A customised collared polished stem may reduce the complication rate of impaction grafting in revision hip surgery

Flécher, Xavier; Blanc, Guillaume Le; Sainsous, Benjamin; Parratte, Sébastien; Argenson, Jean-Noël

doi:10.1302/0301-620x.94b5.26828

Cited by 7 publications

(7 citation statements)

References 60 publications

(61 reference statements)

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“…In addition, allografting was performed in this study. In elderly patients with osteoporosis, bone grafting failure might occur, also causing loosening of the femoral stem [ 8 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Short uncemented femoral component for hip revision: prognosis and risk factors associated with failure

Liu

Zhang

et al. 2021

BMC Surg

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Background The application of short femoral stems is partially restricted in revision surgery. This study will demonstrate the therapeutic effect and unsuitable situation for short stem revision. Methods Demographic characteristics of all patients were recorded in detail (Table 1). Anteroposterior view radiographic examinations of proximal femur are necessary before and after the operation for patients. The primary outcome of interest was the survival rate of the femoral stem at the final follow-up. Risk factors for failure were also investigated. The secondary outcomes of interest included the Harris hip score, excellent to good rate and incidence of complications. The Mann–Whitney U test was performed for comparisons between continuous variables. The chi-square test was performed for comparisons between categorical variables. Cox regression analysis was used to assess the association between potential risk factors and the failure of revision surgery. Results A total of 381 patients with short stems were retrospectively reviewed. There were 188 males and 193 females. The average age and body mass index before revision surgery were 58.85 ± 13.46 years and 23.72 ± 3.40 kg/m2, respectively. The mid-term survival rate of the short femoral component was 94.23%. The prognosis and complications of patients between the two groups were compared. There was no significant difference between the two groups in the Harris score, complication incidence or survival rate of the femoral component. The strongest risk factor in this study was intraoperative periprosthetic femoral fracture during revision surgery (HR = 5.477, 95% CI = 2.156–13.913). Conclusion Three risk factors for failure were identified: ageing, osteoporosis and intraoperative periprosthetic femoral fracture during revision surgery. Therefore, a short femoral stem should be implanted in patients with these risk factors with additional caution.

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“…In addition, allografting was performed in this study. In elderly patients with osteoporosis, bone grafting failure might occur, also causing loosening of the femoral stem [ 8 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Short uncemented femoral component for hip revision: prognosis and risk factors associated with failure

Liu

Zhang

et al. 2021

BMC Surg

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“…In addition, allografting was performed in this study. In elderly patients with osteoporosis, bone grafting failure might occur, also causing the loosen of femoral stem [7,15].…”

Section: Discussionmentioning

confidence: 99%

Short Uncemented Femoral Component for Hip Revision: Prognosis and Risk Factors Associated With Failure

Liu

Zhang

et al. 2020

Preprint

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BackgroundThe application of short uncemented femoral stem is partially restricted in revision surgery. In some patients with mild to moderate bone deficiency, short uncemented stem is certainly a choice. This study will demonstrate the therapeutic effect and unsuitable situation for short uncemented stem revision.MethodsPatients who undergone hip revision from January 2005 to December 2015 were retrospectively analyzed in this study. Preoperative radiological images were evaluated to help estimating the bone deficiency around hip joint. Mann-Whitney U test was performed for comparison between continuous variables. Chi-square test was performed for comparison between categorical variables. Cox regression analysis was used to assess the association between potential risk factors and failure of revision surgery.ResultsA total of 381 patients were retrospectively reviewed. The mean follow-up time was 71.05±16.54 months. The mean time from primary revision surgery to secondary revision surgery was 16.41±17.47 months. According to the survival status of femoral component at final follow-up, patients were divided into two groups. Cox regression analysis revealed that the risk for revision failure approximately increased by 5.6% for every year of age increase (HR=1.056, 95%CI=1.012–1.102). Osteoporosis was another independent risk factor for revision failure (HR=2.802, 95%CI=1.097–7.157). The strongest risk factor was intraoperative periprosthetic femoral fracture during revision surgery in this study (HR=5.477, 95%CI=2.156–13.913).ConclusionThree risk factors for failure are identified, such as aging, osteoporosis and intraoperative periprosthetic femoral fracture during revision surgery. Therefore, short uncemented femoral stem should be implanted in these patients with additional caution.

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“…Numerous studies investigated the benefits and drawbacks of collared stems and found little differences compared to collarless stems (Al-Najjim et al, 2016 ; Caglar et al, 2008 ; Ebramzadeh et al, 2004 ; Lenart et al, 2012 ; Weber et al, 2014 ). Other clinical studies encourage the use of collars because it may improve stem survival and simplify revision THA (Flecher et al, 2012 ; Kale et al, 2000 ; Van Kleunen et al, 2006 ). Finite element analyses suggested that collars improve the distribution of axial loads on the femoral calcar and reduce tensile and rotational stresses within the cancellous bone, and thereby reduce risks of fracture and thigh pain (Fischer et al, 1992 ; Jeon et al, 2011 ; Whiteside et al, 1988 ).…”

Section: Discussionmentioning

confidence: 99%

“…The advent of uncemented Total Hip Arthroplasty (THA) required alternative implant features to grant initial stability and stimulate long-term osteo-integration. The addition of collars to femoral stems was intended to enable load transfer to the resected femoral calcar, and thereby prevent implant subsidence within the cancellous bone of the metaphysis (Demey et al, 2011 ; Flecher et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

“…Several authors investigated the benefits and drawbacks of collared stems and found little or no differences, in either short- or long-term outcomes, when compared to collarless stems (Al-Najjim et al, 2016 ; Caglar et al, 2008 ; Ebramzadeh et al, 2004 ; Lenart et al, 2012 ; Weber et al, 2014 ). Conversely, a number of clinical studies supported the use of collars and argued that they could improve stem survival and facilitate revision THA (Flecher et al, 2012 ; Kale et al, 2000 ; Van Kleunen et al, 2006 ). Furthermore, good collar-calcar coverage could prevent stem subsidence and rotation, which may occur during the first weeks following uncemented THA (Campbell et al, 2011 ; Parvizi et al, 2004 ; Simpson et al, 2010 ; Strom et al, 2007 ; Weber et al, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

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Proximal femoral anatomy and collared stems in hip arthroplasty: is a single collar size sufficient?

Bonin¹,

Gedouin

Pibarot

et al. 2017

J EXP ORTOP

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BackgroundEven if the benefits of collars are unclear, they remain widely used, in several femoral stem designs. This study aimed to determine whether collar size should be proportional to hip dimensions and morphology. The hypothesis was that the collar should be larger for greater stem sizes and for varus femoral necks.MethodsComputed Tomography scans of 204 healthy hips were digitally analysed and manually templated to determine principle dimensions, appropriate stem size and model, as well as cortical distance at the femoral calcar (ideal collar size).ResultsUnivariable analysis revealed that cortical distance was moderately correlated with mediolateral offset (r = 0.572; p < 0.0001) and stem model (r = 0.520; p < 0.0001). Cortical distance was weakly correlated with head diameter (r = 0.399; p < 0.0001), stem size (r = 0.200; p = 0.017), and patient gender (r = 0.361; p < 0.0001). Multivariable analysis confirmed that stem model (p < 0.0001) and head diameter (p = 0.0162) are directly correlated to cortical distance.ConclusionWe found that cortical distance along the femoral calcar is directly correlated with the model of the stem implanted (‘standard’ or ‘varus’) and with the head diameter. This cortical distance indicates optimal collar size, which would grant maximum calcar coverage without prosthetic overhang. Collar size should be proportional to the size of the operated hip, and should be larger for ‘varus’ stem models than for ‘standard’ stem models.

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A customised collared polished stem may reduce the complication rate of impaction grafting in revision hip surgery

Cited by 7 publications

References 60 publications

Short uncemented femoral component for hip revision: prognosis and risk factors associated with failure

Short uncemented femoral component for hip revision: prognosis and risk factors associated with failure

Short Uncemented Femoral Component for Hip Revision: Prognosis and Risk Factors Associated With Failure

Proximal femoral anatomy and collared stems in hip arthroplasty: is a single collar size sufficient?

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