A study of the Elite Plus femoral component using radiostereometric analysis

Derbyshire, Brian; Porter, Martyn

doi:10.1302/0301-620x.89b6.18317

Cited by 15 publications

(12 citation statements)

References 28 publications

(20 reference statements)

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“…The level of migration in the posterior direction was similar in the study by Derbyshire and Porter and in the present study, but there was less migration along the transverse axis in our study. A slow distal migration during the first 3 years shown by Derbyshire and Porter (2007) was confirmed in our study and continued up to 7 years.…”

Section: Discussionsupporting

confidence: 86%

“…In a recent RSA study, Derbyshire and Porter (2007) found that the Elite-Plus stems continued to subside during the 3-year observation period. They also noted that the stems continued to rotate internally and to migrate in the posterior direction.…”

Section: Discussionmentioning

confidence: 98%

“…Should the prosthesis, the surgical technique, or the type of bone cement be blamed for these poor results? The most disappointing result was from a series using low-viscosity cement throughout (Hauptfleisch et al 2006) and the best results have been from studies in which only high-viscosity cement was used (Kalairajah et al 2004, Derbyshire and Porter 2007). These results thus confirm earlier reports, e.g.…”

Section: Discussionmentioning

confidence: 99%

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The Elite-Plus stem migrates more than the flanged Charnley stem

et al. 2010

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Background and purposeThe Charnley Elite-Plus stem was introduced in 1993 as a presumed improvement of the flanged Charnley stem. We started this study in 1996 to investigate the migratory pattern of the Elite-Plus stem.Patients and methodsWe followed 114 patients with osteoarthritis and a primary total hip replacement with the Elite-Plus stem. Mean age at the time of operation was 64 (50–76) years. The mean follow-up time was 6.5 (2–7) years. Radiographs were evaluated with respect to cementing technique, migration, and wear measured by radiostereometry (RSA).ResultsThe stem survival was 98% (CI: 96–100) at 7 years and 92% (CI: 86–97) at 10 years. Mean migration of the femoral head was 0.35 mm (SD 0.3) medially, 0.51 mm (SD 0.6) distally, and 1.1 mm (SD 1.8) in the dorsal direction. Mean total point motion was 1.7 mm (SD 1.7). The migration of the stems stabilized after 5 years in the medial and dorsal directions, but continued to subside slightly. Migration along any of the axes was higher if the cementing technique was inferior.InterpretationPatients with a Charnley Elite-Plus stem and defects in the cement mantle or other signs of inferior implantation technique should be carefully monitored.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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The Elite-Plus stem migrates more than the flanged Charnley stem

et al. 2010

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“…Karrholm et al (2002) evaluated 2 different uncemented stems with RSA; they found subsidence and rotation values close to zero at 2 years and no failures were observed during this time. On the other hand, 2 other studies (Karrholm et al 1994, Derbyshire and Porter 2007) (Table 3) found that pronounced migration within the first 2 years after THA led to revision rates of between 10% and 50%.…”

Section: Discussionmentioning

confidence: 92%

Excessive distal migration of fiber-mesh coated femoral stems

Baad‐Hansen¹,

Kold²,

Olsen³

et al. 2011

Acta Orthopaedica

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BackgroundThe surface texture, localization, and magnitude of the surface material applied to the femoral stem can facilitate bone ingrowth and influence the survival of total hip arthroplasties. Clinical and radiographic studies have shown superior bone ingrowth in proximally porous-coated stems with a diaphyseal grit-blasted surface in comparison to a smooth diaphyseal surface. Surface textures—especially porous surface material—have been suggested to have a sealing effect against migration of polyethylene debris along the implant-bone interface and to reduce the inflammatory response, leading to a prolonged implant survival.Patients and methodsBetween 2004 and 2006, we conducted a randomized, controlled trial (RCT) involving 50 patients with non-inflammatory arthritis. They received either a distally tapered, extended coated stem or a straight, proximally coated stem. During surgery, tantalum markers were inserted into the greater and lesser trochanter. Implant migration was evaluated at 3, 12, and 24 months postoperatively by radiostereometric analysis. The primary endpoint was stem migration 2 years after surgery.ResultsAll femoral components in both groups showed pronounced distal translation, with the highest rate of translation occurring between 0 and 3 months. After 2 years, the mean distal translation was 2.67 (95% CI: –3.93 to –1.42) mm for the tapered, extended coated stem and 1.80 (–2.45 to –1.15) mm for the straight, proximally coated stem. Half of the tapered, extended coated stems and two-thirds of the straight, proximally coated stems had migrated more than 1 mm. No difference between the 2 stems could be seen with regard to translation or rotation at any time point. After 2 years, 2 hips have been reoperated due to mechanical loosening of the stem.InterpretationAn excessive amount of migration of both stem types was seen 2 years postoperatively. It is of vital importance to follow this patient cohort since radiostereometric analysis is known to be predictive of late implant failure, especially in this study where pronounced early migration was observed. We recommend longer follow-up of both stem types.

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“…weight, activity level) or variations in the surgical technique (including the number and scatter of bone markers), postoperative rehabilitation protocol, or time of the reference (index) radiographic examination. For instance, with a “constrained” (Derbyshire and Porter 2007) cemented hip stem or an uncemented hip stem, which would be effectively “loose” immediately after surgery, a large amount of migration would occur in the first few postoperative days as the stem settled in, and this would be affected by the rehabilitation protocol. If the time of the reference radiographic examination was just a few days late, much of the early migration would be “lost” from the recordings.…”

Section: Introductionmentioning

confidence: 99%

Notes on the use and interpretation of radiostereometric analysis

2009

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With increasing numbers of research groups carrying out radiostereometric analysis (RSA), it is important to reach a consensus on how the main aspects of the technique should be carried out and how the results should be presented in an appropriate and consistent way.In this collection of guidelines, we identify a number of methodological and reporting issues including: measurement error and precision, migration and migration direction data, and the use of RSA as a screening technique. Alternatives are proposed, and a statistical analysis is presented, from which a sample size of 50 is recommended for screening of newly introduced prostheses.

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A study of the Elite Plus femoral component using radiostereometric analysis

Cited by 15 publications

References 28 publications

The Elite-Plus stem migrates more than the flanged Charnley stem

The Elite-Plus stem migrates more than the flanged Charnley stem

Excessive distal migration of fiber-mesh coated femoral stems

Notes on the use and interpretation of radiostereometric analysis

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