Five-year prospective subsidence analysis of 100 cemented polished straight stems: A concise clinical and radiological follow-up observation.

Early subsidence (>1.5mm) has been shown to be an indicator for later aseptic loosening of cemented hip stems. For the cemented twinSys® stem we published excellent short-term results at 2 years. Midterm data for this stem are available from national registers (NZL, NL), however in all of these sources, clinical and radiological results are missing. Aim of our study was to analyse mid-term survival and radiological changes around the cemented twinSys® stem with special emphasis on subsidence using EBRA-FCA. We conducted a prospective clinical and radiological 5- year follow-up study of 100 consecutive hybrid total hip arthroplasties (THA) using a polished, cemented collarless straight stem (twinSys®, Mathys AG® Bettlach, Switzerland) with a cementless monobloc pressfit cup (RM pressfit®, Mathys AG® Bettlach, Switzerland). Median age at surgery was 79 (69 to 93) years. No patient was lost to follow-up. Survival rates were calculated using the Kaplan-Meier method. Clinical (Harris Hip Score [HHS]) and radiological (cementing quality, alignment, osteolysis, debonding and cortical atrophy) outcomes and an in-depth subsidence analysis using EBRA-FCA were performed. 22 patients died in the course of follow-up unrelated to surgery, 21 stems had an incomplete radiological follow-up. 2 stems were revised, both due to an infection. The survival rate for the stem at 5 years was 98.0% (95% CI 95.3-100%). The survival rate of the stem for revision due to aseptic loosening at 5 years was 100%. The HHS improved from 53 (14-86) points preoperatively to 90 (49-100) points 5 years after surgery. Osteolysis was found in 2 stems without clinical symptoms. In 49 out of 55 patients with a complete radiological follow- up, the EBRA-FCA analysis was possible and showed an average subsidence of 0.66 (95% CI 0.46 to 0.86) mm 5 years after surgery. 10 patients showed a subsidence >1 mm, 5 of which bigger than 1.5 mm. Subsidence was independent from radiological changes and cementing quality. The cemented twinSys® stem showed excellent clinical and radiological mid-term results at five years' follow-up and seems to be a reliable implant.

Prospective two-year subsidence analysis of 100 cemented polished straight stems - a short-term clinical and radiological observation.

BACKGROUND: Cemented stems show good long-term results and the survival of new implants can be predicted by their early subsidence. With EBRA-FCA (Femoral Component Analysis using Einzel-Bild-Röntgen-Analyse) early subsidence as an early indicator for later aseptic loosening can be analysed. For the cemented TwinSys stem mid- and long-term data is only avalible from the New Zeeland Arthroplasty register, thus close monitoring of this implant system is still mandatory. METHODS: We conducted a 2 year follow up of 100 consecutive hybrid THA (Total hip arthroplasty) of a series of 285 primary THA operated between Jan 2009 und Oct 2010. These 100 received a polished, cemented collarless straight stem (twinSys®, Mathys AG® Bettlach, Switzerland) with an uncemented monobloc pressfit cup (RM pressfit®, Mathys AG® Bettlach, Switzerland). The other patients were treated with the uncemented version of this stem and the same cup. Clinical (Harris Hip Score) and radiological (ap and axial x-rays, cementing quality according to Barrack, alignment) outcomes besides an EBRA-FCA subsidence analysis were performed. RESULTS: Median age at operation was 78 (68 to 93) years. 5 patients died in the course of follow-up unrelated to surgery. The KM (Kaplan-Meier) survival at 2 years for the endpoint reoperation for any reason was 94.9 (95 % confidence interval 90.6-100 %). Survival for the endpoint aseptic loosening at 2 years was 100 %. The HHS (Harris Hip Score) improved from 56 (14-86) preoperatively to 95 (60-100) 2 years after the operation. Cementing results were judged 47 % Grade A, 45 % Grade B and 7 % Grade C. Osteolysis was found in 2 stems without clinical symptoms or correlation to subsidence or cementing quality. The EBRA-FCA analysis showed an average subsidence of -0.30 mm (95 % CI -0.5 mm to -0.1 mm). 11 patients showed a subsidence of more than 1 mm. In this group one patient showed a subsidence of 1.5 mm and one of 3.1 mm without further radiological changes. CONCLUSIONS: The twinSys stem showed excellent clinical and radiologic short term results at 2 years follow-up and seems to be a reliable implant.

Early failure of a non-cemented femoral stem after minimal-invasive total hip arthroplasty: cause analysis and classification.

In this paper, we present a 77-year-old female patient with an early failure of a non-cemented femoral stem 6 months after implantation. We evaluate possible reasons for the implant failure in our case against the literature. Risk factors for stem failure include a BMI >30, varus implantation, a high femoral canal cortex ratio, and a small implant. It should be distinguished between modular and non-modular stems as well as cemented and non-cemented. Early failure would be <1 year postoperatively, late failure >1 year postoperatively. A classification of stem failure differentiating time and cause is suggested as this seems to be missing in the literature.

Treatment of acute Achilles tendon rupture: fibrin glue versus fibrin glue augmented with the plantaris longus tendon.

UNLABELLED: In the surgical repair of Achilles tendon ruptures, suturing is standard, although fibrin glue also has been used for repair since the 1980s. Augmentation with the plantaris longus tendon is also a popular technique; however, no study has yet compared the outcome of augmented versus only glued repair of ruptured Achilles tendons. This study compares the long-term results of surgical repair of Achilles tendon rupture with fibrin glue versus fibrin glue augmented with the plantaris longus tendon. Forty patients who had undergone Achilles tendon repair with fibrin glue took part in a follow-up examination after an average of 11.5 years. The fibrin group consisted of 16 patients and the fibrin glue augmented with plantaris longus tendon group consisted of 15 patients. The modified Thermann score (adapted from Weber) and results of an isokinetic force measurement were the same in both groups, whereas complications in the 2 groups also did not differ. We conclude that augmentation with the plantaris longus tendon is not necessary when operatively treating acute ruptured Achilles tendons with fibrin glue. LEVEL OF CLINICAL EVIDENCE: 2.

Long-term results after operatively treated Achilles tendon rupture: fibrin glue versus suture.

UNLABELLED: The use of fibrin glue for repairing Achilles tendon ruptures was introduced in the 1980s. Although fibrin glue has been in regular use since that time, suturing remains the standard for surgical repair. Studies have indicated that, in the short term, fibrin glue is as effective as suturing. To date, there have been no long-term studies comparing the outcomes of these 2 techniques. This study compares the long-term results of surgical repair of Achilles tendon rupture with sutures versus fibrin glue. Forty-two patients who had undergone Achilles tendon repair with either suture or fibrin glue took part in a follow-up examination after an average of 12.1 years. The fibrin group consisted of 31 patients and the suture group consisted of 11 patients. Patients treated with fibrin glue reached a higher modified Thermann score (adapted from Weber), achieved equal results in an isokinetic force measurement, and showed fewer complications. The authors concluded that the use of fibrin glue for the repair of ruptured Achilles tendon is a suitable alternative to traditional sutures. LEVEL OF CLINICAL EVIDENCE: 2.