cementless total hip arthroplasty
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2022 ◽  
pp. 212-221
Author(s):  
Ruben Y Kok ◽  
Lennard A Koster ◽  
Bart L Kaptein ◽  
Marta Fiocco ◽  
Stefan B Keizer

Background and purpose – The Taperloc Complete hip is the successor of the Taperloc hip, aiming to increase range of motion and optimizing femoral fit with intermediate stem sizes. We evaluated whether these design changes affect fixation, and this RSA study compares 2-year migration. Patients and methods – In this prospective, multi-arm study, 100 patients were randomized to cementless total hip arthroplasty (THA) with Taperloc Complete full profile (TCFP), Taperloc Complete reduced distal (TCRD), Taperloc full profile (TFP), or Taperloc reduced distal (TRD). Migration was measured with model-based RSA postoperatively, and after 3, 12, and 24 months. Results – Results based on mixed-model analysis on 2-year postoperative RSA data from 74 patients showed similar subsidence (mm) in the first 3 months (mean [95% CI] TCFP 0.44 [0.20–0.69], TCRD 0.91 [0.40–1.42], TFP 0.71 [0.22–1.19], TRD 1.25 [0.58–1.91]) and stabilization afterwards. The TCFP showed statistically significantly less retroversion (°) at 2-year postoperatively compared with TFP and TCRD (mean [95% CI] TCFP: –0.13 [–0.64 to 0.38], TCRD: 0.84 [0.35–1.33], TFP: 0.56 [0.12–1.00], TRD: 0.37 [–0.35 to 1.09]). Interpretation – As expected in successful cementless THA, RSA shows stabilization after initial subsidence. Based on these results the Taperloc Complete stem is expected to have similar long-term fixation to the Taperloc stems. The reduced distal groups have larger, but statistically non-significant, initial migration compared with the TCFP group, which could be due to implantation in Dorr B, C femur types. It may be important to consider the femur shape for choosing a full profile or reduced distal stem to minimize migration.


Author(s):  
BW Minto ◽  
LMI Diogo ◽  
CR de Andrade ◽  
WS Santos Junior ◽  
LG de Faria ◽  
...  

Canine cementless total hip arthroplasty (THA) is a successful technique for the management of hip arthrosis; however, serious potential complications, such as femoral fractures and subsidence of the femoral stem, can occur. To evaluate the effect of two femoral stem designs in reducing subsidence in dogs, twenty-four hips from twenty-one dogs undergoing THA were assessed. The twenty-four arthroplasties were divided into two experimental groups: G1 with a first generation, and G2, which is the second generation, system were used. All the dogs were clinically and radiographically evaluated immediately post-operatively and at 30 (M1) and 120 days post-operatively (M2). Three of ten arthroplasties in the G1 system had subsidence and six of fourteen had subsidence in the G2 system. Both systems are effective for management of hip arthrosis. The varus positions with the sub-optimal filling were not related to the subsidence. The two stem designs both showed some resistance to subsidence, but clinical problems were not identified in any case.


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ping Mou ◽  
Hua Li ◽  
An-Jing Chen ◽  
Zheng Ji ◽  
Xin-Yi Dai ◽  
...  

Abstract Background Hip involved secondary to ankylosis spondylitis (AS) had a huge influence on hip function. Cementless total hip arthroplasty (THA) can improve hip function. However, no previous study compared the outcomes of THA for AS patients with three different degrees of hip involvement. Methods The 195 hips were retrospectively analyzed and divided into non-ankylosed group (group A, 94 hips), fibrous ankylosed group (group B, 49 hips), and bony ankylosed group (group C, 52 hips). postoperative range of motion (ROM), harris hip scores (HHS), the short-form 12 health survey (SF-12), length of stay (LOS), cost, radiological assessments, and complications were compared. Results The follow-up time was (79.4 ± 29.5) months for group A, (80.6 ± 28.9) months for group B, and (79.1 ± 28.9) months for group C (P = 0.966). Group A had the best postoperative hip ROM (P < 0.001), while group A and B can realize better HHS than group C (P < 0.001). The three groups had similar SF-12 postoperatively. For group A, LOS and cost for unilateral procedure were the least than that for group B and C (P = 0.003 and P = 0.001). Similar radiological assessments were achieved for three groups. 1 hip in group A encountered delay union of wound. 1 hip in group C encountered delay union of wound and dislocation and another patient encountered femoral fracture intraoperatively. 12 hips (12.8%) in group A, 6 hips (12.2%) in group B, and 6 hips (11.5%) in group C encountered asymptomatic heterotopic ossification (P = 0.977). Conclusion For AS patients with hip involvement, THA can improve hip ROM and function. THA for the non-ankylosed hip can realize the better hip function and postoperative ROM than ankylosed hip.


2021 ◽  
Author(s):  
Satoshi Ikemura ◽  
Goro Motomura ◽  
Satoshi Hamai ◽  
Masanori Fujii ◽  
Shinya Kawahara ◽  
...  

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.


2021 ◽  
pp. 112070002110371
Author(s):  
Michael Wettstein ◽  
Elyazid Mouhsine ◽  
Jean-Manuel Aubaniac ◽  
Laurent Audigé ◽  
Matthieu Ollivier ◽  
...  

Introduction: The anatomy of the proximal femur at the time of total hip arthroplasty has been widely studied but the horizontal plane was never considered, or only limited to the torsion of the femoral neck. Methods: Using CT-scan images from a group of 178 patients scheduled for cementless total hip arthroplasty (THA), we analysed the evolution of the torsion of the proximal femoral metaphysis, in reference to the posterior bicondylar plane of the femur. The evolution of the torsion, between 20 mm below the centre of the lesser trochanter and 20 mm above, was evaluated. Results: In cases of primary osteoarthritis, osteonecrosis, rheumatoid arthritis and epiphysiolysis capitis femoris, the mean torsion decreased from 46° to 20° without significant differences in average values between the different diagnoses, but important individual variations were found. In the groups of dysplasia and congenital hip dislocation, the torsion values were significantly higher, decreasing in mean from 59° to 25° and 63° to 34° respectively, and with important individual variations. Conclusions: These data are important when using cementless femoral stems, since an ideal fit-and-fill in the proximal femur zone has been shown to positively influence bone ingrowth of the stem. However, a strict adaptation of the stem to the medullary canal, without considering its torsion, can lead to an increased or decreased torsion of the prosthesis neck and thus to an instability of the arthroplasty. For these reasons, if a perfect adaptation of the stem to the intramedullary anatomy and an optimal reconstruction of the extramedullary anatomy are to be achieved, 3-dimensional planning should ideally be obtained for every patient. This will allow the best stem choice adapted to every single patient and every kind of anatomy.


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