Radiographic evaluation of cementation technique using polished, conical, triple-tapered femoral stem in hip arthroplasty

Schuroff, Ademir Antônio; Deeke, Mark; Pedroni, Marco; Lupselo, Fernando Silva; Kunz, Rodrigo Ernesto; Lima, Alexandre Matos

doi:10.1016/j.rboe.2017.08.019

Cited by 3 publications

(4 citation statements)

References 22 publications

(31 reference statements)

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“…Leunig et al reported satisfactory component positioning in bikini anterior THA with cementation at 4 years post-operative, although this cementation was used in only 24 of 964 cases [ 5 ]. Schuroff et al conducted a radiographic evaluation of cementation using a posterolateral surgical approach [ 22 ]. Compared to their results we identified a higher percentage of Barracks cementation type A and B in our series.…”

Section: Discussionmentioning

confidence: 99%

The bikini incision anterior cemented total hip arthroplasty: Assessment of radiological and clinical outcomes

Nizam

Alva

Gogos

2021

SICOT-J

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Introduction: There has been an increased interest in minimally invasive direct anterior approach total hip arthroplasty (THA) to provide greater patient satisfaction, improve pain relief, and reduce the duration of hospitalisation. A direct anterior approach hybrid cemented THA, utilising a bikini line incision, can be technically challenging. We aimed to undertake radiological analysis of femoral stem cementation, clinical outcomes, and component survivorship. Methods: Over a 5-year period, 215 primary elective bikini anterior THA conducted by a single surgeon were included. All procedures were performed using a cemented collarless polished stem. The operation was performed on a standard operating table. Patients undergoing posterior approach, revision procedures, and fractured neck of femurs were excluded. Post-operative radiographs were analysed for femoral cementation quality using the Barrack grading system. Harris hip scores (HHS) were determined at 6 weeks, 12 weeks, annually thereafter and the difference in HHS was noted. Results: In total, 215 anterior bikini THA (R = 101, L = 114) were performed in 199 patients (M = 89, F = 110) with a mean age of 77 and mean follow up of 2.9 years (range = 0.5–5). Radiographic analysis of femoral cementation showed 189 femoral stems (88%) were either Barrack A or B cementation grade, suggesting optimal cementation. Lucency in the cement-bone interface occurred mainly in Gruen Zone 1 (43%) and Zone 13(46.9%). At the most recent follow-up (mean 2.9 years), component survivorship was at 99.54% (stem). Significant improvement was noted in Harris hip scores at final follow-up (from 54 preoperatively to 92.7 at 2.9 years postoperatively). Conclusion: Our results suggest that a bikini incision direct anterior approach for total hip arthroplasty can be safely employed to perform cemented femoral stems on a standard operating table.

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Section: Discussionmentioning

confidence: 99%

The bikini incision anterior cemented total hip arthroplasty: Assessment of radiological and clinical outcomes

Nizam

Alva

Gogos

2021

SICOT-J

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“…In our study, 91.5% was inserted in neutral position, and the CMK stem that was also implanted with line-to-line cementing technique, was in a neutral position in 80.5% [ 15 ]. In contrast, 65.3% was inserted within 2 degrees of varus or valgus in the Exeter stem [ 24 ], and 61.7% was in a neutral position in the C-stem [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Minimum ten-year outcome of a triple-tapered femoral stem implanted with line-to-line cementing technique

Ohashi

Iida

Izumi

2021

BMC Musculoskelet Disord

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Background A triple-tapered polished femoral stem was implanted with line-to-line cementing technique. The purpose of this study was to determine the survivorship, loosening rate, stem subsidence, radiologic changes and clinical outcomes in the minimum 10-year follow-up. Methods This was a retrospective study done in three institutes. Finally, 118 hips in 97 patients could be followed-up at the mean follow-up period of 126.3 months. The survivorship, radiological and clinical outcomes were investigated. Results Radiologically, 107 hips (90.7%) were categorized to Barrack cementing grade A, and 108 stems (91.5%) were inserted in neutral position. All hips were not loose and were not revised due to any reason. Survival with revision for any reason as the endpoint was 100% after 10 years. At the last follow-up, the mean subsidence was 0.43 mm, and the subsidence was less than 1 mm in 110 hips (93.2%). JOA hip score improved from 42.7 ± 8.9 points preoperatively to 92.8 ± 6.8 points at the last follow-up. No patient complained thigh pain. Conclusions Line-to-line cementing technique with use of a triple-tapered polished stem was effective to achieve good cementation quality and centralization of the stem. The subsidence was small, and the minimum 10-year results were excellent without any failures related to the stem. Trial registration Retrospectively registered.

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“…In most studies using a different type of implants and approaches, Barrack Type B cementation was the most prevalent [34]. Using the C-stem (DePuy Synthes, Warsaw, Indiana) and posterior approach, Schuroff et al [10] reported 5.8% type A, 53,5% type B, 31.4% type C, and 9.3% type D quality of cement mantle in 86 hips according to the Barrack classification. Ek and Choong [35] using the same stem reported 46% type B, 45.7% type A, and 8% type C cement mantles.…”

Section: Tablementioning

confidence: 99%

“…The limited literature available suggests the DAA is probably related to a higher rate of deficiency of the cement mantle compared with the posterior approach [ 9 ]. However, the cement mantle quality is recognized as being highly associated with the longevity of a prosthesis [ 9 , 10 ]. Although some degree of uncertainty still exists, the initial thickness and homogeneity of the cement mantle, as well as the presence of deficiencies, are critical in the process of aseptic loosening [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Quality of the femoral cement mantle in total hip arthroplasty using the direct anterior hip approach

et al. 2020

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Background: Limited literature exists concerning the femoral cement mantle quality that can be achieved through an anterior approach in total hip arthroplasty (THA). We radiologically evaluated the quality and thickness of the femoral cement mantle in patients undergoing THA utilizing the direct anterior approach (DAA). Methods: Immediate postoperative anteroposterior and lateral radiographs of 116 consecutive patients who underwent hybrid or fully cemented THA using the DAA and cemented Quadra-C stem (Medacta, International, SA, Switzerland) were assessed by 2 arthroplasty surgeons blinded to the study. Surgical indications were hip osteoarthritis or subcapital hip fracture. The cement mantle and stem alignment were evaluated using the Barrack classification and Khalily methods, respectively. After calibration of radiographs, the thinnest part of the cement mantle per Gruen zone was recorded. Parameters were compared between obese and nonobese patients. Results: Agreement between raters was substantial for the cement quality in anteroposterior (k ¼ 0.707, P .001) and moderate for lateral radiographs (k ¼ 0.574, P 001). The cement mantle was graded A in 39.25%, B in 53.0%, and C in 7.75% of anteroposterior radiographs and similarly for lateral radiographs (40.1% A, 51.75% B, 9.5% C). 93% of stems had neutral alignment. The mean thinnest cement mantle (P ¼ .237) and incidence of inadequate cement mantle (<2 mm) per zone (P ¼ .431) were comparable between Gruen zones. The cement mantle quality (P ¼ .174) and inadequacy (P > .05) and stem alignment (P ¼ .652) were comparable between obese and nonobese patients. Conclusions: DAA enables correct implantation and effective cementation of straight femoral stems. A high-quality cement mantle can be achieved using DAA even in obese patients.

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Radiographic evaluation of cementation technique using polished, conical, triple-tapered femoral stem in hip arthroplasty

Cited by 3 publications

References 22 publications

The bikini incision anterior cemented total hip arthroplasty: Assessment of radiological and clinical outcomes

The bikini incision anterior cemented total hip arthroplasty: Assessment of radiological and clinical outcomes

Minimum ten-year outcome of a triple-tapered femoral stem implanted with line-to-line cementing technique

Quality of the femoral cement mantle in total hip arthroplasty using the direct anterior hip approach

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