Distal femoral cortical hypertrophy not associated with thigh pain using a short stem femoral implant

2020 ◽  
pp. 112070002091387 ◽  
Author(s):  
David A Crawford ◽  
Joanne B Adams ◽  
Michael J Morris ◽  
Keith R Berend ◽  
Adolph V Lombardi
Keyword(s):  
Direct Anterior Approach ◽  
Activity Level ◽  
Thigh Pain ◽  
Short Stem ◽  
Thickness Change ◽  
Gruen Zone ◽  
Stem Size ◽  
Patient Reported ◽  
Cortical Hypertrophy ◽  
Lateral Thigh

Background: Thigh pain following a well-fixed total hip arthroplasty (THA) remains problematic and a source of patient dissatisfaction. The purpose of this study is to evaluate if the development of distal femoral cortical hypertrophy (DFCH) is associated with postoperative thigh pain after THA. Methods: All patients who underwent an uncomplicated primary THA via a direct anterior approach with the Taperloc Microplasty (Zimmer Biomet, Warsaw, IN, USA) implant between 2011 and 2015 were mailed a pain drawing questionnaire. Radiographs were reviewed at 1 year minimum to determine cortical thickness change from immediate post-op. Thigh pain was compared to DFCH. 293 patients were included in the study. Results: Mean follow-up was 3.2 years. A total of 218 hips (74%) had cortical hypertrophy in Gruen zone 3 and 165 hips (56%) had cortical hypertrophy in Gruen zone 5. 52 hips (18%) had ⩾25% cortical hypertrophy in zone 3 and 91 hips (31%) had ⩾25% cortical hypertrophy in zone 5. A total of 44 patients (15%) reported anterior thigh pain and 43 patients (15%) reported lateral thigh pain. Development of DFCH in either Gruen zone 3 or 5 was not associated with anterior or lateral thigh pain. Stem size was positively correlated with zone 3 hypertrophy and inversely related to zone 5 hypertrophy. Thigh pain was not associated with patient age, gender, activity level or stem size. Conclusions: The development of distal femoral cortical hypertrophy after THA with a short stem implant was high, but not associated with patient-reported anterior or lateral thigh pain.

The Accuracy and Ability of Preoperative Templating to Restore Femoral Offset in Calcar-Guided Short-Stem Total Hip Prosthesis through Direct Anterior Approach

2021 ◽  
Author(s):  
Barbara Favier ◽  
Nathalie van Beek ◽  
Mike Tengrootenhuysen
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Size Difference ◽  
Femoral Offset ◽  
Stem Size ◽  
Total Hip ◽  
Preoperative Templating

AbstractThe aim of this study was to assess the applicability and ability of preoperative templating to restore femoral offset and hip length with a calcar-guided short-stem implant design in total hip arthroplasty through the direct anterior approach. Preoperative measurements were performed of femoral offset, hip length, and stem size and compared with the perioperative placed prosthesis in 100 patients undergoing primary total hip replacement through direct anterior approach. Additionally, the pre- and postoperative femoral offset and hip length were compared to evaluate the ability to restore the offset and hip length with this kind of femoral short stem. With an acceptance of 1 size difference pre- and postoperatively, a 94% accuracy of predicting the size of the calcar-guided short stem was achieved with templating. Femoral offset was within means of 5 mm in 82.2% of the patients. Postoperative hip length was within 6 mm in 90% of the patients compared with the preoperative length.The use of preoperative templating for total hip arthroplasty with calcar-guided short-stem implants was proven to be a useful tool to predict the definite implanted size of the femoral prosthesis. Our results show that this new stem design does not significantly differ from previous reported outcomes with other stem designs and is competent to restore the femoral offset and hip length within clinical acceptable range. Level of evidence Level 3 retrospective case study.

scholarly journals Decision Making for Treatment After ACL Injury From an Orthopaedic Surgeon and Patient Perspective: Results From the NACOX Study

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712110050
Author(s):  
Hanna Tigerstrand Grevnerts ◽  
Sofi Sonesson ◽  
Håkan Gauffin ◽  
Clare L. Ardern ◽  
Anders Stålman ◽  
...  
Keyword(s):  
Decision Making ◽  
High Activity ◽  
Treatment Decision ◽  
Acl Injury ◽  
Treatment Decisions ◽  
Activity Level ◽  
Knee Instability ◽  
Acl Injuries ◽  
Patient Reported ◽  
And Function

Background: In the treatment of anterior cruciate ligament (ACL) injuries, there is little evidence of when and why a decision for ACL reconstruction (ACLR) or nonoperative treatment (non-ACLR) is made. Purpose: To (1) describe the key characteristics of ACL injury treatment decisions and (2) compare patient-reported knee instability, function, and preinjury activity level between patients with non-ACLR and ACLR treatment decisions. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 216 patients with acute ACL injury were evaluated during the first year after injury. The treatment decision was non-ACLR in 73 patients and ACLR in 143. Reasons guiding treatment decision were obtained from medical charts and questionnaires to patients and orthopaedic surgeons. Patient-reported instability and function were obtained via questionnaires and compared between patients with non-ACLR and ACLR treatment decisions. The ACLR treatment group was classified retrospectively by decision phase: acute phase (decision made between injury day and 31 days after injury), subacute phase (decision made between 32 days and up to 5 months after injury), and late phase (decision made 5-12 months after injury). Data were evaluated using descriptive statistics, and group comparisons were made using parametric or nonparametric tests as appropriate. Results: The main reasons for a non-ACLR treatment decision were no knee instability and no problems with knee function. The main reasons for an ACLR treatment decision were high activity demands and knee instability. Patients in the non-ACLR group were significantly older ( P = .031) and had a lower preinjury activity level than did those in the acute-phase ( P < .01) and subacute-phase ( P = .006) ACLR decision groups. There were no differences in patient-reported instability and function between treatment decision groups at baseline, 4 weeks after injury, or 3 months after injury. Conclusion: Activity demands, not patient-reported knee instability, may be the most important factor in the decision-making process for treatment after ACL injury. We suggest a decision-making algorithm for patients with ACL injuries and no high activity demands; waiting for >3 months can help distinguish those who need surgical intervention from those who can undergo nonoperative management. Registration: NCT02931084 ( ClinicalTrials.gov identifier).

scholarly journals Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Fabrizio Rivera ◽  
Alessandro Bardelli ◽  
Andrea Giolitti
Keyword(s):  
Operating Room ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Medium Term ◽  
Operating Room Table ◽  
Sf 36 ◽  
Standard Operating ◽  
The Mean

Abstract Background In the last decade, the increase in the use of the direct anterior approach to the hip has contributed to the diffusion of the use of short stems in orthopedic surgery. The aim of the study is to verify the medium-term clinical and radiographic results of a cementless anatomic short stem in the anterior approach to the hip. We also want to verify whether the use of the standard operating room table or the leg positioner can affect the incidence of pre- and postoperative complications. Materials and methods All total hip arthroplasty patients with a 1-year minimum follow-up who were operated using the MiniMAX stem between January 2010 and December 2019 were included in this study. Clinical evaluation included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC) Score, and Short Form-36 (SF-36) questionnaires. Bone resorption and remodeling, radiolucency, osteolysis, and cortical hypertrophy were analyzed in the postoperative radiograph and were related to the final follow-up radiographic results. Complications due to the use of the standard operating room table or the leg positioner were evaluated. Results A total of 227 patients (238 hips) were included in the study. Average age at time of surgery was 62 years (range 38–77 years). Mean follow-up time was 67.7 months (range 12–120 months). Kaplan–Meier survivorship analysis after 10 years revealed 98.2% survival rate with revision for loosening as endpoint. The mean preoperative and postoperative HHS were 38.35 and 94.2, respectively. The mean preoperative and postoperative WOMAC Scores were 82.4 and 16.8, respectively. SF-36 physical and mental scores averaged 36.8 and 42.4, respectively, before surgery and 72.4 and 76.2, respectively, at final follow-up. The radiographic change around the stem showed bone hypertrophy in 55 cases (23%) at zone 3. In total, 183 surgeries were performed via the direct anterior approach (DAA) on a standard operating room table, and 44 surgeries were performed on the AMIS mobile leg positioner. Comparison between the two patient groups did not reveal significant differences. Conclusion In conclusion, a short, anatomic, cementless femoral stem provided stable metaphyseal fixation in younger patients. Our clinical and radiographic results support the use of this short stem in the direct anterior approach. Level of evidence IV.

scholarly journals POS1455-HPR RELATIONSHIP BETWEEN PSYCHOLOGICAL FACTORS AND MEASURES OF RHEUMATOID ARTHRITIS ACTIVITY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1011.2-1011
Author(s):  
Y. Olyunin ◽  
V. Rybakova ◽  
E. Likhacheva ◽  
E. Nasonov
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Psychological Factors ◽  
Global Assessment ◽  
Activity Level ◽  
Anxiety And Depression ◽  
Tender Joint Count ◽  
Sf 36 ◽  
Patient Reported

Background:The patient-reported outcomes are important components of quantitative methods of rheumatoid arthritis (RA) activity assessment which are used to choose the appropriate drug therapy. The value of these parameters can be significantly affected not only by the inflammatory process, but also by the psychological characteristics of the patient and, in particular, by hardiness [1].Objectives:To study the relationship between psychological factors and signs of RA activity.Methods:Patients with RA who met the EULAR/ACR 2010 criteria, and observed at the V. A. Nasonova Research Institute of Rheumatology were included. Clinical examination was performed including patient global assessment (PGA), physician global assessment (PhGA), pain measurement on a visual analog scale, tender joint count (TJC), swollen joint count (SJC). The functional status was determined by HAQ, the quality of life – by SF-36 EQ-5D, the nature of pain – by painDETECT, the presence of anxiety and depression – by HADS. Patients also completed Hardiness Survey questionnaire to assess hardiness (HDS) and 3 components of the HDS – commitment (CMT), control (CT) and challenge (CLN). Disease activity was evaluated with DAS28, CDAI, and RAPID3. All patients signed informed consent to participate in the study. Analysis of the data was performed using Spearman’s rank test, Fisher exact test, qui-square and t-tests.Results:85 patients with RA were included. There were 69 women and 16 men. Mean age was 56.7±13.1 years, disease duration – 7.6±2.7 years. 72 patients were positive for rheumatoid factor, 75 – for anti-cyclic citrullinated peptide antibody. CDAI showed high activity in 15, moderate – in 37, low – in 30, and remission in 3 patients, DAS 28 – in 10, 55, 12, and 8, and RAPID3 – in 24, 25, 15, and 21, respectively. 24 patients had subclinically or clinically expressed anxiety and 15 –subclinically or clinically expressed depression (≥8 according to HADS). In 31 patients, the painDETECT questionnaire revealed possible or probable neuropathic pain. Mean HDS was 84.8±21.7, CMT – 38.9±9.2, CT – 29.4±8.6, CLN – 17.3±7.1. These values were comparable with the corresponding population data for this age group. There was a significant inverse correlation between HDS and RA activity measures, including SJC, TJC, DAS28 (p<0.05), pain, PGA, PhGA, CDAI, RAPID3, and HAQ (p<0.01). In addition, HDS and all its components positively correlated with quality of life, assessed by SF-36 and EQ-5D (p<0.01). In patients with subclinically and clinically expressed anxiety and depression, HDS, CMT, and CT were significantly lower than in patients without anxiety and depression (p<0.01), while the values of CLN in these groups did not differ significantly.Conclusion:The results of the present study suggest that low HDS may be one of the significant factors determining RA activity level because it does not allow patients to adapt adequately to a stressful situation produced by the disease.References:[1]Maddi SR. Am Psychol. 2008 Sep;63(6):563-4.Disclosure of Interests:None declared

scholarly journals Distal Femoral Cortical Hypertrophy after Hip Arthroplasty Using a Cementless Double-Tapered Femoral Stem

2016 ◽  
Vol 24 (3) ◽  
pp. 317-322 ◽  
Author(s):  
Yoon Je Cho ◽  
Young Soo Chun ◽  
Kee Hyung Rhyu ◽  
Jong Hun Baek ◽  
Hu Liang
Keyword(s):  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Stress Shielding ◽  
Femoral Stem ◽  
Visual Analogue Score ◽  
Thigh Pain ◽  
Harris Hip Score ◽  
Cortical Hypertrophy ◽  
Flare Index ◽  
The Mean

Purpose To review 437 hips in 404 patients who underwent total hip arthroplasty (THA) or hemiarthroplasty using the Accolade TMZF stem to determine the incidence and risk factors of distal femoral cortical hypertrophy (DFCH). Methods Records of 437 hips in 169 men and 235 women aged 26 to 100 (mean, 65.7) years who underwent THA (n=293) or hemiarthroplasty (n=144) using the Accolade TMZF femoral stem by 2 senior surgeons and were followed up for a mean of 54.7 months were reviewed. Clinical outcome was assessed using the modified Harris Hip Score and visual analogue score for pain. Proximal femoral geometry and canal flare index were assessed on preoperative radiographs, and DFCH, stem position, subsidence, loosening, and stress shielding were assessed on postoperative radiographs according to the Gruen zone. Results Of 437 hips, 27 (6.2%) developed DFCH and 410 did not. Hips with DFCH had a higher incidence of thigh pain (18.5% vs. 2.2%, p<0.001) and earlier onset of thigh pain (12.3 vs. 20.8 months, p=0.015), compared with those without. Nonetheless, all femoral stems were well-fixed, and no osteolysis or loosening was detected. The 2 groups achieved comparable clinical outcome in terms of Harris Hip Score and pain. The mean canal flare index was higher in hips with than without DFCH (3.706 vs. 3.294, p=0.002). The mean vertical subsidence of the femoral stem was lower in hips with than without DFCH (1.5 vs. 3.4 mm p<0.001). Subsidence negatively correlated with the canal flare index (correlation coefficient= −0.110, p=0.022). The incidence of the DFCH increased with each unit of increment in canal flare index (odds ratio [OR]=1.828, p=0.043) and each year younger in age (OR=0.968, p=0.015). Conclusion The incidence of DFCH in hips with the Accolade TMZF stem was 6.2%. Patients with a higher canal flare index and younger age had a higher incidence of DFCH. Nonetheless, DFCH did not affect clinical outcome or femoral stem stability.

scholarly journals Patient and physician perspectives guiding intra-articular treatment choice in knee osteoarthritis: stakeholders are aligned on treatment priorities but have different assessments of treatment effect

2021 ◽  
pp. jisakos-2020-000578
Author(s):  
Vandana Menon ◽  
Caroline Huber ◽  
Alexandria Portelli ◽  
Marissa Baker-Wagner ◽  
Scott Kelley ◽  
...  
Keyword(s):  
Decision Making ◽  
Knee Osteoarthritis ◽  
Shared Decision Making ◽  
Symptom Relief ◽  
Activity Level ◽  
Shared Decision ◽  
Treatment Needs ◽  
Knee Oa ◽  
Patient Reported ◽  
Selection Factors

ObjectivesKnee osteoarthritis (OA) is a leading cause of health-related disability. In the absence of curative non-operative therapies, treatment goals are limited to symptom relief. Data are limited on how patients and physicians prioritise available treatment options. We assessed patients’ preferences for and physicians’ attitudes towards intra-articular treatments including corticosteroids (IACS), an extended-release corticosteroid (TA-ER) and hyaluronic acids (IAHA).MethodsWe conducted a prospective, IRB-exempt, double-blind survey of patients with and providers who treat knee OA. Respondents were required to have received or prescribed TA-ER in a non-trial setting. We evaluated patients’ OA history, impact of knee OA and treatment preferences, and physicians’ decision-making and prescribing experiences.ResultsOf the 97 patient participants, mean age was 56 years, 70.0% were women, 75.0% had bilateral knee OA and 46.4% were diagnosed over 5 years ago. Of the 50 physician participants, 34.0% were rheumatologists, 42.0% were orthopaedic surgeons and 60.0%, on average, treat 50+ patients with knee OA per month. Treatment selection factors considered ‘very important’ to patients and physicians included disease severity (88.7%, 82.0%), impact on quality of life (88.7%, 72.0%), disease extent (84.5%, 54.0%) and activity level (80.4%, 64.0%). A majority (93.8%) of patients indicated moderate to severe difficulty with their knees. Fewer patients (76.3%) reported shared decision making compared with physicians (92.0%). Half (50.5%) of the patients reported that they experienced months of pain relief with TA-ER, 27.7% with IACS and 18.8% with IAHA. Physician assessments were consistent but estimated a greater duration of treatment effects than that reported by patients across all therapies.ConclusionWhile knee OA has a tremendous impact on patients, there are significant unmet treatment needs. The increasing use of patient-reported outcomes will allow patients and physicians to track pain and functional status over time and across therapies, improving shared decision-making.

scholarly journals 5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis

2022 ◽  
Vol 11 (2) ◽  
pp. 346
Author(s):  
Ali Darwich ◽  
Kim Pankert ◽  
Andreas Ottersbach ◽  
Marcel Betsch ◽  
Sascha Gravius ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Hip Osteoarthritis ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Total Hip ◽  
The Mean

The aim of this study was to investigate the radiological and clinical outcome of the direct anterior approach (DAA) in total hip arthroplasty (THA) using a collared cementless femoral short-stem. This retrospective study included 124 patients with 135 THAs operated from 2014 to 2016 using a collared cementless triple tapered hydroxyapatite-coated femoral short-stem (AMIStem H Collared®, Medacta International, Castel San Pietro, Switzerland) implanted with a DAA. Follow-up was performed at three months, 12 months, and five years. Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence. The mean age was 67.7 ± 11.3 years and the mean body mass index (BMI) was 27.4 ± 4.4 kg/m2. The stem survival rate at five years was 99.1% with one revision due to recurrent dislocations. Mean HOOS score improved from 40.9 ± 18.3 preoperatively to 81.5 ± 19.7 at three months, 89.3 ± 10.9 at 12 months, and 89.0 ± 14.0 at five years (all with p < 0.001). No significant correlations were found between age, femoral bone morphology, BMI and HOOS, and the appearance of relevant radiolucencies.

scholarly journals Effect of Biomechanical and Anatomic Characteristics on Patient-Reported Outcomes Following Total Hip Arthroplasty

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Lauren Pitz, BS ◽  
Braeden W. Estes, BS ◽  
Evan R. Deckard, BSE ◽  
R. Michael Meneghini, MD
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Stem ◽  
Activity Level ◽  
Lumbar Pain ◽  
Leg Length ◽  
Acetabular Cup ◽  
Femoral Offset ◽  
Primary Thas ◽  
Patient Reported ◽  
High Bmi

Background and Hypothesis: The success of total hip arthroplasty (THA) is often reported in terms of infection and dislocation rates. While studies have examined the effect of acetabular cup position, anteroposterior (AP) femoral stem alignment, changes in leg length and femoral stem offset on dislocation rates, few studies have investigated the effect of these biomechanical parameters on patient-reported outcome measures (PROMS). The purpose of this study was to evaluate how PROMS may differ by THA component placement in a consecutive series of primary THAs. Awareness of the importance of implant positioning may lead to improved surgical technique and optimized PROMS. Experimental Design or Project Methods: 933 consecutive posterolateral approach primary THAs performed between 2011 and 2018 by one surgeon were retrospectively reviewed. Acetabular cup abduction, femoral stem alignment, changes in leg length and total femoral offset were measured on APview radiographs. Prospectively collected Hip Disability and Osteoarthritis Outcome Score/HOOS Jr., University of California Los Angeles/UCLA Activity Level, and satisfaction (5-point Likert scale) were evaluated at minimum one-year. Results: 743 THAs were analyzed. Mean age and BMI were 64 years and 31 kg/m2, respectively. After multivariate analysis, females with neutral to valgus stem placement (p=0.020) and patients with neutral to valgus stem placement regardless of lumbar pain (p=0.034) were more satisfied. In addition, patients with lumbar pain (p<0.001) and patients with high BMI in combination with increased change in femoral offset (p=0.056) had lower overall HOOS Jr. scores. Interestingly, change in leg length was not a significant predictor of any PROMS (power [1-β]≥88.4%). Conclusion and Potential Impact: AP stem alignment may play a role in increased activity level and satisfaction. In addition, high BMI in combination with increased change in femoral offset negatively influenced HOOS Jr. scores. Unsurprisingly, the presence of lumbar pain continues to negatively affect PROMS. Further research is warranted on the influence of THA component placement, spinopelvic parameters, and PROMS.

scholarly journals Patient-Reported Outcomes with Tibial Baseplate Position and PCL Status in Conforming Total Knee Arthroplast

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Joseph A. Madden, BS ◽  
Payton K. Arnold, MS ◽  
Evan R. Deckard, BSE ◽  
R. Michael Meneghini, MD
Keyword(s):  
Tibial Slope ◽  
Activity Level ◽  
Posterior Tibial Slope ◽  
Consecutive Series ◽  
Posterior Tibial ◽  
Primary Tkas ◽  
Measurement Protocol ◽  
Patient Reported ◽  
Total Knee ◽  
Climbing Stairs

Background and Hypothesis: Anteroposterior (AP) tibial baseplate position, posterior tibial slope, and posterior cruciate ligament (PCL) status in total knee arthroplasty (TKA) undoubtedly affect kinematic patterns. Further, few studies document patient-reported outcome measures (PROMS) in conforming polyethylene TKA with these varying parameters. The purpose of this study was to correlate PROMS with the interaction of AP tibial baseplate position, tibial slope, and PCL status in a consecutive series of primary TKAs with conforming polyethylene. We hypothesized that pain, function, and satisfaction may correlate with a combination of these three parameters. Experimental Design or Project Methods: 589 consecutive primary TKAs of a single implant design performed by a single surgeon between January 2016 and October 2018 were retrospectively reviewed. AP tibial baseplate position (relative to the middle of the tibial canal) and posterior tibial slope measurements were performed on 4-week postoperative sagittal view radiographs with a standardized measurement protocol by two independent blinded raters. Validated PROMS related to activity level, pain, and function were evaluated at minimum one-year. Results: Analyses indicated differences based on ≥8mm vs. <8mm of posterior distance of the tibial baseplate from the tibial canal and whether or not the PCL was released. Four analysis groups (PCL-preserved <8mm, PCL-preserved ≥8mm, PCL-resected <8mm, and PCL-resected ≥8mm) did not differ by demographics/covariates (p≥0.150), tibial slope (p≥0.132), or preoperative PROMS (p≥0.088). The PCL-released <8mm group achieved clinically meaningful higher absolute (92.0) and delta (42.0) median KOOS Jr. scores, higher satisfaction (96.3%), and the greatest reduction in pain while climbing stairs (-7.0) although some findings lacked statistical significance. Conclusion and Potential Impact: In conforming polyethylene TKAs, releasing the PCL in combination with AP tibial baseplate placement <8mm from the tibial canal may eliminate kinematic conflict between the PCL and tibial baseplate leading to improved satisfaction, function, and pain while climbing stairs.

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