outcomes, imaging.

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Short-Term Radiographic Evaluation of a Tri-Tapered Femoral Stem in Direct Anterior Total Hip Arthroplasty

Kansas Journal of Medicine ◽

10.17161/kjm.v13i1.13528 ◽

2020 ◽

Vol 13 (1) ◽

pp. 51-55

Author(s):

William Messamore ◽

Matthew Vopat ◽

Elizabeth Helsper ◽

Andrew Bachinskas ◽

Michelle Nentwig ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Bone Quality ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Direct Anterior Approach ◽

Radiographic Evaluation ◽

Femoral Bone ◽

Stem Design ◽

Total Hip ◽

Radiographic Measurements

Introduction. Direct anterior approach (DAA) total hip arthroplasty (THA) has become increasingly popular, largely due to utilization of a true internervous and intermuscular plane. However, recent literature has demonstrated an increased rate of femoral implant subsidence with this approach. Hence, different femoral implants, such as the tri-tapered femoral stem, have been developed to facilitate proper component insertion and positioning to prevent this femoral subsidence. The purpose of this study was to evaluate the subsidence rate of a tri-tapered femoral stem implanted utilizing a DAA, and to determine if the proximal femoral bone quality affects the rate of subsidence. Methods. A retrospective analysis of 155 consecutive primary THAs performed by a single surgeon was conducted. Age, gender, primary diagnosis, and radiographic measurements of each subject were recorded. Radiological evaluations, such as bone quality, femoral canal fill, and implant subsidence, were measured on standardized anteroposterior (AP) and frog-leg lateral radiographs of the hip at 6-week and 6-month postoperative follow-up evaluations. Results. The average subsidence of femoral stems was 1.18 ± 0.8 mm. There was no statistical difference in the amount of subsidence based on diagnosis or proximal femora quality. The tri-tapered stem design consistently filled the proximal canal with an average of 91.9 ± 4.9% fill. Subsidence was not significantly associated with age, canal flare index (CFI), or experience of the surgeon. Conclusion. THA utilizing the DAA with a tri-tapered femoral stem can achieve consistent and reliable fit regardless of proximal femoral bone quality.

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

Hip International ◽

10.5301/hipint.5000470 ◽

2017 ◽

Vol 27 (4) ◽

pp. 311-316 ◽

Cited By ~ 5

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.

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

BioMed Research International ◽

10.1155/2019/1932191 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 6

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

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03852-w ◽

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.

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