Distal femoral stem tip resection for thigh pain complicating uncemented total hip arthroplasty. Five patients followed up for 6-10 years

2006 ◽  
Vol 16 (3) ◽  
pp. 210-214
Author(s):  
L. Kandel ◽  
M. Kligman ◽  
R. Sekel
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Thigh Pain ◽  
Total Hip ◽  
Uncemented Total Hip Arthroplasty

Definition and validation of a system for classifying the undersized Corail femoral stem in total hip arthroplasty

2021 ◽  
pp. 112070002199600
Author(s):  
Jamie S McConnell ◽  
Farhan A Syed ◽  
Paul Saunders ◽  
Raviprasad Kattimani ◽  
Anthony Ugwuoke ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Classification System ◽  
Femoral Stem ◽  
Observer Agreement ◽  
Stem Size ◽  
Total Hip ◽  
Initial Fixation ◽  
Uncemented Total Hip Arthroplasty ◽  
Hip Arthroplasties

Introduction: The uncemented total hip arthroplasty relies on a secure initial fixation of the femoral stem to achieve osseointegration. Undersizing of the femoral implant compromises this. Surgeons routinely review postoperative radiographs to assess appropriate sizing, but existing methods of assessment lack standardisation. We present a system of accurately and reliably classifying radiological undersizing, which will help us better understand the factors that might have led to undersizing. Aim: To describe and evaluate a classification system for assessing radiological undersizing of the uncemented stem in hip arthroplasty. Method: We conducted a retrospective review of 1,337 consecutive hip arthroplasties using the Corail stem. Two independent investigators reviewed post-operative radiographs and classified them as either appropriately sized or undersized. Undersized stems were sub-categorised into four subtypes: uniformly undersized, varus undersized, valgus undersized or ‘cocktail-glass’ undersized. Inter- and intra-observer agreement was determined. The accuracy of our classification system was validated by comparison with digital re-templating. We further assessed patient demographics and stem size in relation to sizing. Results: 1 in 5 cases (19.75%) were deemed radiologically undersized. The commonest subtypes of undersizing were uniformly (47%) and varus (39%) undersized. When assessing sizing and subtype categorisation, inter-observer agreement was 89–92% and intra-observer agreement 86%. Classification decisions showed 92% and 97% accuracy for uniformly undersizing and varus undersizing respectively when validated against digital re-templating. Age, gender and smaller stem size were significantly associated with radiological undersizing. The Corail KLA model (125° neck) was found to have a higher incidence of stems undersized in varus. Conclusions: This study describes and validates a classification system for the analysis of radiological undersizing.

A Study of Thigh Pain in Uncemented Total Hip Arthroplasty

2003 ◽  
Vol 2003.7 (0) ◽  
pp. 141-142
Author(s):  
Ryota SHIMIZU ◽  
Ikuya NISHIMURA ◽  
Toshiki NAKAMURA ◽  
Takeo MATSUNO ◽  
Yoshinori MITAMURA
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Thigh Pain ◽  
Total Hip ◽  
Uncemented Total Hip Arthroplasty

scholarly journals Impact of Femoral Stem Prosthesis Tip On Femoral Cortex After Primary Total Hip Arthroplasty (THA)

2021 ◽  
Author(s):  
Yang Zhang ◽  
Qiang Wang ◽  
Qi Cheng ◽  
Dasai Wang ◽  
Jian Cheng ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Thigh Pain ◽  
Harris Hip Score ◽  
Total Hip ◽  
Femoral Cortex ◽  
Increased Risk ◽  
The Impact ◽  
Primary Total Hip Arthroplasty

Abstract Background: The mechanisms of pain after total hip arthroplasty (THA) is not clear, which may be related to its impact on the femoral cortex caused by improper prosthesis placement. This study was to explore the the impact of the femoral stem prosthesis on the femoral cortex after implantation, and its relationship with postoperative thigh pain. Methods: Totally 172 patients who underwent primary THA were retrospectively analyzed, who were divided into the impact (n=25) and non-impact (n=147) groups. Contact or penetration of the femoral stem prosthesis tip with the distal femoral cortex was defined as impingement. Patients were followed up and recorded.Results: In the patients undergoing primary THA, 25 patients (14.5%) had impact, including 7 males and 18 females. Most of the patients in the impact group were women of small stature. In the impact group, the postoperative thigh pain was more obvious, and the Harris Hip score (HHS) was lower, compared with the non-impact group (P < 0.05). The regression analysis showed that height (OR=1.196; 95%CI: 1.059-1.351; P=0.004) and prosthesis implant angle (PIA) (OR=0.208; 95%CI: 0.074-0.584; P=0.003) were important risk factors for distal femoral cortical impingement in patients who underwent THA. Conclusions: Patients with short stature should have adequate preoperative planning for primary THA, to prevent increased risk of postoperative thigh pain due to impinging femoral stem implants.

scholarly journals Malalignment and Distal Contact of Short Tapered Stems Could be Associated with Postoperative Thigh Pain in Primary Total Hip Arthroplasty

2020 ◽  
Author(s):  
Zhijie Chen ◽  
Bin Li ◽  
Kaizhe Chen ◽  
Jianmin Feng ◽  
Yi Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Thigh Pain ◽  
Type I ◽  
Radiographic Findings ◽  
Total Hip ◽  
Femoral Stems ◽  
Tapered Stem ◽  
Primary Total Hip Arthroplasty

Abstract Purpose Short tapered stem placement has been extensively employed in total hip arthroplasty (THA). Suboptimal fixation tends to cause postoperative complications, such as thigh pain. However, it remains unclear whether poor seating/alignment of short tapered stems contributes to thigh pain. In this study, we retrospectively examined the factors that might be associated with the thigh pain. Methods Medical records of 230 patients who had undergone THAs at our hospital were reviewed retrospectively. All patients received the same mediolateral (ML) short tapered femoral stems. The association between thigh pain and patients’ demographics, radiographic findings, or the type of fitting of the femoral stems was investigated.Results In our cohort, 68 patients (27.8%) presented with thigh pain. Among 203 type I fit patients, 62 (30.5%) developed thigh pain, while only 6 out of 43 (12.2%) type II fit patients had thigh pain, with the differences being statistically significant (x2=6.706, p=0.01). In addition, hip anteroposterior radiographs exhibited that the stem angulation (mean 2.52°), variation in angulation (mean 1.32°), and the extent of femoral stem subsidence (mean 0.29cm) were greater in patients with thigh pain than in their counterparts without thigh pain (all p<0.05). Conclusion Malalignment and improper seating of short tapered stems could be at least one of the reasons for post-THA thigh pain. The distal contact between the stem tip and medial femoral cortex might result in thigh pain. Our study suggested that distal implant contact should be avoided, and stem alignment should be meticulously performed in the placement of ML short tapered femoral stems for THA.

scholarly journals Malalignment and distal contact of short tapered stems could be associated with postoperative thigh pain in primary total hip arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zhijie Chen ◽  
Bin Li ◽  
Kaizhe Chen ◽  
Jianmin Feng ◽  
Yi Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Thigh Pain ◽  
Type I ◽  
Radiographic Findings ◽  
Total Hip ◽  
Femoral Stems ◽  
Tapered Stem ◽  
Primary Total Hip Arthroplasty

Abstract Purpose Short tapered stem placement has been extensively employed in total hip arthroplasty (THA). Suboptimal fixation tends to cause postoperative complications, such as thigh pain. However, it remains unclear whether poor seating/alignment of short tapered stems contributes to thigh pain. In this study, we retrospectively examined the factors that might be associated with thigh pain. Methods Medical records of 230 patients who had undergone THAs at our hospital were reviewed retrospectively. All patients received the same mediolateral (ML) short tapered femoral stems. The association between thigh pain and patients’ demographics, radiographic findings, or the type of fitting of the femoral stems was investigated. Results In our cohort, 68 patients (27.8%) presented with thigh pain. Among 203 type I fit patients, 62 (30.5%) developed thigh pain, while only 6 out of 43 (12.2%) type II fit patients had thigh pain, with the differences being statistically significant (x2 = 6.706, p = 0.01). In addition, hip anteroposterior radiographs exhibited that the stem angulation (mean 2.52°), the variation in angulation (mean 1.32°), and the extent of femoral stem subsidence (mean 0.29 cm) were greater in patients with thigh pain than in their counterparts without thigh pain (all p < 0.05). Conclusion Malalignment and improper seating of short tapered stems could be at least one of the reasons for post-THA thigh pain. The distal contact between the stem tip and the medial femoral cortex might result in thigh pain. Our study suggested that distal implant contact should be avoided, and stem alignment should be meticulously performed in the placement of ML short tapered femoral stems for THA.

scholarly journals Value of 3D Preoperative Planning for Primary Total Hip Arthroplasty Based on Biplanar Weightbearing Radiographs

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Y. Knafo ◽  
F. Houfani ◽  
B. Zaharia ◽  
F. Egrise ◽  
I. Clerc-Urmès ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Preoperative Planning ◽  
Femoral Stem ◽  
Leg Length ◽  
Femoral Offset ◽  
Postoperative Result ◽  
Total Hip ◽  
Planning Software ◽  
Navigated Surgery

Two-dimensional (2D) planning on standard radiographs for total hip arthroplasty may not be sufficiently accurate to predict implant sizing or restore leg length and femoral offset, whereas 3D planning avoids magnification and projection errors. Furthermore, weightbearing measures are not available with computed tomography (CT) and leg length and offset are rarely checked postoperatively using any imaging modality. Navigation can usually achieve a surgical plan precisely, but the choice of that plan remains key, which is best guided by preoperative planning. The study objectives were therefore to (1) evaluate the accuracy of stem/cup size prediction using dedicated 3D planning software based on biplanar radiographic imaging under weightbearing and (2) compare the preplanned leg length and femoral offset with the postoperative result. This single-centre, single-surgeon prospective study consisted of a cohort of 33 patients operated on over 24 months. The routine clinical workflow consisted of preoperative biplanar weightbearing imaging, 3D surgical planning, navigated surgery to execute the plan, and postoperative biplanar imaging to verify the radiological outcomes in 3D weightbearing. 3D planning was performed with the dedicated hipEOS® planning software to determine stem and cup size and position, plus 3D anatomical and functional parameters, in particular variations in leg length and femoral offset. Component size planning accuracy was 94% (31/33) within one size for the femoral stem and 100% (33/33) within one size for the acetabular cup. There were no significant differences between planned versus implanted femoral stem size or planned versus measured changes in leg length or offset. Cup size did differ significantly, tending towards implanting one size larger when there was a difference. Biplanar radiographs plus hipEOS planning software showed good reliability for predicting implant size, leg length, and femoral offset and postoperatively provided a check on the navigated surgery. Compared to previous studies, the predictive results were better than 2D planning on conventional radiography and equal to 3D planning on CT images, with lower radiation dose, and in the weightbearing position.

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