femoral stem
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Author(s):  
Matthias Luger ◽  
Sandra Feldler ◽  
Lorenz Pisecky ◽  
Jakob Allerstorfer ◽  
Tobias Gotterbarm ◽  
...  

Abstract Purpose Varus positioning of the femoral stem can affect the hip offset (HO). The critical trochanter angle (CTA) was introduced in 2019 as a novel geometric angle, to predict varus stem alignment in cementless straight stem THA. The aim of this study was to evaluate the applicability of the CTA as a predictor for stem alignment in THA with a cementless neck resecting short stem. Patients and methods In this retrospective study, 106 patients (index surgery 2014–2019) with unilateral THA and a morphologically healthy contralateral hip as a reference (Kellgren–Lawrence ≤ 1) were included. A cementless short stem with meta-diaphyseal fixation and press-fit cup was implanted in all cases. Stem alignment, CCD angle, CTA and offset reconstruction were measured on preoperative and 3 months postoperative AP radiographs of the pelvis. Results Preoperative lower CTA and lower CCD angle were positively correlated (r = 0.472; p < 0.001). Higher varus stem alignment is correlated with lower CTA (r = − 0.384; p < 0.001) and lower CCD angle (r = − 0.474; p < 0.001). A CTA of 23.1° or lower showed a sensitivity of 59.1% and a specificity of 87.1% (AUC: 0.733) and a CCD angle of 132.75° or lower a sensitivity of 68.2% and a specificity of 80.6% (AUC: 0.77) for a varus stem alignment > 3°. Conclusion The CTA is also applicable in cementless THA with a neck resecting short stem to evaluate risk of intraoperative varus stem positioning. The CCD angle shows higher sensitivity with marginally lower specificity. Therefore, the CTA is not superior in predicting varus stem alignment in short-stem THA. Level of evidence IV.


Author(s):  
Pravin K. Vanchi ◽  
Raghav Ravi Veeraraghavan ◽  
Saravanan Vasudevan ◽  
Mohan Kumar Murugesan

<p class="abstract"><strong>Background:</strong> Dislocation remains at the forefront of complications after primary total hip arthroplasty (THA). In our study, we talk about the use of constrained liners and its outcomes in an unstable hip.</p><p class="abstract"><strong>Methods:</strong> The total number of patients included in the study was 15. The total number of hips in the study were 15. The age group of the patients varied between 51 years and 89 years with mean age group of 73 years. The most common indication in our study was dislocation contributing 60% (n=9) of the hips.<strong></strong></p><p class="abstract"><strong>Results:</strong> The post-operative mean Harris hip score (HHS) at immediate post-operative was 67.6. There was a gradual improvement in the HHS through 6 months (77.6), one year (83.3), two years (86.7) and 3 years (90.33). There were no cases with post-operative septic or aseptic loosening in the radiological analysis. The mean cup inclination was 34.3. Out of the 13 hips, in eight hips the femoral stem was in varus. Five hips had a centrally placed femoral stem. Stability management in THA have seen the component design take centre stage, primarily with the use of larger diameter femoral heads and the rise in popularity of constrained acetabular liners (CAL). Several authors have done studies which talk about the stability of this implant design and the reliability of this implant in unstable hips and in hips where instability was expected.</p><p class="abstract"><strong>Conclusions:</strong> In our study, proximal femur tumours, dislocated total hips, abductor insufficiencies and aseptic loosening all showed good results.</p>


Author(s):  
Anne-Sophie Poudrel ◽  
Giuseppe Rosi ◽  
Vu-Hieu Nguyen ◽  
Guillaume Haiat
Keyword(s):  

2022 ◽  
Vol 104-B (1) ◽  
pp. 19-26
Author(s):  
Kirsti Sevaldsen ◽  
Otto Schnell Husby ◽  
Øystein Bjerkestrand Lian ◽  
Kamel Mohamed Farran ◽  
Vigdis Schnell Husby

Aims Highly polished stems with force-closed design have shown satisfactory clinical results despite being related to relatively high early migration. It has been suggested that the minimal thickness of cement mantles surrounding the femoral stem should be 2 mm to 4 mm to avoid aseptic loosening. The line-to-line cementing technique of the femoral stem, designed to achieve stem press-fit, challenges this opinion. We compared the migration of a highly polished stem with force-closed design by standard and line-to-line cementing to investigate whether differences in early migration of the stems occur in a clinical study. Methods In this single-blind, randomized controlled, clinical radiostereometric analysis (RSA) study, the migration pattern of the cemented Corail hip stem was compared between line-to-line and standard cementing in 48 arthroplasties. The primary outcome measure was femoral stem migration in terms of rotation and translation around and along with the X-, Y-, and Z- axes measured using model-based RSA at three, 12, and 24 months. A linear mixed-effects model was used for statistical analysis. Results Results from mixed model analyses revealed a lower mean retroversion for line-to-line (0.72° (95% confidence interval (CI) 0.38° to 1.07°; p < 0.001), but no significant differences in subsidence between the techniques (-0.15 mm (95% CI -0.53 to 0.227; p = 0.429) at 24 months. Radiolucent lines measuring < 2 mm wide were found in three and five arthroplasties cemented by the standard and line-to-line method, respectively. Conclusion The cemented Corail stem with a force-closed design seems to settle earlier and better with the line-to-line cementing method, although for subsidence the difference was not significant. However, the lower rate of migration into retroversion may reduce the wear and cement deformation, contributing to good long-term fixation and implant survival. Cite this article: Bone Joint J 2022;104-B(1):19–26.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Lucian Capitanu ◽  
Liliana-Laura Badita ◽  
Constantin Tiganesteanu ◽  
Virgil Florescu

Purpose The purpose of this paper is to study the roughness effect on the fixation of taper junction components and surfaces wear in terms of taper surface design. The roughness of the femoral heads’ taper and of the femoral stems’ trunnions can influence the fretting wear of the taper junction. Design/methodology/approach It was analysed whether a microgrooved taper surface of the femoral stem trunnion improves the fixation and reduces the wear rate at the taper junction of the hip prosthesis. Two models have studied: a femoral head with a smooth tapered surface combined with a microgrooved stem trunnion and a femoral head with a smooth tapered surface combined with a trunnion that had a smooth surface of the tapered. To compare the wear evolution between these two models, a computerised finite element model of the wear was used. Findings The results obtained after analysis carried out during millions of loading cycles showed that the depth of the linear wear and the total material loss were higher for the femoral heads joined with microgrooved trunnions. The main conclusion of this paper is that the smooth surfaces of the taper and of the trunnions will ensure a better fixation at the taper junction, and therefore, will reduce the volumetric wear rates. Originality/value A higher fixation of the taper junction will reduce the total hip prosthesis failure and, finally, it will improve the quality and durability of modular hip prostheses.


Cureus ◽  
2021 ◽  
Author(s):  
Tyler J Humphrey ◽  
Daniel Marchwiany ◽  
Hany S Bedair ◽  
Christopher M Melnic
Keyword(s):  

2021 ◽  
Vol 11 (1) ◽  
pp. 36
Author(s):  
Sebastian Hardt ◽  
Vincent Justus Leopold ◽  
Thilo Khakzad ◽  
Matthias Pumberger ◽  
Carsten Perka ◽  
...  

Background: This study sought to compare the results of two-stage revision total hip arthroplasty (THA) for periprosthetic infection (PJI) in patients with and without the use of an extended trochanteric osteotomy (ETO) for removal of a well-fixed femoral stem or cement. Methods: Thirty-two patients who had undergone an ETO as part of a two-stage revision without spacer placement were matched 1:2 with a cohort of sixty-four patients of the same sex and age who had stem removal without any osteotomy. Clinical outcomes including interim revision, reinfection and aseptic failure rates were evaluated. Modified Harris hip scores (mHHS) were calculated. Minimum follow-up was two years. Results: Patients undergoing ETO had a significantly lower rate of interim re-debridement compared to non-ETO patients (0% vs. 14.1%, p = 0.026). Reinfection following reimplantation was similar in both groups (12.5% in ETO patients vs. 9.4% in non-ETO patients, p = 0.365). Revision for aseptic reason was necessary in 12.5% in the ETO group and 14.1% in the non-ETO group (p = 0.833). Periprosthetic femoral fractures were seen in three patients (3.1%), of which all occurred in non-ETO patients. Dislocation was the most common complication, which was equally distributed in both groups (12.5%). The mean mHHS was 37.7 in the ETO group and 37.3 in the non-ETO group, and these scores improved significantly in both groups following reimplantation (p < 0.01). Conclusion: ETO without the use of spacer is a safe and effective method to manage patients with well-fixed femoral stems and for thorough cement removal in two-stage revision THA for PJI. While it might reduce the rate of repeated debridement in the interim period, the use of ETO appears to lead to similar reinfection rates following reimplantation.


Author(s):  
Betül Başar ◽  
Hakan Başar

BACKGROUND: Early full weight-bearing mobilization is controversial in osteoporotic patients who have undergone uncemented hemiarthroplasty (CH). OBJECTIVES: The aim of the study was to compare the results of early full weight-bearing mobilization in CH and uncemented hemiarthroplasty (UCH). The effect of subsidence on the results was also evaluated. METHODS: Fifty-nine patients who underwent CH and UCH were evaluated. The mean age was 79.8 years (10 females, 15 males) for CH and 75.5 years (10 females, 24 males) for UCH. All patients started immediate full weight-bearing mobilization and weight-bearing exercises. RESULTS: There was no difference between the groups according to the Harris Hip Score. Both groups were evaluated in subgroups according to whether there is varus in the femoral stem. There was no difference between subgroups according to the Harris Hip Score. The femoral subsidence was not determined in CH group. In the UCH group, the subsidence was 1.13 ± 1.03 mm in varus femoral stem subgroup and 0.81 ± 0.85 mm in without femoral stem varus subgroup. There was no difference in subsidence between femoral stem with varus and without varus. The subsidence did not affect the Harris Hip Score. CONCLUSION: Full weight-bearing mobilization could be safely preferred in UCH, as in CH. Femoral stem varus below 5 degrees does not affect the results and subsidence.


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.


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