scholarly journals Preoperative BMD does not influence femoral stem subsidence of uncemented THA when the femoral T-score is > –2.5

2021 ◽  
pp. 1-6
Author(s):  
Karen Dyreborg ◽  
Michala S Sørensen ◽  
Gunnar Flivik ◽  
Søren Solgaard ◽  
Michael M Petersen
Keyword(s):  
Femoral Stem ◽  
T Score ◽  
Stem Subsidence

scholarly journals Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

2021 ◽  
Author(s):  
Franziska Leiss ◽  
Julia Sabrina Götz ◽  
Matthias Meyer ◽  
Günther Maderbacher ◽  
Jan Reinhard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Enhanced Recovery ◽  
Weight Bearing ◽  
Femoral Stem ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Fill Ratio ◽  
Stem Subsidence ◽  
Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

scholarly journals Mid-term Subsidence and Periprosthetic Radiolucency of the AMIStem: A 5-year EBRA-FCA Analysis

2020 ◽  
Author(s):  
Julian Hasler ◽  
Andreas Flury ◽  
Dimitris Dimitriou ◽  
Iris Holweg ◽  
Naeder Helmy ◽  
...  
Keyword(s):  
Aseptic Loosening ◽  
Clinical Outcomes ◽  
Femoral Stem ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Related Factors ◽  
Stem Subsidence ◽  
Metaphyseal Bone ◽  
Short Stems

Abstract Background: There has been an evolution in cementless total hip arthroplasty (THA) with newer short stem designs aim to preserve metaphyseal bone stock and facilitate implantation through minimally invasive approaches. While early subsidence has been correlated to aseptic loosening in conventional stems, there is a paucity of data regarding short stems. The current study aims to report on stem subsidence and midterm clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, specifically designed for the direct anterior approach (DAA).Methods: 94 consecutive patients (100 hips) with a minimum follow-up of 5 years following cementless THA were included in this single-center retrospective study. Subsidence was evaluated using the “Ein-Bild-Roentgen-Analyse” (EBRA). Periprosthetic radiolucency allocated to the Zones of Charnley and Gruen was assessed. Additionally, demographic and implant-related factors potentially associated with increased subsidence and clinical outcomes were evaluated.Results: At the last follow-up, the average stem subsidence was 1.98 ± 1.20 mm, with 48% of the implants demonstrating subsidence of > 2 mm. Periprosthetic radiolucency of > 2 mm was found in 26% of the implants in Zone 1, and in 9% in Zone 7, respectively. Neither the amount of subsidence nor proximal periprosthetic radiolucency was associated with aseptic loosening or worse clinical outcomes. Conclusions: Comparable to other proximally-fixed short stem designs, the highest subsidence was observed within the first 3 months following implantation. No demographic or implant-related factors were found to have a statistically significant influence on stem subsidence. Periprosthetic radiolucency and subsidence of the AMISstem is not correlated with worse clinical outcomes at 5-years follow-up.

scholarly journals Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Michael O. Schaer ◽  
Michael Finsterwald ◽  
Iris Holweg ◽  
Dimitris Dimitriou ◽  
Alexander Antoniadis ◽  
...  
Keyword(s):  
Femoral Stem ◽  
Invasive Approach ◽  
Factors Affecting ◽  
Stem Size ◽  
Stem Subsidence ◽  
Single Center Study ◽  
Short Femoral Stem ◽  
Migration Analysis ◽  
Stem Migration

Abstract Background Early femoral stem subsidence following a cementless THA is correlated with aseptic loosening of the femoral component. The short femoral stems allow bone sparing and implantation through a minimally invasive approach; however, due to their metaphyseal anchoring, they might demonstrate different subsidence pattern than the conventional stems. Methods In this prospective single-center study, a total of 68 consecutive patients with an average age of 63 years, and a minimum follow-up of 5 years following a cementless THA with a metaphyseal-anchored short femoral stem were included. The femoral stem subsidence was evaluated using “Ein Bild Roentgen Analyse” (EBRA). Results Average stem migration was 0.96 +/− 0.76 mm at 3 months, 1.71 +/− 1.26 mm at 24 months, and 2.04+/− 1.42 mm at last follow-up 60 months postoperative. The only factor that affected migration was a stem size of 6 or more (r2 = 5.74; p = 0.039). Subdivision analysis revealed, that only in females migration appeared to be affected by stem size irrespective of weight but not in men (female stem size of 6 or more vs. less (Difference = − 1.48 mm, R2 = 37.5; p = 0.001). Migration did not have an impact on clinical outcome measures. Conclusions The examined metaphyseal-anchored short femoral stem showed the highest subsidence within the first 3 months postoperative, the implant began to stabilize at about 24 months but continued to slowly migrate with average total subsidence of 2.04 mm at 5 years following the THA. The amount of stem subsidence was not associated with worse clinical outcomes such as HHS, patient satisfaction, or pain.

scholarly journals Predicting Cementless Stem Fixation in Total Hip Arthroplasty Using Radiodensity Mapping

10.29007/dv5n ◽  
2020 ◽  
Author(s):  
Teja Cherukuri ◽  
Chameka Madurawe ◽  
Jim Pierrepont ◽  
Jonathan Bare ◽  
Stephen McMahon ◽  
...  
Keyword(s):  
Bone Density ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
X Rays ◽  
Implant Fixation ◽  
X Ray ◽  
Total Hip ◽  
Stem Subsidence

Femoral component loosening due to poor fixation is a common failure mode in cementless total hip arthroplasty (THA). We sought to develop a technique to predicted femoral stem fixation using pre-operative CT.Forty-nine patients requiring THA received pre-operative CTs as part of Corin OPSTM 3D dynamic planning. All patients received a taper wedged blade stem (TriFitTM TS, Corin UK) implanted through a posterior approach. Post-operatively, patients received an immediate CT and AP x-ray and a 1-year follow-up x-ray. The distance between the most superior point of the greater trochanter and the shoulder of the stem was measured and scaled using the known cup diameter on both the immediate and 1- year follow-up x-rays. The difference was recorded as stem subsidence. Subsidence greater than 4mm was deemed clinically relevant. The precise placement of the stem determined by registering the known 3D implant geometry to the post-op CT was virtually implanted back into the pre-operative OPSTM planning software. A colour map of the bone density at the stem/bone interface using the Hounsfield Units (HU) of each CT pixel was generated. Blue represents low density bone transitioning through to green and then red.Mean stem subsidence was 1.8mm (0 to 11.1mm). Five patients had clinically relevant subsidence. Significant areas of blue and green around the proximal portion of the stem was observed in high subsidence stems when compared to the stems with minimal subsidence.Using the HU of the CT scan as an indicator for bone density, we were able to predict poor implant fixation and subsequent subsidence in a taper wedge stem.

scholarly journals Minimum ten-year outcome of a triple-tapered femoral stem implanted with line-to-line cementing technique

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hirotsugu Ohashi ◽  
Satoshi Iida ◽  
Izumi Minato
Keyword(s):  
Retrospective Study ◽  
Clinical Outcomes ◽  
Femoral Stem ◽  
Trial Registration ◽  
Neutral Position ◽  
Cementing Technique ◽  
Stem Subsidence ◽  
The Mean ◽  
Loosening Rate

Abstract Background A triple-tapered polished femoral stem was implanted with line-to-line cementing technique. The purpose of this study was to determine the survivorship, loosening rate, stem subsidence, radiologic changes and clinical outcomes in the minimum 10-year follow-up. Methods This was a retrospective study done in three institutes. Finally, 118 hips in 97 patients could be followed-up at the mean follow-up period of 126.3 months. The survivorship, radiological and clinical outcomes were investigated. Results Radiologically, 107 hips (90.7%) were categorized to Barrack cementing grade A, and 108 stems (91.5%) were inserted in neutral position. All hips were not loose and were not revised due to any reason. Survival with revision for any reason as the endpoint was 100% after 10 years. At the last follow-up, the mean subsidence was 0.43 mm, and the subsidence was less than 1 mm in 110 hips (93.2%). JOA hip score improved from 42.7 ± 8.9 points preoperatively to 92.8 ± 6.8 points at the last follow-up. No patient complained thigh pain. Conclusions Line-to-line cementing technique with use of a triple-tapered polished stem was effective to achieve good cementation quality and centralization of the stem. The subsidence was small, and the minimum 10-year results were excellent without any failures related to the stem. Trial registration Retrospectively registered.

scholarly journals Mid-term subsidence and periprosthetic radiolucency of the AMIStem: a 5-year EBRA-FCA analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Julian Hasler ◽  
Andreas Flury ◽  
Dimitris Dimitriou ◽  
Iris Holweg ◽  
Naeder Helmy ◽  
...  
Keyword(s):  
Aseptic Loosening ◽  
Clinical Outcomes ◽  
Femoral Stem ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Related Factors ◽  
Stem Subsidence ◽  
Metaphyseal Bone ◽  
Short Stems

Abstract Background There has been an evolution in cementless total hip arthroplasty (THA) with newer short stem designs aimed to preserve metaphyseal bone stock and facilitate implantation through minimally invasive approaches. While early subsidence has been correlated to aseptic loosening in conventional stems, there is a paucity of data regarding short stems. The current study aims to report on stem subsidence and mid-term clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, specifically designed for the direct anterior approach (DAA). Methods Ninety-four consecutive patients (100 hips) with a minimum follow-up of 5 years following cementless THA were included in this single-center retrospective study. Subsidence was evaluated using the “Ein-Bild-Roentgen-Analyse” (EBRA). Periprosthetic radiolucency allocated to the zones of Charnley and Gruen was assessed. Additionally, demographic and implant-related factors potentially associated with increased subsidence and clinical outcomes were evaluated. Results At the last follow-up, the average stem subsidence was 1.98 ± 1.20 mm, with 48% of the implants demonstrating subsidence of > 2 mm. Periprosthetic radiolucency of > 2 mm was found in 26% of the implants in zone 1 and in 9% in zone 7, respectively. Neither the amount of subsidence nor proximal periprosthetic radiolucency was associated with aseptic loosening or worse clinical outcomes. Conclusions Comparable to other proximally fixed short stem designs, the highest subsidence was observed within the first 3 months following implantation. No demographic or implant-related factors were found to have a statistically significant influence on stem subsidence. Periprosthetic radiolucency and subsidence of the AMISstem is not correlated with worse clinical outcomes at 5-year follow-up.

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