scholarly journals Uncemented short stems in primary total hip arthroplasty

2018 ◽  
Vol 3 (5) ◽  
pp. 149-159 ◽  
Author(s):  
Mattia Loppini ◽  
Guido Grappiolo
Keyword(s):  
Great Trochanter ◽  
Stress Shielding ◽  
Specific Pattern ◽  
Short Term ◽  
Physiological Loading ◽  
Bone Atrophy ◽  
Long Stem ◽  
Short Stems ◽  
Primary Total Hip Arthroplasty

Over the last two decades, several conservative femoral prostheses have been designed. The goals of conservative stems include: the spearing of the trochanteric bone stock; a more physiological loading in the proximal femur reducing the risk of stress shielding; and to avoid a long stem into the diaphysis preventing impingement with the femoral cortex and thigh pain. All stems designed to be less invasive than conventional uncemented stems are commonly named ‘short stems’. However, this term is misleading because it refers to a heterogeneous group of stems deeply different in terms of design, biomechanics and bearing. In the short-term follow-up, all conservative stems provided excellent survivorship. However, variable rates of complications were reported, including stem malalignment, incorrect stem sizing and intra-operative fracture. Radiostereometric analysis (RSA) studies demonstrated that some conservative stems were affected by an early slight migration and rotation within the first months after surgery, followed by a secondary stable fixation. Dual-energy x-ray absorptiometry (DEXA) studies demonstrated an implant-specific pattern of bone remodelling. Although the vast majority of stems demonstrated a good osseointegration, some prostheses transferred loads particularly to the lateral and distal-medial regions, favouring proximal stress shielding and bone atrophy in the great trochanter and calcar regions.Cite this article: EFORT Open Rev 2018;3:149-159. DOI: 10.1302/2058-5241.3.170052

Safety of vitamin E-infused highwall liners for routine use in primary total hip arthroplasty: single centre, short-term follow-up of 1221 cases

2020 ◽  
pp. 112070002096964
Author(s):  
Kirill Gromov ◽  
Nanna H Sillesen ◽  
Thomas Kallemose ◽  
Henrik Husted ◽  
Henrik Malchau ◽  
...  
Keyword(s):  
Patient Safety ◽  
Vitamin E ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Single Centre ◽  
Short Term ◽  
Total Hip ◽  
Arthroplasty Registry ◽  
Primary Total Hip Arthroplasty

Background: Introduction of new implants should be monitored closely to capture any signs of compromising patient safety. Vitamin E infused highly-crosslinked polyethylene liners (VEPE) offer the potential for reduced wear. Highwall liners have been hypothesised to result in increased wear and potential liner fractures. The aim of this study was to determine the 3–7-year follow-up of highwall VEPE for primary total hip arthroplasty (THA), focusing on liner-related complications. Methods: We included 1221 consecutive THA operations from July 2010 to May 2014 with minimum follow-up of 3 (3.1–6.8) years Data collected included demographics, implant data, complications, reoperations, and deaths. Data were cross-referenced with the Danish Hip Arthroplasty Registry in order to ensure validity and completeness. Acetabular shell position was measured using Martell Hip Analysis Suite in a subgroup of 931 THAs. Results: Cumulative stem revision and shell revision at 3-year follow-up was 3.4% and 0.4% respectively. There were no revisions due to liner failure. Reason for revision included 11 dislocations, 15 soft-tissue revisions for infection, 44 stem revisions of which 34 were periprosthetic fractures and 13 shell revisions of which 6 were combined shell and stem revisions. Conclusion: Early follow-up of VEPE liners for primary THA have not shown any revisions associated with liner failure. Continued monitoring of new materials are necessary to capture any signs of compromised patient safety.

Stemless hip arthroplasty versus traditional implants: a comparative observational study at 30 months follow-up

2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 21-27 ◽  
Author(s):  
Giandomenico Logroscino ◽  
Fabrizio Donati ◽  
Vincenzo Campana ◽  
Michela Saracco
Keyword(s):  
Short Form ◽  
Stress Shielding ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Harris Hip Score ◽  
Retrospective Case ◽  
Chi Square ◽  
Length Discrepancy ◽  
Short Stems

Introduction: The aim of this retrospective case-control study is to evaluate clinical and radiographic results of short stems compared with traditional hip prostheses. Methods: 46 short stems (SS) and 50 traditional stems (TS) were selected. All the stems were implanted by the same surgeon using posterior approach because of primary osteoarthritis, post-traumatic osteoarthritis and avascular necrosis. All the patients were compared clinically by Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF-12F/M) and radiographically (offset, CD angle, limb length discrepancy, cup inclination, subsidence, osseointegration, heterotopic ossification). Radiographic evaluations were carried out by 3 different blinded surgeons. A statistical analysis was performed (chi-square, t-test, Mann-Whitney). Results: At a mean follow-up of 30 months all the implanted stems were well-positioned and osseointegrated. In both groups there was a marked improvement in pain ( p < 0.001) with a statistically significant advantage in the SS group for WOMAC (90.8 vs. 87.5; p = 0.02) and in part for HHS (93 vs. 91.7; p = 0.18). The radiographic evaluations, with high concordance correlation between the 3 blinded surgeons (ICC consistently >0.80), showed no significant differences in the restoration of the articular geometry, with a reduction of cortical hypertrophy (2% SS vs. 7% TS) and periprosthetic stress-shielding ( p < 0.05) in the SS group. On the other hand, SS were more related to limb length discrepancy (61% vs. 33%; p < 0.05). No major complications were recorded in the 2 groups. Conclusion: Short stems were shown to be comparable or better than traditional implants at short-term follow-up.

scholarly journals Safety and Efficacy of Hemispherical with Flattened Pole Dual-Mobility Acetabular Cup in Primary Hip Arthroplasty: The SYMCOR-1 study

2020 ◽  
Author(s):  
Nicolas Bonin ◽  
Gilles Estour ◽  
Jean-Emmanuel Gedouin ◽  
Olivier Guyen ◽  
Frederic Christopher Daoud
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Cobalt Chromium ◽  
Acetabular Cup ◽  
Short Term ◽  
Dual Mobility ◽  
Safety And Efficacy ◽  
Total Hip ◽  
Primary Total Hip Arthroplasty

Abstract Background: This study estimated the short-term clinical safety and efficacy of hemispherical with flattened pole cobalt-chromium metal-back with porous outer hydroxyapatite coating dual-mobility acetabular cup (HFPC-DM-HA) in primary total hip arthroplasty.Methods: Single-center retrospective observational cohort study of consecutive patients undergoing total hip arthroplasty with a HFPC-DM-HA 2 years prior to study start. Prospective 2-year follow-up with letter and phone questionnaires.Results: Sampling frame: 361 patients including 59 patients (16.3%) in the cohort. 6 patients (10%) lost to follow-up. Median age 77.5 years (range: 67 ; 92), 32% female, median BMI 25.2 kg.m-2 (18.4 to 56.8). Clinical indications: Primary THA in all patients, resulting from primary osteoarthritis in 80% of them. Median follow-up 3.0 years (2.7 to 4.1). Primary endpoint: 2-year implant survival rate: 97% [87, 99]. Prosthetic dislocation: 0%. Secondary endpoint: Modified HHS (pain & functional subscore) improved from baseline 39.7 [34.6, 44.7] to 75.8 [72.1, 79.6] at 1-year and to 86.7 [83.7, 89.7] at 2-year follow-up (p<0.0001).Conclusions: The authors deemed the short-term outcomes of this acetabular cup in primary total hip arthroplasty to be satisfactory.Study registration: clinicaltrials.gov NCT04209374.

scholarly journals Clinical and radiological results of high offset tri-lock bone preservation stem in unilateral primary total hip arthroplasty at a minimum follow-up of 3 years

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Linbo Peng ◽  
Jun Ma ◽  
Yi Zeng ◽  
Yuangang Wu ◽  
Haibo Si ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Radiolucent Line ◽  
Stress Shielding ◽  
Ectopic Ossification ◽  
Stem Subsidence ◽  
Radiological Results ◽  
Bone Preservation ◽  
Clinical And Radiological Results ◽  
Primary Total Hip Arthroplasty

Abstract Background Although the high offset Tri-Lock bone preservation stem (BPS) was used widely, few studies explored the clinical and radiological results. The purpose of this study was to determine the clinical and radiological results of high offset Tri-Lock BPS in unilateral primary total hip arthroplasty (THA) at a minimum follow-up of 3 years. Methods 55 patients who underwent cementless THA with high offset Tri-lock BPS from 2017 to 2018 were followed for a minimum follow-up of 3 years. Patients were assessed clinically for complications, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Oxford Hip Score (OHS). Femoral offset (FO), acetabular offset (AO), hip offset (HO), HO difference, and leg length discrepancy (LLD) were measured on the anteroposterior (AP) pelvic radiograph. Standard pelvic AP and lateral radiographs were used to evaluate for evidence of bone ingrowth, stem subsidence, stem alignment, radiolucent line around the stem, osteolysis, loosening, ectopic ossification, and femoral stress shielding. Results No patients reported complications during hospitalization nor the follow-up period. At a mean follow-up of 42.5 months, the mean HHS, WOMAC, and OHS scores showed a significant improvement from preoperative to the latest follow-up. No patients reported thigh pain. No revision nor sign of radiographic loosening had been detected. The high offset Tri-Lock BPS significantly improved the FO and HO postoperatively. HO difference and LLD were balanced postoperatively. No sign of stem subsidence, radiolucent line, osteolysis, loosening, ectopic ossification, nor severe stress shielding (more than grade 3–4) were observed at the latest follow-up. Conclusion The high offset Tri-Lock BPS demonstrated excellent clinical and radiographic outcomes at a minimum follow-up of 3 years. HO difference and LLD between legs decreased significantly and achieved balance postoperatively. Long-term follow-up is required for a definitive conclusion.

scholarly journals Preserved periprosthetic bone stock at 5 years post-operatively with uncemented short hip stem in both collared and collarless version

2021 ◽  
Author(s):  
Ola Belfrage ◽  
Erik Weber ◽  
Martin Sundberg ◽  
Gunnar Flivik
Keyword(s):  
Clinical Outcome ◽  
Bone Remodeling ◽  
Stress Shielding ◽  
Bone Stock ◽  
Mineral Density ◽  
Physiological Loading ◽  
Uncemented Total Hip Arthroplasty ◽  
Registration Number ◽  
Specific Outcome ◽  
Short Stems

Abstract Introduction Previous bone density studies have generally shown bone resorption around both cemented and uncemented total hip arthroplasty (THA) stems. This is presumed to be due to stress shielding. Short stems have been introduced partly to preserve bone in the proximal femur by a more physiological loading of the bone. The purpose of this study was to evaluate bone remodeling around a short, fully hydroxyapatite-coated titanium stem that comes in a collared and collarless version. Patients and methods A prospective cohort of 50 patients included in a study evaluating the Furlong Evolution stem has been followed for 5 years. Examination was done with dual energy X-ray absorptiometry (DXA) postoperatively, at 1, 2 and 5 years. Clinical outcome was followed with radiography and both general and hip specific outcome measures. Results The two versions of the stem behaved similarly regarding bone remodeling. After an initial decrease up to 1 year, bone mineral density (BMD) increased in all Gruen zones up to 2 years and at 5 years bone stock was still preserved compared with postoperatively (net BMD + 1.2% (95% CI − 0.4 to 2.8)). Increase in BMD occurred mainly in the greater trochanter and distally around the stem with a decrease in the calcar area. Both versions showed excellent clinical outcome up to 5 years. Conclusion This short stem seems to preserve proximal bone stock up to 5 years, exhibiting similar behaviour both with and without a collar. Trial registration number and date of registration ClinicalTrials.gov, (identifier: NCT01894854). July 10, 2013.

scholarly journals Short-term clinical and radiological results of two different design metaphyseal fitting femoral stems in total hip arthroplasty: a prospective, randomized trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
I. Tatani ◽  
K. Solou ◽  
A. Panagopoulos ◽  
J. Lakoumentas ◽  
A. Kouzelis ◽  
...  
Keyword(s):  
Stress Shielding ◽  
Harris Hip Score ◽  
Neutral Position ◽  
Complication Rates ◽  
Short Term ◽  
Radiological Results ◽  
Patient Reported ◽  
Femoral Stems ◽  
Clinical And Radiological Results

Abstract Background There is great design variability on short femoral stems available on the market. This study aims to evaluate the short-term clinical and radiological results of two different design short femoral stems, both classified as shortened tapered stems. Methods From March 2016 to March 2018, a prospective, randomized, parallel-group design study was conducted to compare functional and radiological outcomes of 45 patients underwent THA using the Tri-Lock Bone Preservation Stem and 45 patients underwent THA with the Minima S stem at a minimum 2 years of follow-up. Patients were assessed clinically and radiographically prior to surgery as well as at 3, 6, 12, and 24 months postoperatively. Primary outcomes were the change in health-related quality of life assessed with Western Ontario and McMaster Universities Osteoarthritis Index and 36-Item Short Form Health Survey and also the incidence of all hip-related complications. Secondary aims included hip function evaluated with the Harris hip score, rates of patient satisfaction, and the outcomes of a detailed radiological analysis. Results There were no significant differences between the 2 study groups in terms of patient-reported outcomes measurements, satisfaction scores, and complication rates at any of the measurement times. In both groups, stable fixation and radiographic osseointegration were achieved. However, analysis of the calcar region showed that 57.8% and 28.9% of patients had grade 1 or 2 stress shielding, in Tri-Lock and Minima S implantation group, respectively (p=0.015). Regarding coronal alignment, stems were placed in slight varus, valgus, and neutral position in 51.1%, 13.3%, and 35.6% of patients, respectively, in Tri-Lock BPS group. The Minima S stem was implanted at slight varus and valgus in 60% and 40% of patients, respectively, and neither stem in the exact neutral position. Conclusions Both different design short femoral stems demonstrated excellent clinical performance at short-term follow up. Nevertheless, concerns were raised regarding the incidence of stress shielding phenomenon and mild discrepancies in coronal stem alignment during implantation. The clinical impact of these observations should be further evaluated through larger cohorts and longer follow-up. Trial registration ISRCTN registry, ISRCTN10096716. Registered on May 8, 2018—Retrospectively registered

scholarly journals Downsizing in total hip arthroplasty. A short stem as a revision implant

2021 ◽  
Author(s):  
Marcel Coutandin ◽  
Yama Afghanyar ◽  
Philipp Rehbein ◽  
Jens Dargel ◽  
Philipp Drees ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Case Series ◽  
Stress Shielding ◽  
Short Stem ◽  
Total Hip ◽  
The Mean ◽  
Short Stems

Abstract Background Short stems have constantly gained popularity in primary total hip arthroplasty (THA) over the last decade. Although cementless short stems are not primarily designed to be used as revision implants, there may be certain indications for which downsizing the femoral component in failed conventional THA is potentially advantageous. Methods In this single center retrospective case series, six patients who underwent revision using a calcar-guided short stem after failed THA are presented. The mean follow-up was 3.32 years (SD 0.63 years). The health status was evaluated by the EQ-5D-5L score. Patient reported outcome measurements (PROM) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain and satisfaction were assessed using a visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignment and signs of aseptic loosening. Complications were documented. Results At last follow-up the mean EQ-5D-5L index was 0.851 (SD 0.098). Clinical outcome was excellent (HHS ≥ 90) in 4 patients and moderate (HHS 71 and 79) in 2 patients. The mean WOMAC score was 9.20% (SD 12.61%). Pain and satisfaction on VAS were 1.00 (SD 1.15) and 9.17 (SD 0.37), respectively. No major complications occurred. To date, no further revision surgery was needed. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fractures were obvious. Conclusion The present case series indicates that in failed conventional THA downsizing may be considered a treatment option, using short stem THA in selected cases.

Short-Term Follow-Up of the PROSTALAC Implant for Primary Total Hip Arthroplasty in Patients with an Infected Native/Total Hip

2021 ◽  
Author(s):  
Jean Chia ◽  
Alfred Roy ◽  
Emma Jackman ◽  
Mark Inglis ◽  
Christopher Wilson
Keyword(s):  
Standard Treatment ◽  
Symptomatic Relief ◽  
Clinical Results ◽  
Short Term ◽  
Total Hip ◽  
Hip Infection ◽  
Previous Infection ◽  
History Of ◽  
Primary Total Hip Arthroplasty

AbstractInfection after a total hip replacement (THR) is a significant complication for patients and is costly for health services. The two-stage Prosthesis with Antibiotic Loaded Acrylic (PROSTALAC) procedure has been the gold standard treatment for managing THR infections. The aim of this study is to evaluate using a one-stage PROSTALAC procedure as an alternative for patients who would otherwise not be able to undergo THR surgery due to a previous hip infection.We evaluated nine cases where the PROSTALAC implant was used in the native hip. The reasons for surgery, clinical results, and complications were reviewed. An Australian Orthopaedic Association National Joint Replacement Registry data report verified that no patients were revised outside of our local center.All patients reported symptomatic relief and satisfactory function, one patient had a peri-prosthetic fracture after experiencing a fall, and one patient underwent surgery for loosening of the joint. No cases were revised to another implant or had further infection. Minimum follow-up was 2 years.Our results suggest that this implant is useful in patients with osteoarthritis of the hip with a history of previous infection or chronic infection of the native hip.

Two Different Cementless Femoral Components in Primary Total Hip Arthroplasty

2002 ◽  
Vol 12 (3) ◽  
pp. 289-302 ◽  
Author(s):  
E. García-Rey ◽  
A. Coello-Nogués ◽  
E. Caicoya-Abati
Keyword(s):  
Hip Replacement ◽  
First Generation ◽  
Second Generation ◽  
Bone Remodelling ◽  
Stress Shielding ◽  
Total Hip ◽  
Femoral Stems ◽  
Femoral Osteolysis ◽  
Primary Total Hip Arthroplasty

The results of first (51 Harris-Galante stems with an average follow-up of 12.3 years) and second generation (53 MultiLock stems with an average of 6.4 years) cementless femoral stems in total hip replacement were analysed. Ten Harris-Galante stems were revised (9.8% at 8 years and 22.8% at 13 years) and one unstable MultiLock stem (2.6% at 8 years). Thirty-seven Harris-Galante and 45 MultiLock stems were osseo-integrated. Femoral osteolysis was seen in 21 Harris-Galante (26.6% at 8 years and 43.7% at 13 years) and in 3 MultiLock stems (8.0% at 8 years). At intermediate follow-up, second generation stems show less bone remodelling changes than first generation stems at the same interval. Distal osteolysis and pronounced stress-shielding have not been encountered in second generation stems.

The Link Between Verbal Short-Term Memory and Anomia Treatment Gains

2019 ◽  
Vol 28 (3) ◽  
pp. 1039-1052
Author(s):  
Reva M. Zimmerman ◽  
JoAnn P. Silkes ◽  
Diane L. Kendall ◽  
Irene Minkina
Keyword(s):  
Short Term Memory ◽  
Controlled Trial ◽  
Treatment Success ◽  
Linear Regression Models ◽  
Language Performance ◽  
Short Term ◽  
Term Memory ◽  
Treatment Gains ◽  
Post Hoc

Purpose A significant relationship between verbal short-term memory (STM) and language performance in people with aphasia has been found across studies. However, very few studies have examined the predictive value of verbal STM in treatment outcomes. This study aims to determine if verbal STM can be used as a predictor of treatment success. Method Retrospective data from 25 people with aphasia in a larger randomized controlled trial of phonomotor treatment were analyzed. Digit and word spans from immediately pretreatment were run in multiple linear regression models to determine whether they predict magnitude of change from pre- to posttreatment and follow-up naming accuracy. Pretreatment, immediately posttreatment, and 3 months posttreatment digit and word span scores were compared to determine if they changed following a novel treatment approach. Results Verbal STM, as measured by digit and word spans, did not predict magnitude of change in naming accuracy from pre- to posttreatment nor from pretreatment to 3 months posttreatment. Furthermore, digit and word spans did not change from pre- to posttreatment or from pretreatment to 3 months posttreatment in the overall analysis. A post hoc analysis revealed that only the less impaired group showed significant changes in word span scores from pretreatment to 3 months posttreatment. Discussion The results suggest that digit and word spans do not predict treatment gains. In a less severe subsample of participants, digit and word span scores can change following phonomotor treatment; however, the overall results suggest that span scores may not change significantly. The implications of these findings are discussed within the broader purview of theoretical and empirical associations between aphasic language and verbal STM processing.

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