Bipolar Hemiarthroplasty with Cementless Femoral Stem for Unstable Intertrochanteric Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the usefulness of bipolar hemiarthroplasty using a cementless femoral stem for treating unstable intertrochanteric fractures in elderly patients. MATERIALS AND METHODS: This study included 41 hips of 41 patients who were followed up for over 2 years after bipolar hemiarthroplasty using cementless femoral stem between October 2006 and November 2008. The mean follow-up period was 33 months (24-42 months). RESULTS: At the last follow-up, the mean Harris hip score was 81.3 points. All stems were stable without significant changes in alignment or progressive subsidence. There were no cases of leg length discrepancy over 5 mm. There were 3 cases of wire fixation breakage and 1 case of posterior hip dislocation. CONCLUSION: The short-term results over 2 years of clinical and radiological evaluation of cementless bipolar hemiarthroplasty and wire fixation were satisfactory in elderly patients with unstable intertrochanteric fracture.

Cementless Total Hip Arthroplasty for Osteonecrosis of the Femoral Head: A Follow-up Study for 10+ Years

PURPOSE: The aim of this study was to assess the outcome of cementless total hip arthroplasty (THA) in cases of osteonecrosis of the femoral head. MATERIALS AND METHODS: We studied long-term outcomes for 54 patients (72 hips). Mean duration of follow-up was 13.5 years. Clinical outcomes were evaluated by the Harris Hip Score. Radiographic evaluation from the preoperative and follow-up periods included assessment of the fixation of the femoral and acetabular components, polyethylene wear, osteolysis, and radiolucent line. RESULTS: The mean Harris Hip Score improved from a preoperative value of 51.9 points to 89.4 at final follow-up. Regarding the femoral components, there was radiographic evidence of stable bony ingrowth in 69 hips, stable fibrous ingrowth in 2 hips and unstable fixation in 1 hip. There was a radiolucent line of less than 1 mm in 7 hips, and femoral osteolysis in 27 hips. Regarding the acetabular components, there was radiographic evidence of stable fixation in 68 hips, unstable fixation in 4 hips, and osteolysis in 39 hips. There was a significant correlation between (i) failure of components and (ii) femoral osteolysis, acetabular osteolysis, polyethylene thickness, linear wear rate per year, or total linear wear. CONCLUSION: The findings of this study show favorable long term results, both clinical and radiographic, using cementless total hip replacement arthroplasties. However, the revision rates for the Harris-Galante acetabular components were high. Wear of the load? weight? bearing surface continues to limit the long-term success rate of THA, and improved design of the acetabular components should be considered.

Modular Cementless Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy in Patients with High Hip Dislocation

PURPOSE: The purpose of this study was to report on the results of performing modular cementless total hip arthroplasty with a simultaneous subtrochanteric shortening osteotomy in patients with high hip dislocation. MATERIALS AND METHODS: We evaluated 23 patients (24 hips) with high hip dislocation and who had undergone total hip arthroplasty using a proximally modular cementless stem in combination with a subtrochanteric shortening osteotomy in order to place the acetabular cup at the level of the anatomic hip center between May 1996 and June 2008. There were 6 males and 17 females with a mean age of 44 years. The mean duration of follow-up was 5.6 years. RESULTS: The mean Harris hip score improved from 53 points preoperatively to 88 points at the time of final follow-up (P<0.001), and there were good or excellent results in 21 hips (87.5%). There was one instance of isolated loosening of the acetabular component. With the exception of one hip requiring revision surgery at 12 years postoperatively because of polyethylene wear and cup loosening, all the remaining components were well-fixed at the time of the last follow-up. A total of 4 hips (17%) had complications during follow-up; one dislocation, two transient femoral nerve palsies and one nonunion of the subtrochanteric osteotomy site. CONCLUSION: Modular cementless total hip arthroplasty with a subtrochanteric shortening osteotomy in patients with high hip dislocation was associated with excellent clinical outcomes while it minimized additional fixation of the osteotomy site.

Total Hip Arthroplasty with F2L Multineck Cementless Femoral Stem

PURPOSE: To analyze the results of cementless total hip arthroplasty with a F2L Multineck femoral stem. MATERIALS AND METHODS: A total of 64 patients (73 hips), who underwent cementless total hip arthroplasty with a F2L Multineck femoral stem, SPH acetabular cup and a ceramic liner from December of 1998 to October of 2001 were followed up for at least 4 years, were selected for the clinical and radiological evaluations. RESULTS: At the final evaluation, 63 patients had an improved average Harris hip score ranging from 51.4 preoperatively to 95.1. None of the patients had any significant leg length inequality. Thigh or inguinal pain was observed in 3 hips (1 hip of femoral stem subsidence and 2 hips of damaged ceramic parts), for which revision total hip arthroplasty was performed. Hip dislocation occurred in 2 hips within 2 weeks after surgery and conservative management was performed after a closed reduction. CONCLUSION: Total hip arthroplasty with a F2L Multineck femoral stem produced satisfactory results. Postoperative complications such as hip dislocation and leg length inequality could be minimized by modulating the anteversion angle, femoral offset and leg length with multineck femoral stem.

Reduction of Broach Rotation for Versys Fibermetal Tapered Stem during the Femoral Canal Shaping / 대한정형외과연구학회지

PURPOSE: Inaccurate femoral canal shaping can result in post-operative complications in hip arthroplasty. We addressed the amount of broach rotation during shaping of the femoral canal and compared it with respect to newly designed broaches which were modified to minimize the rotation. MATERIALS AND METHOD: we designed the broaches that had canal guide which restricts the broach motion such that it is always aligned with the femoral axis while the broach machines the metaphyseal bone. Conventional broaches and the modified broach applied to 5 pair of fresh-frozen cadaver femurs and its spatial motion was measured with motion tracker. Rotations in coronal, saggital and frontal plane during the final 10 mm of broach advance were measured. RESULTS: 2.4..of axial rotation was occurred during final 10 mm advance of broach in the conventional method, which was the largest component of the rotation. Rotation of the broach during machining was decreased to 37% (p=0.075) and 25% (p=0.042) in the sagittal plane and coronal plane, respectively, by proposed method. CONCLUSION: The canal guide in the proposed method significantly reduced the rotation of the broach without any extra incision or measurement devices, resulting in increased accuracy in the femoral canal shaping.

A Modular Cementless Femoral Prosthesis for Revision HipArthroplasty

Purpose: The goal of study was to evaluate the clinical and radiographic performance of the proximal modular cementless femoral stem for use in revision total hip arthroplasty. Material and method: Fifty seven patients (57 hips) were followed for longer than 24 months or up to 8.4 years after performing revision total hip arthroplasty with using the proximal modular cementless femoral stem between January 1997 and December 2002. The preoperative diagnosis included 45 cases of aseptic loosening, 5 cases of septic loosening (re-revision operation), 6 cases of periprosthetic fracture and 1 case of recurrent dislocation. The bone deficiencies were classified according to the Paprosky classification: there were 27 cases of Type I and II, 19 cases of Type IIIA, 9 cases of Type IIIB and 2 cases of Type IV. Results: The average Harris hip score improved from 47 to 87.6. Clinically satisfactory results were noted in 50 patients (87.7%). Radiographically, distal stable fixation was observed in 54 patients (94.7%). Intraoperative complications included two greater trochanteric fractures and two proximal femur fractures. Postoperative complications included 5 femoral stem subsidences (2hips20mm), 4 deep infections, 2 non-unions of the greater trochanter and the osteotomy site and set screw dissociation was noted in 1 case. 5 proximal component changes were done due to progressive subsidence in two cases, non-union at the osteotomy site and trochanteric displacement in two cases and set screw dissociation in one hip. For the infection cases, the proximal segment was removed and re-revised with a 2nd stage operation. (Ed note: check this.) The subsidence of the femoral stems was showed in 3 Paprosky grade IIIA cases and in 2 cases of grade IIIB or more. There was no postoperative periprosthetic fracture observed at the last follow-up. Conclusion: Revision total hip arthroplasty using the proximal modular cementless femoral stem showed good results in the face of the infection of the proximal component and deficient proximal bony support. This procedure appears to be convenient for the surgeon to correct anteversion of the femoral head and leg length discrepancy.

Reference Line Closer to the True Femoral Anteversion During Primary Cementless Total Hip Arthroplasty / 대한정형외과연구학회지

PURPOSE: We investigated the reference line closer to the true femoral anteversion on only the cutting surface of the proximal femoral neck during the femoral stem insertion in cementless total hip arthroplasty. MATERIALS AND METHODS: A postoperative CT of both hips was taken to observe the positioning of the stem and its correlation with the true anteversion of the contralateral side of 33 consecutive patients after unilateral primary cementless total hip arthroplasty with avascular necrosis of the femoral head. We defined several parameters and measured the true anteversion on the contralateral side and the stem anteversion on the lesion side. RESULTS: The average of the midcortical angle was 13.9 degrees +/-6.8 degrees on the lesion side and 0.1 degrees +/-1.3 degrees less than the true anteversion on the contralateral side. CONCLUSION: The study has shown that anteversion using a midline between the anterior cortical line and the posterior cortical line is compatible with the true femoral anteversion.

Clinical Study of Cementless Femoral Stem: Comparative Study between Porous Coating and Uncoating in Superolateral Portion of the Femoral Stem / 대한정형외과학회잡지

The authors analyzed clinical and radiographic results of the 87 cases which had done THRA with porous coated femoral stem followed up more than 2 years to study the difference of clinical and radiologic findings between the absence (group 1 ; 53 cases) and presence(group 2 ; 34 cases) of the porous coating in superolateral portion of the femoral stem. The following results were obtained : 1. Harris hip scores were improved 34.4 points from 56.5 points preoperatively to 90.9 points postoperatively in group Ι, and 32.7 points from 61 points preoperatively to 93.7 points postoperatively in group 2. The clinical results of the group 1 were Excellent in 45 cases, Good in 5 cases and Fair in 3 cases, and clinical result of the group 2 were Excellent in 33 cases and Good in 1 case. 2. The changes of femoral stem angle were below 2 degrees in 7 cases, above 2 degrees in 2 cases in group 1, and below 2 degrees in 5 cases, but not found more than 2 degrees of change of the femoral stem angle in group 2. 3. The osteolysis around femoral stem were 15 cases(28%) in Group 1, and 5 cases(15%) in Group 2. Diffuse osteolysis were 3 cases in Group 1, but was not observed in Group 2. 4. The vertical subsidence more than 2 mm was 3 cases in group 1, but was not observed in group 2. 5. The stable femoral stem were 51 cases in group 1, and 34 cases in group 2. The unstable femoral stem were 3 cases in group 1, but was not observed in group 2. Above results suggest that the porous coating in the superolateral portion of the femoral stem showed better results in radiologic and clinical findings in short term follow up.

Intrapoperative Femur fractures during Cementless femoral stem insertion / 대한정형외과학회잡지

Fracture of the femur during total hip arthroplasty presents the simultaneous problems of prosthetic stability and fracture treatment. The treatment of such fractures can be complex and is one of the major challenges and this complication is associated with a high morbidity and a significant delay in convalescence. Among the 237 cases, who were treated by cementless total hip arthroplasty from Jan. 1986 to Dec. 1992, 13 cases of femoral fracture were experienced. They usually occured during insertion of prosthesis and preparation of the medullary canal. There were 6 cases of type II fracture, 1 case of type III fracture, 5 cases of type IV fracture and 1 case of type V fracture according to AAOS classification. All of the fracture healed, but the prognosis of these cases must be determined by follow up. We recommend that femoral fractures can be prevented by accurate preoperative evaluation of the size of the femoral canal, identification and management of the predisposing factors for intraoperative fractures.

Clinical analysis of Canal Filling of Cementless Femoral Stem / 대한정형외과학회잡지

We Studied 48 patients(62 hips) who were performed hip arthroplasties at the Department of Orthopaedic Surgery, Soonchunhyang University hospital from February 1990 to August 1992. The purpose of the present study was to compare canal filling ratio and clinical results of cases treated by cementless femoral stem with 19 Harris Galante(straight stem), 23 Anatomic(curved stem) and 20 Multilock (straight stem). The follow-up periods ranged from 12 months to 36 months. We assessed canal filling at metaphysis, mid-stem and distal canal, and clinical results according to canal filling. The results were as follows ; 1. The average filling ratio of the medullary canal by each type of stem in the coronal plane were as follows. Harris Galante ; 80. 5%, Anatomic ; 79. 4%, Multilock; 79. 8% in metaphysis. Harris Galante ; 88. 7%, Anatomic ; 88. 3%, Multilock ; 87. 3% in mid-stem. Harris Galante ; 95. 1%, Anatomic 90. 2%, Multilock ; 94. 5% in distal canal. At distal canal, the average canal filling of Harris Galante and Multilock were more excellent than Anatomic in coronal plane. 2. The average filling ratio of the medullary canal by each type of stem in the saggital plane were as follows. Harris Galante ; 64. 0%, Anatomic 69. 6%, Multilock ; 68. 6% in metaphysis. Harris Galante ; 79. 6%, Anatomic; 84. 5%, Multilock; 80. 2 in mid-stem. Harris Galante ; 78. 3%, Anatomic ; 82. 6%, Multilock ; 84. 5% in distal canal. At mid-stem, the average canal filling of Anatomic was more excellent than Multilock and Harris Galante. At metaphysis and distal canal, the average canal filling of Anatomic and Multilock were more excellent than Harris Galante in saggital plane. 3. The average Harris's hip scores of each type of stem at the final follow-up was 89. 9 in Harris Galante, 90. 3 in Anatomic and 91. 9 points in Multilock. There was no significance statistically(p>0.05). 4. The correlation between the average canal filling and thigh pain was not statistically significant (p>0. 05).