Tapered wedge stems decrease early postoperative subsidence following cementless total hip arthroplasty in Dorr type C femurs compared to fit-and-fill stems

2021 ◽  
Author(s):  
Satoshi Ikemura ◽  
Goro Motomura ◽  
Satoshi Hamai ◽  
Masanori Fujii ◽  
Shinya Kawahara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Stem Subsidence ◽  
Cementless Total Hip Arthroplasty ◽  
Stem Group ◽  
Significant Difference ◽  
Type C ◽  
The Mean ◽  
Fit And Fill

Abstract Background: To compare the degree of stem subsidence between two different femoral component designs and to determine the risk factors associated with stem subsidence after cementless total hip arthroplasty (THA) in Dorr type C femurs. Methods: We retrospectively reviewed 91 consecutive hips in 87 patients with Dorr type C proximal femoral morphology who underwent primary cementless THA using a fit-and-fill stem or a tapered wedge femoral stem at our institution between January 2013 and June 2020. A fit-and-fill stem was used in 48 hips and a tapered wedge stem was used in 43 hips. Radiologically, the distance between the apex of the major trochanter and the stem shoulder were measured at three different time points (immediately [0W], one week [1W], and six weeks [6W] after surgery) and the degrees of stem subsidence were assessed by comparing the distance between 0W and 1W, 1W and 6W, and 0W and 6W, respectively. Results: The mean degree of stem subsidence (0W vs. 1W) was 0.25 mm (standard deviation [SD] 0.58) in the fit-and-fill stem group, and 0.24 mm (SD 0.43) in the tapered wedge stem group. There was no significant difference between the two groups (P = 0.4493). However, the mean degrees of subsidence were significantly higher in the fit-and-fill stem group (1W vs. 6W, 0.38 mm [SD 0.81]; 0W vs. 6W, 0.64 mm [SD 1.17]) than in the tapered wedge stem group (1W vs. 6W, 0.17 mm [SD 0.29]; 0W vs. 6W, 0.25 mm [SD 0.35]) (P < 0.05 for both). In addition, the rates of >3 mm subsidence (in which instability can be observed) were 16.7% (8 of 48 hips) and 2.3% (1 of 43 hips), respectively. There was also a significant difference between the two stems (P = 0.0324). Multivariate analysis demonstrated that higher age and fit-and-fill stem were risk factors for >3 mm subsidence after THA in Dorr type C femurs (P = 0.0396 and 0.0227, respectively). Conclusion: Our findings suggest that the tapered wedge stem is more suitable for Dorr type C femurs than the fit-and-fill stem to avoid early postoperative subsidence in cementless THA.

scholarly journals 32-mm ceramic-on-ceramic total hip arthroplasty versus 28-mm ceramic bearings: 5- to 15-year follow-up study

2018 ◽  
Vol 29 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Yoshitoshi Higuchi ◽  
Taisuke Seki ◽  
Yukiharu Hasegawa ◽  
Yasuhiko Takegami ◽  
Daigo Morita ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Total Hip ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Average Patient ◽  
The Mean ◽  
Ceramic On Ceramic

Introduction: This study aimed to compare the clinical and radiographic results of 28-mm ceramic-on-ceramic (CoC) total hip arthroplasty (THA) to those of 32-mm CoC during a 5- to 15-year follow-up period. Methods: 107 joints (95 women and 6 men) underwent 28-mm CoC, and 60 (49 women and 7 men) underwent 32-mm CoC. The average patient age at the time of surgery was 56.1 and 55.7 years in the 28-mm and 32-mm CoC groups, respectively. Clinical and radiologic measurements of all patients were analysed. Results: The mean preoperative Harris hip score (HHS) was similar in the 2 groups (28-mm, 58.9; and 32-mm, 58.5). However, at final follow-up, the mean HHS of the 32-mm CoC (91.8) was significantly better than that of the 28-mm CoC (88.2) ( p = 0.003), as were the ranges of motion (ROM) for flexion (98.3 ± 13.5° vs. 87.3 ± 19.3°, p < 0.001) and abduction (27.8 ± 14.9° vs. 22.1 ± 19.3°, p = 0.007). The mean wear rate was 0.0044 mm/year for the 28-mm CoC and 0.0044 mm/year for the 32-mm CoC. No ceramic fractures were found in the 2 groups. One joint in the 28-mm CoC (0.9%) required revision owing to progressive osteolysis. Kaplan-Meier survival at 10 years, with implant loosening or revision THA as the endpoint, was 98.3% for 28-mm CoC and 100% for 32-mm CoC ( p = 0.465). Conclusion: There was no significant difference in ceramic-related complications between the 2 groups. Our study demonstrated that the 32-mm and 28-mm CoC are safe and are associated with good clinical outcomes.

Outcome and Risk Factors Associated with Failures of Isolated Bearing Exchange for Osteolysis in Well-Fixed Cementless Total Hip Arthroplasty

2021 ◽  
Vol 36 (1) ◽  
pp. 255-260 ◽  
Author(s):  
Wenhao Chen ◽  
Christian Klemt ◽  
Anand Padmanabha ◽  
Venkatsaiakhil Tirumala ◽  
Liang Xiong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Factors Associated ◽  
Total Hip ◽  
Cementless Total Hip Arthroplasty

scholarly journals Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty

2015 ◽  
Vol 87 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Simo S A Miettinen ◽  
Tatu J Mäkinen ◽  
Inari Kostensalo ◽  
Keijo Mäkelä ◽  
Heini Huhtala ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Total Hip ◽  
Cementless Total Hip Arthroplasty

scholarly journals High conversion rate to total hip arthroplasty after hemiarthroplasty in young patients with a minimum 10 years follow‐up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nam Hoon Moon ◽  
Won Chul Shin ◽  
Min Uk Do ◽  
Sang Woo Kang ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Conversion Rate ◽  
High Conversion ◽  
High Conversion Rate ◽  
The Mean ◽  
Acetabular Erosion

Abstract Background This study aimed to evaluate the follow-up results of bipolar hemiarthroplasty (BHA) for more than 10 years in patients aged < 60 years and to analyze the risk factors for acetabular erosion after BHA. Methods This retrospective study included 114 patients who underwent BHA were followed-up for at least 10 years. The mean age was 54.1 years, and the mean follow-up duration was 13.8 years. The patients were divided into two groups according to the presence of acetabular erosion, and the preoperative parameters were compared between the two groups. Moreover, the risk factors related to acetabular erosion after BHA were analyzed using statistical comparisons. Results Reoperation was performed in 44 of the 114 patients (38.6 %). The survival rate when the end point was reoperation related to acetabular erosion was found to be significantly time-dependent: 73.2 % at 5 years, 48.8 % at 10 years, and 25.9 % at 15 years. The acetabular erosion group showed significantly younger age at the time of surgery, higher body mass index (BMI), more avascular necrosis of the femoral head, and smaller prosthetic femoral head. The final multivariate logistic regression analysis showed that young age at the time of surgery were independent risk factors for acetabular erosion after BHA in patients aged < 60 years. Conclusions The minimum 10-year follow-up outcomes of BHA in patients aged < 60 years showed a relatively high conversion rate to total hip arthroplasty. When considering BHA in younger patients, more careful decisions should be made with respect to patient’s choice, keeping in mind that long-term survival cannot be guaranteed.

scholarly journals Periprosthetic fragility fracture of the femur after primary cementless total hip arthroplasty

2021 ◽  
Author(s):  
Masanobu Hirao ◽  
Kazumasa Miyatake ◽  
Ryohei Takada ◽  
Tetsuya Tachibana ◽  
Atsushi Okawa ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Fragility Fracture ◽  
Survival Rates ◽  
Stress Shielding ◽  
Epidemiological Data ◽  
Total Hip ◽  
Cementless Total Hip Arthroplasty ◽  
End Point ◽  
Significant Difference

ABSTRACT Objectives Periprosthetic bone fragility due to stress shielding (SS) can be a risk factor of periprosthetic fracture after cementless total hip arthroplasty (THA). We aimed to obtain epidemiological information on periprosthetic fragility fracture of the femur (PPFF) after THA. Methods We retrospectively reviewed the medical records of 1062 hips that had undergone cementless THA. We evaluated the epidemiological data as well as the features of PPFFs. Results Of the 1062 hips, 8 (0.8%) were diagnosed with PPFFs. The survival rates, with the occurrence of PPFF as the end point, were 99.2% and 97.6% at 10 and 16 years postoperatively, respectively. When patients were classified as having either mild or severe SS on radiographs 5 years postoperatively, there was no significant difference in the survival rate, with PPFF as the end point. Conclusions In our cases, the incidence of PPFF after cementless THA was 0.8%.

scholarly journals Cementless total hip arthroplasty for failed treatment of subtrochanteric fracture

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sheng-Yu Jin ◽  
Jing-Yao Jin ◽  
Min-Gwang Kim ◽  
Woo-Jong Kim ◽  
Taek-Rim Yoon ◽  
...  
Keyword(s):  
Survival Rate ◽  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Subtrochanteric Fracture ◽  
Subtrochanteric Fractures ◽  
Cementless Total Hip Arthroplasty ◽  
Previously Treated ◽  
The Mean

Abstract Background Failed treatment of subtrochanteric fractures commonly leads to pain, limping, and poor limb function. Cementless total hip arthroplasty (THA) could serve as an efficient salvage procedure in such cases. This study aimed to evaluate the outcomes and complications of salvage THA in failed subtrochanteric fracture fixation cases. Methods From January 2001 to December 2017, cementless THA for failed treatment of subtrochanteric fractures was performed in 18 hips of 11 men and 7 women (average age, 74 years; age range, 57.0–89.0 years). Patients were followed up for clinical and radiological assessments in terms of implant survival and complications after a minimum follow-up of 2 years. The Wagner femoral stems (Zimmer, Warsaw, USA) were used in all 18 patients (100%), with the long-length stem (Wagner SL stem) and standard-length stem (Wagner cone stem) used in 11 and 7 patients, respectively. Results The mean follow-up period was 5.2 years (range: 2.2–10.8 years). The mean Harris hip score (HHS) was 38.2 (range: 24–56) preoperatively and 85.4 (range: 79–92) at the last follow-up. The mean postoperative limb length discrepancy was 6.4 mm (range: 4–9 mm). Only one patient underwent revision due to bone in-growth failure of the femoral stem. One patient had an episode of postoperative dislocation and was treated with closed reduction without reoccurrence. Delayed union of the fracture site occurred in one patient. Patients who were previously treated with an intramedullary nail had a significantly shorter surgical duration, lesser intraoperative blood loss, and fewer blood transfusions than those who were previously treated with plate and screws. Kaplan–Meier survival rate with an endpoint of revision was 94.4% (95% confidence interval 72.7–99.9) at 5 years. Conclusion Our results indicate that cementless THA is a beneficial and effective procedure for salvaging the failed treatment of subtrochanteric fractures. The Wagner conical prosthesis has shown satisfactory function outcomes, stable fixation, and survival rate for these complex situations. However, attention should be paid to increased operation time, blood loss, and complications when performing THA for subtrochanteric fractures with failed fixation devices especially, plates and screws.

scholarly journals Functional and radiographical results of asymmetrically reconstructed total hip arthroplasty in patients with bilateral dysplastic arthritic hips with one hip Crowe II–III and the other Crowe IV: a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Junmin Shen ◽  
Jingyang Sun ◽  
Yinqiao Du ◽  
Bohan Zhang ◽  
Tiejian Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
The Other ◽  
Anatomical Reconstruction ◽  
Center Of Rotation ◽  
Total Hip ◽  
Anatomical Position ◽  
Significant Difference ◽  
The Mean

Abstract Background The study aimed to evaluate the functional and radiographical results of asymmetrically reconstructed total hip arthroplasty in patients with bilateral dysplastic arthritic hips with one hip Crowe II–III and the other hip Crowe IV. Materials and methods From April 2006 to April 2019, we evaluated 23 patients who had a reconstruction of one Crowe II–III hip with high hip center (HHC) and the other Crowe IV hip at the anatomical position (H group). The radiographic and clinical outcomes were compared with those of a control group of 19 patients with bilateral dysplasia who had one Crowe IV hip and the contralateral hip both reconstructed in the anatomical position (A group). Medical records and radiographs were reviewed, and a complete follow-up was conducted for all patients. Results The mean vertical center of rotation (V-COR) and horizontal center of rotation (H-COR) in the H group were 30.6 ± 5.8 mm and 30.0 ± 5.5 mm, respectively. In the A group, the corresponding values were 14.0 ± 4.3 mm and 23.0 ± 2.3 mm, respectively. A significant difference was found in terms of V-COR and H-COR between the two groups, and no significant difference was shown regarding the cup inclination, abductor lever arm (ALA), ALA ratio, and leg length discrepancy (LLD). Three patients of the H group and four patients of the A group exhibited LLD > 10 mm. All seven patients who had LLD > 10 mm underwent the shortening subtrochanteric osteotomy (SSTO) of the Crowe IV hip. Subgroup analysis based on the presence and absence of SSTO showed that the LLD of the SSTO group was greater than that of the non-SSTO group in both groups, but the difference was only statistically significant in the A group. At the last follow-up, the mean Harris Hip Scores significantly improved in the two groups, and there was no revision during the follow-up period. In the H group, four patients presented with a slight limp and three patients with a moderate limp, while it was six patients and one patient in the A group, respectively. Conclusions Asymmetrical reconstruction in patients with bilateral dysplastic arthritic hips with one hip Crowe II–III and the other Crowe IV is acceptable and comparable when compared with bilateral anatomical reconstruction. Level of evidence III, retrospective observational study. Trial registration Chinese Clinical Trail Registry. ChiCTR2000033848

scholarly journals Exeter total hip arthroplasty with matte or polished stems

Medicina ◽  
2007 ◽  
Vol 43 (3) ◽  
pp. 215 ◽  
Author(s):  
Alfredas Smailys ◽  
Šarūnas Tarasevičius ◽  
Uldis Kesteris ◽  
Romas Kalesinskas ◽  
Hans Wingstrand
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Survival Rates ◽  
Implant Survival ◽  
Total Hip ◽  
Stem Group ◽  
Significant Difference ◽  
Matte Surface ◽  
Stem Type ◽  
The Relationship

Objective. To compare implant survival rates after total hip arthroplasty with Exeter matte or polished stems and to determine the relationship of synovitis/joint effusion to signs of implant loosening and stem type. Material and methods. The first part of the study included retrospective revision rate analysis of 118 primary hip replacements performed during 1991–1995. Two different designs of Exeter stems were used: matte surface stems during 1991–1995 (matte surface group – 47 cases), and polished stems during 1992–1995 (polished stem group – 71 cases). During the second part of the study, 24 patients (11 in polished stem group and 13 in matte stem group) were prospectively examined with radiography and sonography. Sonography was performed in order to evaluate capsular distension, i.e. the distance between prosthetic femoral neck and anterior capsule. Capsular distension depends on synovitis and/or synovia in prosthetic hip. The relationship between capsular distension, stem type, and radiographic signs of loosening was assessed. Results. For the first part of our study, total implant survival was 78% with matte stems and 61% with polished stems 13 years postoperatively (P=0.27). Stem survival was 82% for matte stems, and 88% for polished stems (P=0.54). In the second part of study, a significant relationship between increased capsular distension and cup loosening was determined (P=0.04). We did not find significant difference in capsular distension when compared matte and polished stems. Conclusion. Implant survival rates did not differ between the groups. The relationship between capsular distension and cup loosening was statistically significant.

scholarly journals Relationship Between the Accuracy of Acetabular Cup Angle and Body Mass Index in Posterolateral Total Hip Arthroplasty With CT-Based Navigation: A Retrospective Case-Control Study

2020 ◽  
Author(s):  
Hisatoshi Ishikura ◽  
Masaki Nakamura ◽  
Hanae Nishino ◽  
Shigeru Nakamura ◽  
Takeyuki Tanaka ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Significant Difference ◽  
The Mean ◽  
Navigation Errors ◽  
The Relationship

Abstract Background: Precise acetabular cup placement is essential for successful total hip arthroplasty (THA). In obese patients, its accuracy is often difficult to achieve because of the thickness of the soft tissues. This study aimed to determine the relationship between the accuracy of acetabular cup angle and body mass index (BMI) in posterolateral THA using the computed tomography-based navigation (CT-navi) system.Methods: We retrospectively reviewed 145 consecutive primary THAs using the CT-navi system between January 2015 and January 2018. All surgeries were performed using cementless cups employing the posterolateral approach with the patient in the decubitus position. We compared the radiographic inclination and anteversion obtained from the angle displayed on the CT-navi screen with those measured by the postoperative CT using the three-dimensional templating software. We evaluated the relationship between the extent of errors and correlation with BMI. Statistical analyses were performed using the Student’s t-test and Spearman’s rank coefficient test.Results: In non-overweight patients (BMI < 25, 88 hips), the mean navigation errors for inclination were 2.8 ± 2.2° and for anteversion were 2.6 ± 2.3°. Meanwhile, in overweight patients (BMI ≥ 25, 57 hips), the mean navigation errors were 2.6 ± 2.4° for inclination and 2.4 ± 2.4° for anteversion. We found no significant difference between overweight and non-overweight patients in both inclination and anteversion. The Spearman’s rank correlation coefficients were -0.04 for inclination and -0.11 for anteversion, showing no correlation between the extent of errors and BMI.Conclusions: In posterolateral THA, CT-navi can aid the precise placement of the acetabular cup irrespective of a patient’s BMI.Trial registration: This trial was retrospectively registered and approved by the institutional ethics committee of Teikyo University. The registration number is 17-190, and the date of approval was March 1, 2018. URL of trial registry is: https://www.teikyo-u.ac.jp/application/files/7015/8432/1341/2016_all_syounin_1.pdf

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