Taxonomic history, comparative morphology, and variation in Astrophytum myriostigma and its subspecies tulense (Cactaceae)

Astrophytum myriostigma subsp. myriostigma and subsp. tulense are distinguished by both vegetative and reproductive characters. The stem of the nominotypical subspecies is broad and depressed becoming broadly cylindrical in age, reaching a known maximum height of ca. 52 cm. In subsp. tulense, the stem is relatively slen-der and columnar and can reach a maximum height of ca. 90 cm. Both taxa show variation in the angle and profile of the ribs. In the nominotypical subspecies, the ribs are usually obtuse with a rounded or angular profile, or moderately acute with an angular profile. In subsp. tulense, the ribs are typically moderately to very acute with an angular profile. There are exceptions to these generalities. Both taxa have a modal number of five ribs, and both have the tendency to insert additional ribs with age, although the tendency seems more pronounced in subsp. tulense. The flower of the nominotypical subspecies differs from that of subsp. tulense in having a significantly larger mean perianth diameter (P <= 0.01), a significantly higher mean number of stigma lobes (P <= 0.05), and more tepal rows (3–5 vs. 1–3). The color of the tepals is pale yellow to whitish yellow in subsp. tulense, but brighter yellow or golden yellow in the nominotypical subspecies. The seeds of the nominotypical subspecies are significantly larger (P <= 0.01) than the seeds of subsp. tulense. Morphological variation was studied in nine populations of the subsp. myriostigma and six populations of the subsp. tulense. The nominotypical subspecies displays rib angle and rib profile differences among individual plants within a population. Plants with a depressed stem and obtuse, rounded ribs are predominant at some localities. At other localities, plants with more moderately acute, angular ribs are predominant, or at least common. Populations of subsp. tulense show individual variation in stem morphology. The stem varies from attenuated (tapered) to non-attenuated and from relatively slender (diameter ca. 20% of height) to relatively broad (diameter ca. 77% of height). The plants from near Mama León and adjacent localities in Tamaulipas, have very robust stems and are the least typical of the columnar subspecies. The rela-tionships of this population to other columnar populations warrant further study. The population near Las Tablas, San Luis Potosí, shows considerable variation in the stem and rib morphology. Some plants resemble the nominotypical subspecies whereas others are similar morphologically to subsp. tulense. The perianth diameter is intermediate between those of the two subspecies. The evidence suggests that this is an area of past or ongoing hybridization between the two taxa; the question of hybridization warrants further investigation. Attenuated and non-attenuated stems are the result of differential rates of vertical and lateral growth due to cellular activity in the apical and lateral meristems, respectively. The attenuated (tapered) stem is produced by a gradually increasing lateral growth rate which remains slower than the vertical rate. A non-attenuated stem is produced by the lateral growth rate exceeding the vertical rate early in development, then stabilizing at some point and not surpassing the vertical rate.

Analysis of the Exeter V40 femoral stem prosthesis fracture

Aims The Exeter V40 cemented polished tapered stem system has demonstrated excellent long-term outcomes. This paper presents a systematic review of the existing literature and reports on a large case series comparing implant fractures between the Exeter V40 series; 125 mm and conventional length stem systems. Methods A systematic literature search was performed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. In parallel, we performed a retrospective single centre study of Exeter V40 femoral stem prosthetic fractures between April 2003 and June 2020. Results There are 25 reported cases of such prosthetic fractures confined to small case series and case reports within the literature. We report an additional 19 cases to the literature (mean age 66.3 years (SD 11.7); 12 (63%) females; BMI 32.9 kg/m2 (SD 5.9)). The mean time from index procedure to fracture was 7.8 years (SD 3.6; 2.5 to 16.3). Exeter V40 stem fracture incidence was 0.15% and 1.21% for primary and revision arthroplasty, respectively. Incidence was significantly higher in revision arthroplasty (p < 0.001) and 125 mm length stems compared to ≥ 150 mm length stems (1.25% vs 0.13%, respectively; p < 0.001). When comparing different stem length cohorts, 125 mm short-stems were associated with stem-body fractures (92% vs 29%; p = 0.0095), earlier time to fracture (6.2 years vs 11.0 years; p = 0.0018), younger patient age at time of fracture (62.7 years vs 72.6 years; p = 0.037), and female sex (75% vs 43%; p = 0.326). Conclusion This complication remains rare, although we report a significantly higher incidence at up to 17 years follow-up than in the literature. Short 125 mm length Exeter V40 stems undoubtedly have a role in restoring anatomy and biomechanics in smaller femoral geometries, although the surgeon has to appreciate the higher risk of stem fracture and the associated predisposing factors which may necessitate particular attention to surgical technique and planning. Cite this article: Bone Jt Open 2021;2(6):443–456.

Mind the gap! The Lucent Line Sign: A Pathognomonic Radiographic Finding in Periprosthetic Hip Fractures Around Cemented Polished Tapered Femoral Stems

Introduction: Diagnosing minimally displaced femoral PPFs using plain-film radiographs can be challenging. As a result, fractures can be missed. Case Report: We present four cases of minimally displaced PPFs around cemented polished tapered stems. In each case, radiographs demonstrate no clear cortical breach, but the presence of a fracture is highlighted by a pathognomic lucent line between the cement mantle and the prosthesis: The Lucent Line Sign. Conclusion: Paying attention to the Lucent Line Sign can be pivotal in the diagnosis of minimally displaced PPFs around cemented polished tapered stems. Keywords: Periprosthetic fracture, hip fracture, femoral fracture, taper-slip stem, polished-tapered stem, radiographs.

Primary stability of a proximally coated and tapered stem

Aims The aim of this prospective cohort study was to evaluate the early migration of the TriFit cementless proximally coated tapered femoral stem using radiostereometric analysis (RSA). Methods A total of 21 patients (eight men and 13 women) undergoing primary total hip arthroplasty (THA) for osteoarthritis of the hip were recruited in this study and followed up for two years. Two patients were lost to follow-up. All patients received a TriFit stem and Trinity Cup with a vitamin E-infused highly cross-linked ultra-high molecular weight polyethylene liner. Radiographs for RSA were taken postoperatively and then at three, 12, and 24 months. Oxford Hip Score (OHS), EuroQol five-dimension questionnaire (EQ-5D), and adverse events were reported. Results At two years, the mean subsidence of the head and tip for the TriFit stem was 0.38 mm (SD 0.32) and 0.52 mm (SD 0.36), respectively. The total migration of the head and tip was 0.55 mm (SD 0.32) and 0.71 mm (SD 0.38), respectively. There were no statistically significant differences between the three to 12 months' migration (p = 0.105) and 12 to 24 months' migration (p = 0.694). The OHS and EQ-5D showed significant improvements at two years. Conclusion The results of this study suggest that the TriFit femoral stem achieves initial stability and is likely to be stable in the mid and long term. A long-term outcome study is required to assess late mechanisms of failure and the effects of bone mineral density (BMD) related changes. Cite this article: Bone Joint J 2021;103-B(4):644–649.

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

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.

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

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.

Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes

Introduction: The aim of the study was to evaluate the mortality and the outcomes of femoral revision in periprosthetic femoral fractures (PFF) using a titanium modular fluted tapered stem. Methods: We retrospectively reviewed femoral revisions performed for PFF with a titanium modular fluted tapered stem in 25 patients. The average age was 74.32 years. In 21 patients the type of fracture was Vancouver B2 and type B3 in 4 cases. The mean follow-up was 29.16 (0.83–104.1) months SD ± 29.49. Results: The 30-day and 1-year mortality were 8% and 12% respectively. The mean value of the Charlson Comorbidity Index was 4.8 and the mean value of ASA score was 2.4. The average time to surgery from admittance was 5.45 days with 20% of patients operated on within 48 hours. A significant correlation was found between ASA score and mortality. The mean HHS was 76 points; good-excellent results were recorded in 56% of patients. 72% had no pain and 28% had slight pain (VAS 1–3). 52% of patients were able to walk without pain, limp or aids. The mean implant subsidence was 1.57 mm and superior to 5 mm in 2 cases. As complications we recorded 4 implant dislocations (16%) and 2 infections. Reoperation rate was 12%. Conclusions: Femoral revision with a modular fluted tapered stem in patients with periprosthetic fractures results in good clinical and radiological outcomes. However, mortality remains high and, despite the modularity design, dislocation is the most frequent complication.