Subsidence after calcar-guided short stem total hip arthroplasty: five-year results of a prospective multicentre study.

PURPOSE: Calcar-guided short-stem total hip arthroplasty (THA) has shown excellent clinical outcomes. However, the migration pattern of such prostheses and its effect on clinical outcomes are less known. Therefore, we assessed the five-year subsidence after calcar-guided short-stem THA and its implications on clinical outcomes, patient-related factors, and complications. METHODS: In this prospective multicentre study, we enrolled 213 patients (224 hips) who underwent calcar-guided short-stem THA mostly for degenerative hip diseases. We examined patients radiographically and clinically after six to 12 weeks, one year, two years, and five years. We evaluated subsidence using Einzel-Bild-Roentgen-Analyse femoral component analysis, assessed clinical outcomes, and systematically recorded all complications. RESULTS: Overall, 131 patients (133 hips) were available for final follow-up at a median of 60 months (range, 2 to 72 months). We found a mean subsidence of 0.63 ± 1.22 mm at three months, 1.03 ± 1.60 mm at one year, 1.21 ± 1.91 mm at two years, and 1.54 ± 1.97 mm at five years. Patient-related factors (sex, age, weight, and BMI) did not significantly impact subsidence at five years (P > 0.05). Additionally, the Harris hip score, pain, and satisfaction improved significantly at five years compared to pre-operative values (P < 0.0001). Lastly, five patients underwent revision. CONCLUSION: Calcar-guided short-stems revealed the highest subsidence rate within the first three months after THA and stabilisation after one year through the final follow-up examination. Moreover, patient-related factors had no influence on subsidence. Finally, clinical scores and patient satisfaction remained high at five years.

[Comparison of filling ratio, alignment, and stability between ABG â ¡ short-stem and Corail long-stem in total hip arthroplasty for Dorr type C femur].

Objective: Using the mono-energy reconstruction images and X-ray films to investigate whether the ABG Ⅱ short-stem could improve the filling ratio, stability, and alignment in the Dorr type C femur, compared with the Corail long-stem. Methods: Among patients who were with Dorr type C femurs and treated with total hip arthroplasty between January 2006 and March 2012, 20 patients with a Corail long-stem (Corail group) and 20 patients with an ABG Ⅱ short-stem (ABG Ⅱ group) were randomly selected. The differences in gender, age, body mass index, and preoperative diagnoses between the two groups were not significant ( P>0.05). The ABG Ⅱ group was with a mean follow-up of 142 months (range, 102-156 months), and the Corail group was with a mean follow-up of 107 months (range, 91-127 months). There was no significant difference in the Harris score and subjective satisfaction score between the two groups at last follow-up ( P>0.05). At last follow-up, dual-energy CT scans with mono-energy image reconstruction were used to calculate the prosthetic filling ratio and to measure the alignment of the prosthesis in the coronal and sagittal positions. Stability assessment was performed based on X-ray films, and the subsidence distance was measured using EBRA-FCA software. Results: X-ray film observation showed that the prostheses in the two groups were stable and no signs of loosening was found. The incidence of pedestal sign was significantly lower in the ABGⅡ group than in the Corail group ( P<0.05), and the incidence of heterotopic ossification was significantly higher in the ABGⅡ group than in the Corail group ( P<0.05). The subsidence distance of femoral stem in ABG Ⅱ group was significantly greater than that in Corail group ( P<0.05), and the subsidence speed of femoral stem in ABG Ⅱ group was also greater than that in Corail group, but the difference was not significant ( P>0.05). The overall prosthesis filling ratio was significantly higher in the ABG Ⅱ group than in the Corail group ( P<0.05), while the coronal filling ratio at the lesser trochanter, 2 cm below the lesser trochanter, and 7 cm below the lesser trochanter were not significant ( P>0.05). The results of prosthesis alignment showed that there was no significant difference in the sagittal alignment error value and the incidence of coronal and sagittal alignment error >3° between the two groups ( P>0.05), while the coronal alignment error value in the ABG Ⅱ group was significantly greater than that in the Corail group ( P<0.05). Conclusion: Although the ABG Ⅱ short-stem avoids the distal-proximal mismatch of the Corail long-stem in the Dorr type C femur and thus achieves a higher filling ratio, it does not appear to achieve better alignment or stability.

Comparison of filling ratio, alignment, and stability between ABG Ⅱ short-stem and Corail long-stem in total hip arthroplasty for Dorr type C femur / 中国修复重建外科杂志

OBJECTIVE@#Using the mono-energy reconstruction images and X-ray films to investigate whether the ABG Ⅱ short-stem could improve the filling ratio, stability, and alignment in the Dorr type C femur, compared with the Corail long-stem.@*METHODS@#Among patients who were with Dorr type C femurs and treated with total hip arthroplasty between January 2006 and March 2012, 20 patients with a Corail long-stem (Corail group) and 20 patients with an ABG Ⅱ short-stem (ABG Ⅱ group) were randomly selected. The differences in gender, age, body mass index, and preoperative diagnoses between the two groups were not significant ( P>0.05). The ABG Ⅱ group was with a mean follow-up of 142 months (range, 102-156 months), and the Corail group was with a mean follow-up of 107 months (range, 91-127 months). There was no significant difference in the Harris score and subjective satisfaction score between the two groups at last follow-up ( P>0.05). At last follow-up, dual-energy CT scans with mono-energy image reconstruction were used to calculate the prosthetic filling ratio and to measure the alignment of the prosthesis in the coronal and sagittal positions. Stability assessment was performed based on X-ray films, and the subsidence distance was measured using EBRA-FCA software.@*RESULTS@#X-ray film observation showed that the prostheses in the two groups were stable and no signs of loosening was found. The incidence of pedestal sign was significantly lower in the ABGⅡ group than in the Corail group ( P<0.05), and the incidence of heterotopic ossification was significantly higher in the ABGⅡ group than in the Corail group ( P<0.05). The subsidence distance of femoral stem in ABG Ⅱ group was significantly greater than that in Corail group ( P<0.05), and the subsidence speed of femoral stem in ABG Ⅱ group was also greater than that in Corail group, but the difference was not significant ( P>0.05). The overall prosthesis filling ratio was significantly higher in the ABG Ⅱ group than in the Corail group ( P<0.05), while the coronal filling ratio at the lesser trochanter, 2 cm below the lesser trochanter, and 7 cm below the lesser trochanter were not significant ( P>0.05). The results of prosthesis alignment showed that there was no significant difference in the sagittal alignment error value and the incidence of coronal and sagittal alignment error >3° between the two groups ( P>0.05), while the coronal alignment error value in the ABG Ⅱ group was significantly greater than that in the Corail group ( P<0.05).@*CONCLUSION@#Although the ABG Ⅱ short-stem avoids the distal-proximal mismatch of the Corail long-stem in the Dorr type C femur and thus achieves a higher filling ratio, it does not appear to achieve better alignment or stability.

Clinical results and radiological bony adaptations on a cementless short-stem prosthesis - A comparative study between anatomical and reverse total shoulder arthroplasty.

INTRODUCTION: Although the use of short stem and stemless shoulder prosthesis is trending, the surgical outcome may vary due to varying biomechanics. Objectives were to evaluate and compare the short-term clinical results and radiological changes between anatomical total shoulder arthroplasty (TSA) and reverse TSA (rTSA) with a short-stem humeral design. HYPOTHESIS: There is no clinical and radiological difference between TSA and rTSA using a short-stem humeral design. METHODS: This retrospective study included 66 patients who underwent TSA and rTSA (33 patients each) with a minimum 2-year follow-up. Radiographic findings, including preoperative Tingart cortical index (TCI), postoperative filling ratios of metaphysis (FRmet) and diaphysis (FRdia), bone adaptations, and osteolysis around the humeral stem at the immediate postoperative period, and the most recent follow-up were measured. Pre and postoperative Constant-Murley score, subjective shoulder value (SSV), and complications were noted. RESULTS: At a mean follow-up of 27 (range 24-50) months, FRmet was significantly higher in rTSA group than the TSA group (0.65 vs. 0.60, p=0.009). Bone resorption was similar in both groups (p=0.76) and was correlated to a lower TCI value of<2.9mm (p=0.02). Despite significant clinical improvement in individual groups, the comparison between groups was non-significant (p>0.05). Negative correlation was observed between TCI and total clinical score (p=0.045) in TSA group, active external rotation (p=0.019), activity (p=0.005), SSV (p=0.008) and total score (p=0.025) in rTSA group. Radiographic changes were not influenced by patient characteristics and clinical results (p>0.05). CONCLUSION: Although no radiographic difference was observed between TSA and rTSA, better short-term clinical results observed with the usage of the short-stem humeral design prosthesis are encouraging. LEVEL OF EVIDENCE: III; Retrospective cohort study.

Perioperative Fractures in Cementless Total Hip Arthroplasty Using the Direct Anterior Minimally Invasive Approach: Reduced Risk With Short Stems.

BACKGROUND: The direct minimally invasive anterior approach (DMIAA) and the use of uncemented stems demonstrated an increase in intraoperative fractures in recent literature. Whether the different design of the stems additionally influences the incidence of perioperative local complications, was the goal of this study. METHODS: From January 2008 until June 2010, all patients undergoing primary cementless total hip arthroplasty, using a DMIAA, were consecutively included. The choice of the implant was defined by the day of operation. Age, gender, body mass index, type of prosthesis, and the practical experience of the performing surgeon were retrospectively analyzed. Of main interest were intraoperative fractures, postoperative hematoma, and wound healing. RESULTS: Six hundred forty consecutive patients (64 years [18-94], 339 female, 53%, body mass index 26) have been included. A Quadra-H stem (Medacta) was used in 457 patients (71%). In 183 (29%) patients, a short stem designed for the DMIAA (130 Fitmore, Zimmer and 53 AMIStem, Medacta) was used. We counted 34 (5.3%) intraoperative fractures (16 at the greater trochanter, 18 proximal shaft fractures), 20 (4%) hematomas, and 8 (2%) wound healing problems. The standard length stem showed more local complications (11.8% vs 4.4%) (P = .014, odds ratio 1.63, confidence interval 1.1-2.4) and significantly more (6.8% vs 1.6%) intraoperative fractures (P = .027, odds ratio 1.98, confidence interval 1.1-3.6). CONCLUSION: The standard length stem showed more perioperative complications, especially periprosthetic fractures. It seems that these implants not only put more stress to proximal osseous structures, but there might also be more traction and irritation to the soft tissue while preparing, resulting in more hematomas and wound healing problems.

Clinical Performance, Patient Reported Outcome, and Radiological Results of a Short, Tapered, Porous, Proximally Coated Cementless Femoral Stem: Results up to Seven Years of Follow-Up.

BACKGROUND: The primary aim of our study was to assess clinical performance, patient reported outcome and radiological results of cementless primary total hip arthroplasty using Tri-Lock Bone Preservation Stem. METHODS: Between March 2010 and June 2012, 163 consecutive patients, were enrolled in the study. Patients were assessed clinically and radiographically prior to surgery as well as at 6, 12, 24 months and then at 5, 6, and 7 years postoperatively. RESULTS: Using the Dorr classification, 39 patients (23.9%) were classified as Dorr A, 116 patients (71.2%) as Dorr B, and 8 patients (4.9%) as Dorr C. A total of 139 patients (85.3%) received a high offset, whereas 24 patients (14.7%) received a standard offset stem. Total Harris Hip Score of the patients increased from a mean of 27.29 (±4.6) preoperatively, upto 97.28 (±9.0) after 5 years. Mean preoperative Short Form-12 (SF-12) Physical Health Composite Scale score was 27.31 (±3.8). After 5 year was 55.3 (34-57). The mean preoperative SF-12 Mental Health Composite Scale score was 57.02 (±5.9). After 5 year was 59.3 (28.7-60.8). Only one patient underwent revision surgery for dislocation and revision of the head. CONCLUSION: Tri-lock Bone Preservation Stem DePuy proved to be an easy-to-use device. Results obtained up to 7 years of FU show excellent clinical performance, as well as radiographic osseointegration, with no cases of aseptic loosening and no images of progressive radiolucent lines or periprosthetic osteolysis.

Comparison between preoperative digital planning and postoperative outcomes in 197 hip endoprosthesis cases using short stem prostheses.

BACKGROUND: Preservation of hip geometry is important for treatment success in endoprosthesis implantation. Digital planning can be used to estimate postoperative hip geometry. This study examined whether digital planning accurately predicts surgical outcomes for two femoral neck resecting short stem implants, Mayo® (Zimmer) and Metha® (Aesculap). METHODS: Preoperative digital planning of the short stem and acetabular cup was performed for 191 patients (197 endoprostheses) with hip osteoarthritis. Digital planning was done with mediCAD II (Hectec) to evaluate types of prosthesis stems and sizes, leg lengthening and offset, and angle of stem inclination within the femur. The predicted values for these parameters were compared to the postoperative measurements. A double coordinate system was developed to measure pelvic and femoral distances separately. Individual scale factors were applied to minimize measurement bias. FINDINGS: Implantation of the planned short stem prostheses resulted in a mean femoro-acetabular leg lengthening of 4.2mm (SD 5.8mm) and a mean femoro-acetabular offset-reduction of 4.2mm (SD 5.9mm) in comparison with preoperative planning. Implantation of both stems resulted in increased valgization compared to planning (Metha®, mean 5.4° (SD 3.7°); Mayo®, mean -3.2° (SD 3.4°)). INTERPRETATION: Differences between preoperative planning and postoperative outcomes were greater for femoro-acetabular than for cup-related leg length and offset. On average, leg length was longer than predicted and there was loss of femoro-acetabular offset. Compared with the planning, valgization of the implanted stems was frequently observed.