Early subsidence of shape-closed hip arthroplasty stems is associated with late revision

Abstract

Background and purpose Few studies have addressed the association between early migration of femoral stems and late aseptic revision in total hip arthroplasty. We performed a meta-regression analysis on 2 parallel systematic reviews and meta-analyses to determine the association between early migration and late aseptic revision of femoral stems.Patients and methods Of the 2 reviews, one covered early migration data obtained from radiostereometric analysis (RSA) studies and the other covered long-term aseptic revision rates obtained from survival studies with endpoint revision for aseptic loosening. Stems were stratified according to the design concept: cemented shape-closed, cemented force-closed, and uncemented. A weighted regression model was used to assess the association between early migration and late aseptic revision, and to correct for confounders. Thresholds for acceptable and unacceptable migration were determined in accordance with the national joint registries (≤ 5% revision at 10 years) and the NICE criteria (≤ 10% revision at 10 years).Results 24 studies (731 stems) were included in the RSA review and 56 studies (20,599 stems) were included in the survival analysis review. Combining both reviews for the 3 design concepts showed that for every 0.1-mm increase in 2-year subsidence, as measured with RSA, there was a 4% increase in revision rate for the shape-closed stem designs. This association remained after correction for age, sex, diagnosis, hospital type, continent, and study quality. The threshold for acceptable migration of shape-closed designs was defined at 0.15 mm; stems subsiding less than 0.15 mm in 2 years had revision rates of less than 5% at 10 years, while stems exceeding 0.15 mm subsidence had revision rates of more than 5%.Interpretation There was a clinically relevant association between early subsidence of shape-closed femoral stems and late revision for aseptic loosening. This association can be used to assess the safety of shape-closed stem designs. The published research is not sufficient to allow us to make any conclusions regarding such an association for the force-closed and uncemented stems.

Bone Mineral Density and Cortical-Bone Thickness of the Distal Radius Predict Femoral Stem Subsidence in Postmenopausal Women

“…As a study limitation, the limited group size and the inclusion of only postmenopausal women preclude implementation of the results to different groups of THA patients and different stem designs. Concerning the selection of the stem subsidence threshold, the limit of clinically significant migration remains incompletely defined for uncemented femoral stems [27]. The generalizability of the observed cutoff values remains to be verified in larger populations of different stems.…”

Effect of Denosumab on Femoral Periprosthetic BMD and Early Femoral Stem Subsidence in Postmenopausal Women Undergoing Cementless Total Hip Arthroplasty

“…(65) However, there are not enough published results to draw definite conclusions. (45) The difference between RSA-measurable stem migration and clinically significant stem migration remains incompletely defined. Without doubt, excessive subsidence may cause permanent functional disability and carries even a risk for failure of osseointegration.…”

“…Stem subsidence has been applied as a predictor of late revision. (45) Computer-aided design surface models of each stem size were provided by the implant manufacturer and converted to the model-based format for calculation of stem 3D migration (MBRSA software version 3.34; Medis Specials BV, Leiden, The Netherlands) by using a combination of stem-head models. Multiple tantalum RSA markers (1-mm diameter) were implanted into the trochanteric bone.…”

Cementless Stem for Femoral Neck Fractures in a Patient’s 10th Decade of Life: High Rate of Periprosthetic Fractures

“…Early migration of prostheses is known to predict later loosening and implant failure. 22 , 23 Van der Voort et al 24 defined the threshold for acceptable migration as 0.15 mm in 2 years. Their revision rate was <5% at 10 years, while stems exceeding 0.15 mm of subsidence had revision rates of >5%.…”