Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties

Issa, Kimona; Stroh, Alex D; Mont, Michael A.; Bonutti, Peter M.

doi:10.1002/jor.22648

Cited by 15 publications

(8 citation statements)

References 32 publications

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“…However, as Engh and Bobyn had calculated the theoretic degree of stress shielding in the stem-implanted femur, decreased ratio of the outer diameter of the femur to the diameter of stem (i.e., femur with thin cortex and large stem) increases bending stiffness which results in increasing the degree of stress shielding in turn 47. Our study and other clinical studies also support Engh and Bobyn's calculation with more pronounced remodeling in Dorr Type C femurs 22343638…”

Section: Discussionsupporting

confidence: 82%

Does Proximally Coated Single-Wedge Cementless Stem Work Well in Dorr Type C Femurs? Minimum 10-year Followup

Kim

Jeong

Lee

et al. 2019

IJOO

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Background: Total hip arthroplasty (THA) with a proximally coated single-wedge (PSW) cementless stem had been generally considered not to be suitable for Dorr Type C femurs. This study compares the long term outcomes of PSW stem according to the type of proximal femoral geometry. Materials and Methods: 307 primary THAs in 247 patients were performed with PSW cementless stem and followed up for over 10 years in this retrospective study. According to Dorr's criteria, 89 femurs were classified as Type A, 156 as Type B, and 62 as Type C. They were followed up for an average of 13.2 years (range 10.0–17.3 years). All the hips were evaluated clinically and radiologically. Results: There was no significant difference in stem survivorship and clinical outcomes including the incidence of thigh pain and the mean postoperative Harris hip score (HHS) in all three groups. No significant differences were observed in osteolysis, pedestal formation, or cortical hypertrophy among the groups. Radiolucent lines <2 mm in thickness in Gruen zone 4 and 7 ( P = 0.003 and P = 0.044, respectively), spot-weld ( P < 0.001), and stress shielding ( P = 0.010) of proximal femur were more pronounced in Dorr C type femora than in Type A or B. Fifty-six intraoperative fractures were identified among 307 hips with PSW stems. The incidence of intraoperative or postoperative femoral fractures was not significantly different among the groups. Conclusions: From over a 10-year followup, the PSW stem provided a recommendable option with satisfactory outcomes and excellent stem survivorship regardless of the Dorr type.

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Section: Discussionsupporting

confidence: 82%

Does Proximally Coated Single-Wedge Cementless Stem Work Well in Dorr Type C Femurs? Minimum 10-year Followup

Kim

Jeong

Lee

et al. 2019

IJOO

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“…To preserve more bone stock, the new short stems must bear load more proximally. To achieve this, major changes in femoral stem design were necessary that carried the risk of possible upcoming adverse effects like distal CH [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Prospective 5-year study with 96 short curved Fitmore™ hip stems shows a high incidence of cortical hypertrophy with no clinical relevance

et al. 2019

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Background An increased occurrence of cortical hypertrophy (CH) was observed 1–2 years after implanting short curved Fitmore hip stems. There are no published data about either the clinical relevance or the progression of CH over the long term. Methods Ninety-six primary total hip arthroplasties were performed between 2008 and 2010 using the Fitmore hip stem. Clinical and radiological parameters were recorded preoperatively and at 1, 2, 3, and 5 year follow-up. Results CH appeared mainly on antero-posterior radiographs in Gruen Zones 2, 3, 5, and 6. After 1 year, the diameter was 10 ± 2 mm and remained constant thereafter. The CH rate after 1 year was 69% and after 5 years 71%. Subsidence after 1 year was 1.6 ± 1.55 mm and 1.93 ± 1.72 mm after 5 years. Cortical thinning was 46% after 1 year and 56% after 5 years, mainly in Gruen Zones 7 and 8. In the first year radiolucencies were found in 51% in all Gruen Zones, and in 20% after 5 years. Patient, implant, and surgical factors did not correlate with radiological outcomes except that larger stems had more CH. After 5 years, the Harris Hip Score had improved from 59 to 94 and the Oxford Hip Score from 22 to 41. Radiographic parameters, notably CH, were not associated with clinical outcomes except that cortical thinning correlated with lower outcome scores. Conclusions CH correlated neither with clinical outcome nor with patient, surgical or implant factors, except for a positive correlation with stem size. The Fitmore hip stems settled within the first year to a stable fixation and then remained almost unchanged. However, cortical thinning is common in Gruen Zone 7 and 8 meaning that there is stress-shielding.

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“…To the authors' knowledge, no computational studies on the primary stability of cementless femoral stems using a wide range of CT-based patient specific 3D bone models have been reported yet in the literature (Viceconti et al, 2006;Bryan et al, 2012;Rao et al, 2013;Issa et al, 2014 correlation of patient anatomy with degree of implant micromotions. It is anticipated that the applications of these computational tools could form an essential first step towards robust design of new shorter cementless stems, which will involve modifying the geometric features of implants.…”

Section: Introductionmentioning

confidence: 99%

Inter-subject variability effects on the primary stability of a short cementless femoral stem

Bah

Shi

Heller

et al. 2015

Journal of Biomechanics

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TITLEInter-subject variability effects on the primary stability of a short cementless femoral stem AUTHORSBah, Mamadou T.; Shi, Junfen; Heller, Markus O.; et al. JOURNAL Journal of Biomechanics DEPOSITED IN ORE July 2015This version available at http://hdl.handle.net/10871/17901 COPYRIGHT AND REUSEOpen Research Exeter makes this work available in accordance with publisher policies. A NOTE ON VERSIONSThe version presented here may differ from the published version. If citing, you are advised to consult the published version for pagination, volume/issue and date of publication This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. demonstrates that the primary stability and tolerance of the short stem to variability in patient anatomy were high, reducing the need for patient stratification. In addition, the developed tool could be utilised to support implant design and planning of femoral reconstructive surgery.

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Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties

Cited by 15 publications

References 32 publications

Does Proximally Coated Single-Wedge Cementless Stem Work Well in Dorr Type C Femurs? Minimum 10-year Followup

Does Proximally Coated Single-Wedge Cementless Stem Work Well in Dorr Type C Femurs? Minimum 10-year Followup

Prospective 5-year study with 96 short curved Fitmore™ hip stems shows a high incidence of cortical hypertrophy with no clinical relevance

Inter-subject variability effects on the primary stability of a short cementless femoral stem

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