Femoral Stem Subsidence and its Associated Factors after Cementless Bipolar Hemiarthroplasty in Geriatric Patients

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.

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Femoral Stem Displacement During Closed Reduction of a Dislocated Bipolar Hemiarthroplasty of the Hip

Orthopedics ◽

10.3928/01477447-20100104-28 ◽

2010 ◽

Vol 33 (2) ◽

pp. 118-121 ◽

Cited By ~ 4

Author(s):

Ho Hyun Yun ◽

Jung Ho Park ◽

Jong Woong Park ◽

Jae Wook Lee

Keyword(s):

Closed Reduction ◽

Femoral Stem ◽

Bipolar Hemiarthroplasty

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Comparison of Bone Preservation in Elderly Patients with Femoral Neck Fracture After Bipolar Hemiarthroplasty Using Shorter Femoral Stem and Standard Femoral Stem

Indian Journal of Orthopaedics ◽

10.1007/s43465-020-00115-5 ◽

2020 ◽

Vol 54 (6) ◽

pp. 868-878

Author(s):

Jae-Young Lim ◽

Hyeong-Jun Park ◽

Young-Kyun Lee ◽

Yong-Chan Ha ◽

Kyung-Hoi Koo

Keyword(s):

Femoral Neck ◽

Elderly Patients ◽

Femoral Neck Fracture ◽

Femoral Stem ◽

Bipolar Hemiarthroplasty ◽

Bone Preservation ◽

Neck Fracture

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Mid-term Subsidence and Periprosthetic Radiolucency of the AMIStem: A 5-year EBRA-FCA Analysis

10.21203/rs.3.rs-88632/v1 ◽

2020 ◽

Author(s):

Julian Hasler ◽

Andreas Flury ◽

Dimitris Dimitriou ◽

Iris Holweg ◽

Naeder Helmy ◽

...

Keyword(s):

Aseptic Loosening ◽

Clinical Outcomes ◽

Femoral Stem ◽

Direct Anterior Approach ◽

Short Stem ◽

Related Factors ◽

Stem Subsidence ◽

Metaphyseal Bone ◽

Short Stems

Abstract Background: There has been an evolution in cementless total hip arthroplasty (THA) with newer short stem designs aim to preserve metaphyseal bone stock and facilitate implantation through minimally invasive approaches. While early subsidence has been correlated to aseptic loosening in conventional stems, there is a paucity of data regarding short stems. The current study aims to report on stem subsidence and midterm clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, specifically designed for the direct anterior approach (DAA).Methods: 94 consecutive patients (100 hips) with a minimum follow-up of 5 years following cementless THA were included in this single-center retrospective study. Subsidence was evaluated using the “Ein-Bild-Roentgen-Analyse” (EBRA). Periprosthetic radiolucency allocated to the Zones of Charnley and Gruen was assessed. Additionally, demographic and implant-related factors potentially associated with increased subsidence and clinical outcomes were evaluated.Results: At the last follow-up, the average stem subsidence was 1.98 ± 1.20 mm, with 48% of the implants demonstrating subsidence of > 2 mm. Periprosthetic radiolucency of > 2 mm was found in 26% of the implants in Zone 1, and in 9% in Zone 7, respectively. Neither the amount of subsidence nor proximal periprosthetic radiolucency was associated with aseptic loosening or worse clinical outcomes. Conclusions: Comparable to other proximally-fixed short stem designs, the highest subsidence was observed within the first 3 months following implantation. No demographic or implant-related factors were found to have a statistically significant influence on stem subsidence. Periprosthetic radiolucency and subsidence of the AMISstem is not correlated with worse clinical outcomes at 5-years follow-up.

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Bipolar Hemiarthroplasty Using Non-cemented Multilock Femoral Stem: A 7-year Minimum Follow-up Study

The Journal of the Korean Hip Society ◽

10.5371/jkhs.2006.18.3.85 ◽

2006 ◽

Vol 18 (3) ◽

pp. 85

Author(s):

Sang Won Park ◽

Soon Hyuck Lee ◽

Seung Bum Han ◽

Woong Kyo Jeong ◽

Sang Beom Kim ◽

...

Keyword(s):

Femoral Stem ◽

Bipolar Hemiarthroplasty ◽

Follow Up Study

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Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2980-7 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Michael O. Schaer ◽

Michael Finsterwald ◽

Iris Holweg ◽

Dimitris Dimitriou ◽

Alexander Antoniadis ◽

...

Keyword(s):

Femoral Stem ◽

Invasive Approach ◽

Factors Affecting ◽

Stem Size ◽

Stem Subsidence ◽

Single Center Study ◽

Short Femoral Stem ◽

Migration Analysis ◽

Stem Migration

Abstract Background Early femoral stem subsidence following a cementless THA is correlated with aseptic loosening of the femoral component. The short femoral stems allow bone sparing and implantation through a minimally invasive approach; however, due to their metaphyseal anchoring, they might demonstrate different subsidence pattern than the conventional stems. Methods In this prospective single-center study, a total of 68 consecutive patients with an average age of 63 years, and a minimum follow-up of 5 years following a cementless THA with a metaphyseal-anchored short femoral stem were included. The femoral stem subsidence was evaluated using “Ein Bild Roentgen Analyse” (EBRA). Results Average stem migration was 0.96 +/− 0.76 mm at 3 months, 1.71 +/− 1.26 mm at 24 months, and 2.04+/− 1.42 mm at last follow-up 60 months postoperative. The only factor that affected migration was a stem size of 6 or more (r2 = 5.74; p = 0.039). Subdivision analysis revealed, that only in females migration appeared to be affected by stem size irrespective of weight but not in men (female stem size of 6 or more vs. less (Difference = − 1.48 mm, R2 = 37.5; p = 0.001). Migration did not have an impact on clinical outcome measures. Conclusions The examined metaphyseal-anchored short femoral stem showed the highest subsidence within the first 3 months postoperative, the implant began to stabilize at about 24 months but continued to slowly migrate with average total subsidence of 2.04 mm at 5 years following the THA. The amount of stem subsidence was not associated with worse clinical outcomes such as HHS, patient satisfaction, or pain.

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Partial Single Stage Exchange Arthroplasty With Retention of a Well Fixed Cemented Femoral Stem for the Treatment of Culture Negative Infection in a Bipolar Hemiarthroplasty: A Case Report

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211001844 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110018

Author(s):

Marlon M. Mencia ◽

Shamir O. Cawich ◽

Nemandra Sandiford

Keyword(s):

Best Practice ◽

Joint Infection ◽

Femoral Stem ◽

Single Stage ◽

Bipolar Hemiarthroplasty ◽

Hip Hemiarthroplasty ◽

Exchange Arthroplasty ◽

Prosthetic Joint ◽

Gradual Onset ◽

Culture Negative

Background: Prosthetic joint infection (PJI) is the second most common cause for revision following hip hemiarthroplasty (HHA) resulting in a mortality rate of 5.6%. The treatment of PJI is both challenging and controversial, without general consensus on best practice. In an attempt to avoid surgery, patients are commonly prescribed antibiotics, reducing the chance of detecting a microorganism, and culture negative infections are reported to occur in up to 21% of all PJI. Two stage revision is arguably the gold standard treatment but frequently these patients are too frail to undergo such extensive procedures. Some surgeons have attempted to avoid this by leaving well fixed implants undisturbed, effectively performing a partial single-stage revision. Case Presentation: A previously well 83 -year-old female patient presented with a gradual onset of increasing pain and difficulty walking. Just over 1 year prior to this presentation she fell at home and underwent an uncomplicated bipolar hemiarthroplasty. Clinical examination as well as serological and radiological investigations were suspicious for a periprosthetic infection. Her rapidly deteriorating clinical picture required prompt surgical intervention. In theater the patient underwent a single stage partial exchange arthroplasty leaving the well cemented femoral stem undisturbed. Although multiple samples were taken, no microorganism was identified. The patient has been followed up for 1 year and remains well, with no recurrence of infection. Her inflammatory markers have returned to normal and radiographs demonstrate no evidence of loosening of the total hip replacement. Conclusion: The burden of infection following hip hemiarthroplasty is likely to parallel the predicted increase in hip fractures. The combination of physiologic frailty, osteoporosis and multiple medical comorbidities are pertinent factors for consideration in the development of a treatment strategy. A partial single stage revision THR performed by an experienced arthroplasty surgeon, along with expertly led antimicrobial therapy may be considered in carefully selected patients.

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Bipolar hip arthroplasty in geriatric patients using a conjoined tendon-preserving posterior approach

10.21203/rs.3.rs-25407/v1 ◽

2020 ◽

Author(s):

Tomonori Tetsunaga ◽

Tomoko Tetsunaga ◽

Kazuki Yamada ◽

Tomoaki Sanki ◽

Yoshi Kawamura ◽

...

Keyword(s):

Soft Tissue ◽

Geriatric Patients ◽

Operation Time ◽

Surgical Approaches ◽

Neutral Position ◽

Bipolar Hemiarthroplasty ◽

Joint Stability ◽

Short External Rotator ◽

Postoperative Dislocation ◽

Conjoined Tendon

Abstract Background In bipolar hemiarthroplasty (BHA), it is important to preserve soft tissue to reduce the risk of postoperative dislocation. While a variety of surgical approaches have been reported recently, extra care is needed with muscle- and tendon-preserving approaches in geriatric patients due to the fragility of their soft tissue. We investigated the usefulness of BHA using a conjoined tendon-preserving posterior (CPP) approach, which only dissects the external obturator muscle, in geriatric patients. Methods This retrospective study included 40 femoral neck fracture patients (10 men, 30 women) aged ≥ 80 years who underwent BHA using the CPP approach. The average age of the subjects was 85.8 years (80–94 years). We examined operation time, bleeding, preservation of short external rotator muscles, complications, and stem alignment and subsidence from postoperative radiographs. Results Although, gemellus inferior muscle injury was detected in 4 patients (10%), hip joint stability was very excellent in all cases. There was no intraoperative fracture and postoperative dislocation. On postoperative radiographs, all femoral stems were in a neutral position. There was no stem subsidence in all the patients. Conclusions BHA using the CPP approach was not associated with postoperative dislocation and appeared to be useful even in geriatric patients with soft tissue fragility.

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Predicting Cementless Stem Fixation in Total Hip Arthroplasty Using Radiodensity Mapping

10.29007/dv5n ◽

2020 ◽

Author(s):

Teja Cherukuri ◽

Chameka Madurawe ◽

Jim Pierrepont ◽

Jonathan Bare ◽

Stephen McMahon ◽

...

Keyword(s):

Bone Density ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Stem ◽

X Rays ◽

Implant Fixation ◽

X Ray ◽

Total Hip ◽

Stem Subsidence

Femoral component loosening due to poor fixation is a common failure mode in cementless total hip arthroplasty (THA). We sought to develop a technique to predicted femoral stem fixation using pre-operative CT.Forty-nine patients requiring THA received pre-operative CTs as part of Corin OPSTM 3D dynamic planning. All patients received a taper wedged blade stem (TriFitTM TS, Corin UK) implanted through a posterior approach. Post-operatively, patients received an immediate CT and AP x-ray and a 1-year follow-up x-ray. The distance between the most superior point of the greater trochanter and the shoulder of the stem was measured and scaled using the known cup diameter on both the immediate and 1- year follow-up x-rays. The difference was recorded as stem subsidence. Subsidence greater than 4mm was deemed clinically relevant. The precise placement of the stem determined by registering the known 3D implant geometry to the post-op CT was virtually implanted back into the pre-operative OPSTM planning software. A colour map of the bone density at the stem/bone interface using the Hounsfield Units (HU) of each CT pixel was generated. Blue represents low density bone transitioning through to green and then red.Mean stem subsidence was 1.8mm (0 to 11.1mm). Five patients had clinically relevant subsidence. Significant areas of blue and green around the proximal portion of the stem was observed in high subsidence stems when compared to the stems with minimal subsidence.Using the HU of the CT scan as an indicator for bone density, we were able to predict poor implant fixation and subsequent subsidence in a taper wedge stem.

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Recovery after Hip Fractures: Influence of Bipolar Hemiarthroplasty on Physical Disability and Social Dependency in the Elderly

Hip International ◽

10.5301/hip.2011.8824 ◽

2011 ◽

Vol 21 (6) ◽

pp. 751-756 ◽

Cited By ~ 6

Author(s):

Johannes Schneppendahl ◽

Marcel Betsch ◽

Vanco Petrov ◽

Friedrich Böttner ◽

Simon Thelen ◽

...

Keyword(s):

Quality Of Life ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Geriatric Patients ◽

Femoral Neck Fractures ◽

Bipolar Hemiarthroplasty ◽

Displaced Femoral Neck Fractures ◽

Neck Fracture ◽

Original Type

Surgical treatment of femoral neck fractures is associated with a significant impact on quality of life. The aim of this study was to determine the long-term influence of displaced femoral neck fractures treated by bipolar hemiarthroplasty on the activities of daily living, quality of life and social dependency. We studied 487 geriatric patients treated in the years 1989 to 2003. At the beginning of follow-up in 2004, 166 patients were alive and evaluation was carried out on 145 patients (87.3%) at 91.3 (14 - 244) months postoperatively by a standardized questionnaire. All enrolled patients had been treated with cemented bipolar hemiarthroplasty for a displaced femoral neck fracture. Patients were evaluated concerning their average pre- and postoperative ability to walk, the need for assisting devices, type of residency and the SF-12® Score. Femoral neck fracture and hemiarthroplasty had a significant influence on all recorded aspects of quality of life. Even though almost two thirds of the patients needed assisting devices to walk after surgery, about two thirds returned to their original type of accommodation and the majority reached their original degree of mobility. Compared to a normal population no significant impact was observed on the quality of life measured by the SF-12® score. We consider bipolar hemiarthroplasty an effective treatment option for displaced femoral neck fractures in geriatric patients. Most patients returned to their original type of accommodation and level of mobility, even though the majority required a number of assisting devices to do so.

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