Risk factors for femoral stem breakage: an analysis of the AOANJRR results

2019 ◽  
Vol 30 (3) ◽  
pp. 319-326
Author(s):  
Mark S Rickman ◽  
Peter L Lewis ◽  
Daud TS Chou ◽  
William Donnelly ◽  
Stephen E Graves ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Replacement ◽  
Femoral Stem ◽  
Large Data ◽  
Cementless Stem ◽  
Stem Design ◽  
Stem Breakage ◽  
Cemented Stem ◽  
Patient Groups ◽  
Manufacturing Techniques

Introduction: Breakage of the femoral stem component of a total hip replacement is now uncommon but continues to be seen with certain stem designs and in certain patient groups. Data previously published on this topic has been limited, either gathered from a single surgeon or centre, or included only a single stem design. Methods: We reviewed the data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), identified and analysed 143 stem breakages over a period of 16 years, covering 44 different stem designs. Results: Our data confirms previously published findings that risk factors for stem breakage include patient age at implantation of under 70, male gender, as well as the use of exchangeable necks. We found no association with initial diagnosis, or type of acetabular component implanted. We did however also find, excluding exchangeable neck designs, that after 4.5 years a cemented stem had a significantly higher risk of breakage then a cementless stem. Discussion: To our knowledge this is the 1st paper to suggest cemented fixation as a specific risk factor for stem breakage. The analysis of rare complications such as stem breakage is only possible through large data collection systems such as the AOANJRR. Whilst there have been recent advances in materials and manufacturing techniques, we recommend that surgeons are aware of all the specific risks when considering implant choices for individual patients.

scholarly journals Fixation of the Cemented Stem: Clinical Relevance of the Porosity and Thickness of the Cement Mantle

2009 ◽  
Vol 3 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Philippe Hernigou ◽  
Gildasio Daltro ◽  
Charles Henri Flouzat Lachaniette ◽  
Xavier Roussignol ◽  
Martin Mukisi Mukasa ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Review Paper ◽  
Mechanical Stability ◽  
Femoral Stem ◽  
Clinical Results ◽  
Cement Mantle ◽  
Frictional Torque ◽  
Stem Design ◽  
Cement Interface ◽  
Cemented Stem

The aim of this review paper is to define the fixation of the cemented stem. Polymethyl methacrylate, otherwise known as “bone cement”, has been used in the fixation of hip implants since the early 1960s. Sir John Charnley, the pioneer of modern hip replacement, incorporated the use of cement in the development of low frictional torque hip arthroplasty. In this paper, the concepts of femoral stem design and fixation, clinical results, and advances in understanding of the optimal use of cement are reviewed. The purpose of this paper is to help understanding and discussions on the thickness and the porosity of the cement mantle in total hip arthroplasty. Cement does not act as an adhesive, as sometimes thought, but relies on an interlocking fit to provide mechanical stability at the cement–bone interface, while at the prosthesis– cement interface it achieves stability by optimizing the fit of the implant in the cement mantle, such as in a tapered femoral stem.

Mechanics of the canine femur with two types of hip replacement stems

2003 ◽  
Vol 16 (03) ◽  
pp. 145-52 ◽  
Author(s):  
L. Banks-Sills ◽  
R. Eliasy ◽  
R. Shahar
Keyword(s):  
Finite Element ◽  
Hip Replacement ◽  
Three Dimensional ◽  
Stress Shielding ◽  
Femoral Stem ◽  
Cementless Stem ◽  
Entire Cross Section ◽  
Element Analysis ◽  
Periprosthetic Bone Loss ◽  
Intact Femur

SummaryThe long-term performance of total hip replacement is of concern to veterinary surgeons. Two of the main complications associated with this procedure are implant loosening and stress shielding. Designs of the femoral stem which will avoid loosening and achieve maximum endurance while reducing stress shielding and periprosthetic bone loss are sought.In the intact femur the stress is distributed over the entire cross section of the bone. After hip replacement this pattern of stress distribution is altered because of the manner in which the load is transferred from the prosthesis to the bone.The objective of this study was to examine the stresses that develop in the femur and implant components of two different methods of hip replacement used clinically in dogs. Anatomic, three-dimensional finite element models of the canine femur with a cemented femoral stem and a Zurich cementless stem were constructed. The stresses and displacements were calculated by the finite element analysis method, under physiologic loads that included muscle forces and joint reaction forces. The results were compared to results obtained by a similar analysis of an intact femur.This study demonstrates that the Zurich cementless method causes less stress shielding in the proximal femoral cortex than does the cemented method. Implant stresses are higher in the Zurich cementless stem, but still within an acceptable range.

Comparison of Anatomic Vs. Straight Femoral Stem Design in Total Hip Replacement - Femoral Canal Fill in Vivo

2016 ◽  
Vol 27 (3) ◽  
pp. 241-244 ◽  
Author(s):  
Friso A. de Boer ◽  
Elhadi Sariali
Keyword(s):  
Hip Replacement ◽  
Femoral Stem ◽  
X Rays ◽  
Femoral Canal ◽  
Stem Design ◽  
Total Hip ◽  
Straight Stem ◽  
Satisfactory Outcome ◽  
Central Level

Introduction The femoral canal fill between an anatomic and a straight prosthesis design in cementless total hip arthroplasty (THA) was compared. We hypothesised that the anatomic SPS stem has higher proximal fill and lesser distal fill than the straight stem. Material and methods The femoral canal fill was measured on 3 months routine postoperative x-rays at 5 levels of the stem in 50 consecutive patients, aged 35-83 years, who underwent 56 THA procedures by a single surgeon in this hospital. 22 patients received a straight design Ceramconcept Global stem, 34 patients received an anatomic design Symbios SPS stem. Both anteroposterior (AP) and lateral x-rays were combined to suggest a 3-D measurement. Results On the AP x-rays, the canal fill was significantly higher using the anatomic design stem at the proximal measurement levels, and was significantly higher at the distal levels using the straight stem. With the AP and lateral x-rays combined, the canal fill at the proximal levels was also significantly higher in the anatomic groups, nonsignificantly lower at the central level and significantly lower at the distal levels. Discussion In THA surgery, achieving high fill at the metaphysis of the femur and less fill at the diaphysis has been suggested to result in satisfactory outcome and high stability of the prosthesis. This study demonstrated that, compared to straight stem design, an anatomically designed stem has a significantly higher metaphyseal femoral canal fill.

scholarly journals Biomechanical evaluation of a new femoral stem design for total hip replacement in a canine model

2021 ◽  
Vol 36 (5) ◽  
Author(s):  
Luís Guilherme de Faria ◽  
Bruno Watanabe Minto ◽  
Antonio Carlos Shimano ◽  
Ana Paula Macedo ◽  
Lucia Maria Izique Diogo ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Femoral Stem ◽  
Canine Model ◽  
Stem Design ◽  
Total Hip ◽  
Biomechanical Evaluation

scholarly journals High rates of implant fracture of a generic polished tapered femoral stem

2020 ◽  
pp. 112070002092573
Author(s):  
Jens Vanbiervliet ◽  
Annabel Braem ◽  
Jean-Pierre Simon ◽  
Jan Van Humbeek ◽  
Jonas Brouwers ◽  
...  
Keyword(s):  
Failure Analysis ◽  
Femoral Stem ◽  
High Rate ◽  
Obese Patients ◽  
Stem Design ◽  
Premature Failure ◽  
Stress Riser ◽  
Hip Replacements ◽  
Modular Revision Stem ◽  
Cemented Stem

Objectives: Cemented polished tapered stems have demonstrated excellent long-term outcomes. Based on this concept, many generic tapered stems have been released into the market. The aim of this study was to evaluate implant-related complications of 1 specific stem design. Methods: Between 2010 and 2017, 315 total hip replacements were performed using a Fortress stem (Biotechni, La Ciotat, France). Patient records and radiology were retrospectively reviewed for implant-related complications. A failure analysis was performed on the failed Fortress stems in order to determine the cause of premature failure. Results: 7 (2.2%) patients sustained a fracture of the neck of the implant after a mean of 5 years (range 50–81 months). All fractures were atraumatic, originating at the introducer inlet of the stem. All fractured occurred in obese patients (BMI >33 kg/m2) with a small sized prosthesis. Of these, there were 5 135° and 2 125° stems. Fracture risk was 23% (7/30) for patients with a small sized stem and a BMI >30 kg/m2. All cases were revised using a cement-in-cement technique or a cementless modular revision stem. Failure analysis on the retrieved stems revealed a stress riser at the bottom of the introducer inlet. Conclusions: An alarmingly high rate of early implant fractures was seen using this specific type of cemented stem, particularly when using smaller implant sizes in obese patients. Although based on a proven design, a specific modification led to a stress riser in the neck area, which resulted in a high incidence of implant failure. This series underlines the importance of a stepwise introduction into the market of new orthopaedic devices even when based on established concepts. Generic stems may not behave as the original stem upon which it was designed.

scholarly journals Routine clinical care data from thirteen cardiac outpatient clinics: design of the Cardiology Centers of the Netherlands (CCN) database

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sophie H. Bots ◽  
Klaske R. Siegersma ◽  
N. Charlotte Onland-Moret ◽  
Folkert W. Asselbergs ◽  
G. Aernout Somsen ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Practitioner ◽  
Data Collection ◽  
The Netherlands ◽  
Strong Base ◽  
Daily Care ◽  
Cardiac Symptoms ◽  
Number Of Patients ◽  
Patient Groups

Abstract Background Despite the increasing availability of clinical data due to the digitalisation of healthcare systems, data often remain inaccessible due to the diversity of data collection systems. In the Netherlands, Cardiology Centers of the Netherlands (CCN) introduced “one-stop shop” diagnostic clinics for patients suspected of cardiac disease by their general practitioner. All CCN clinics use the same data collection system and standardised protocol, creating a large regular care database. This database can be used to describe referral practices, evaluate risk factors for cardiovascular disease (CVD) in important patient subgroups, and develop prediction models for use in daily care. Construction and content The current database contains data on all patients who underwent a cardiac workup in one of the 13 CCN clinics between 2007 and February 2018 (n = 109,151, 51.9% women). Data were pseudonymised and contain information on anthropometrics, cardiac symptoms, risk factors, comorbidities, cardiovascular and family history, standard blood laboratory measurements, transthoracic echocardiography, electrocardiography in rest and during exercise, and medication use. Clinical follow-up is based on medical need and consisted of either a repeat visit at CCN (43.8%) or referral for an external procedure in a hospital (16.5%). Passive follow-up via linkage to national mortality registers is available for 95% of the database. Utility and discussion The CCN database provides a strong base for research into historically underrepresented patient groups due to the large number of patients and the lack of in- and exclusion criteria. It also enables the development of artificial intelligence-based decision support tools. Its contemporary nature allows for comparison of daily care with the current guidelines and protocols. Missing data is an inherent limitation, as the cardiologist could deviate from standardised protocols when clinically indicated. Conclusion The CCN database offers the opportunity to conduct research in a unique population referred from the general practitioner to the cardiologist for diagnostic workup. This, in combination with its large size, the representation of historically underrepresented patient groups and contemporary nature makes it a valuable tool for expanding our knowledge of cardiovascular diseases. Trial registration: Not applicable.

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 Initial therapeutic dose of corticosteroid for an acute exacerbation of IPF is associated with subsequent early recurrence of another exacerbation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryo Yamazaki ◽  
Osamu Nishiyama ◽  
Sho Saeki ◽  
Hiroyuki Sano ◽  
Takashi Iwanaga ◽  
...  
Keyword(s):  
Risk Factors ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Therapeutic Dose ◽  
Early Recurrence ◽  
Time To Recurrence ◽  
Acute Exacerbations ◽  
Patient Groups ◽  
The Mean ◽  
Mean Time

AbstractSome patients with idiopathic pulmonary fibrosis (IPF) undergo recurrent acute exacerbations (AEs). This study aimed to elucidate the risk factors for recurrent AEs of IPF (AE-IPF). Consecutive patients with IPF admitted for their first AE-IPF between January 2008 and December 2018 were retrospectively recruited. Of 63 patients admitted for an AE-IPF and discharged alive, 9 (14.3%) developed a recurrence of AE within 1 year. The mean time to recurrence was 233 ± 103 days. Total doses (mg/month and mg/kg/month) of corticosteroids administered over day 1 to 30 after the AE were significantly higher in patients without recurrences of AE-IPF (5185 ± 2414 mg/month, 93.5 ± 44.0 mg/kg/month) than the doses in patients with recurrences (3133 ± 1990 mg/month, 57.2 ± 37.7 mg/kg/month) (p = 0.02 and p = 0.03, respectively). However, no differences were observed between the total doses of corticosteroids administered over days 31 to 60, 61 to 90, 91 to 120, and 151 to 180 after the AE. Furthermore, differences between the administration rates of immunosuppressive and antifibrotic treatments administered to the 2 patient groups were not significant. An increased total dose of corticosteroid administered over day 1 to 30 after an AE-IPF was associated with a decreased risk of subsequent recurrence of AE-IPF within 1 year after the first AE.

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