Effect of stem alignment on long-term outcomes of total hip arthroplasty with cementless Bi-Metric femoral components

Shishido, Toetsu; Tateiwa, Toshiyuki; Takahashi, Yasuhito; Masaoka, Toshinori; Ishida, Tsunehito; Yamamoto, Kenjiro

doi:10.1016/j.jor.2018.01.008

Cited by 17 publications

(14 citation statements)

References 34 publications

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“…Önceki çalışmalarda; sementli total kalça protezlerinde, varus valgus malpozisyonu ile osteolizis ve "stress shielding" etkilerinin meydana geldiği bildirilmektedir. Ancak, sementsiz total kalça protezlerinde dizilim bozukluğuna bağlı bu tip sorunların daha düşük oranda görüldüğü belirtilmektedir (12) . Biomateryallerin gelişmesi, titanyum implantların kemik entegrasyonunun, paslanmaz çeliğe göre daha iyi olması nedeniyle tüm dünyada titanyum implantlar yaygın olarak kullanılmaktadır.…”

Section: Discussionunclassified

“…Sementsiz kalça protezinin stem (sap) yapısının wedge (kama) biçiminde olması ya da femur kemik morfolojisine uygun olması, stabilite ve kemik entegrasyonu (bone ingrowing) yönünden oldukça iyi sonuçlar vermektedir. Mal-pozisyonun femur proksimaline stres yığılması oluşturmasına karşın, uzun dönemde osteolizis ve gevşeme sıklığının düşük oranda görüldüğü bildirilmektedir (12) .…”

Section: Discussionunclassified

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Peroperative Complications and Postoperative Alignment Problems in Patients with Primary Total Hip Replacement

Karakaşlı¹

2021

HIP

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INTRODUCTION: The application of hip joint arthroplasty in hip joint degenerative diseases improves joint pain. The lower elastic modulus of titanium alloy prostheses in hip prostheses than stainless steel elastic modulus ensures higher bone "bone ingrowing" in titanium alloy prostheses. However, malaligment applications during surgery shorten the life of the prosthesis. The aim of this study is to investigate post-operative alignment and to examine perioperative complications in patients undergoing total hip prosthesis. METHODS: In this study, 122 patients who underwent total hip arthroplasty for degenerative hip joint disease and elderly collum femoris fractures between 2013-2017 were evaluated. Perioperative complications in total hip prostheses and early complications of prosthesis alignment in retrospective early follow-up. RESULTS: 78 of these patients were female, 44 of them were male, the mean age was 66 years (42-87), the mean follow-up period was 27 months (6-48). Intraoperatively, femoral calcar fractures developed in 2 patients while 1.5% femoral component was placed. Malaligment was placed at an average of 6 degrees (3-9 degrees) in 9% valgus position in 11 patients. Intraoperative blood loss was observed on average 855 ml (460-1250 ml) DISCUSSION AND CONCLUSION: The results of the implants produced in our country show similar clinical and radiological results with the results stated in the literature. It is considered to be advantageous in terms of both the contribution to the country's economy and the contribution to the patient's health and being easily available.

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Section: Discussionunclassified

Peroperative Complications and Postoperative Alignment Problems in Patients with Primary Total Hip Replacement

Karakaşlı¹

2021

HIP

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“…However, valgus stem alignment does not seem to be better than varus in terms of clinical outcome or long-term survival. A valgus position may enhance stress shielding at the proximal femur compared to varus [7] and is at higher risk to loose femoral offset compared to the preoperative status. A loss of femoral offset should be avoided as this shortens the lever arm and enhances the stress for the gluteal muscles.…”

Section: Discussionmentioning

confidence: 99%

The ‘critical trochanter angle’: a predictor for stem alignment in total hip arthroplasty

et al. 2019

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Introduction Stem malalignment can affect offset reconstruction and may result in gluteal muscle insufficiency. In this retrospective study, a novel geometric angle named ‘critical trochanter angle’ (CTA) is described and investigated towards the risk of malposition of a collarless straight tapered hydroxyapatite-coated stem in primary total hip arthroplasty (THA). Material and methods A total of 100 cementless THA were implanted in patients with unilateral coxarthrosis via the direct anterior ( n = 50) or direct lateral Hardinge approach ( n = 50) in a two surgeon setting using the Corail® or Trendhip® stem (DePuy Synthes or Aesculap). Stem alignment was analysed in postoperative AP pelvic radiographs and correlated to the CTA: the angle crest was defined by the intersection of the femoral shaft and neck axis and the angle was measured between the shaft axis and a leg intersecting the vertex between the lateral and superoposterior facet of the trochanter. Results Forty-seven stems were implanted in varus (≥ + 1°), 42 in neutral (< + 1°/> − 1°) and 11 in valgus position (≤ − 1°). The mean critical trochanter angle was 25.0° (SD ± 7.5°), and there was a negative and statistically significant correlation to stem alignment ( r = − 0.52; p ≤ 0.001) independent from the surgical approach. For stem malposition of 2° and above ( n = 23), mean CTA was 17.2° for varus ( n = 20) and 31.6° for valgus ( n = 3). A CTA lesser or equal to 22.75° had a sensitivity of 90% and specificity of 80% for varus stem position of 2° or greater. Specificity raised to 100% with a cutoff CTA of 12.5° or lesser. Conclusion Varus stem alignment in THA is associated with coxa vara deformity and a radiological low CTA. In preoperative planning, the critical trochanter angle can help to evaluate the risk for intraoperative stem malpositioning. If navigation or robotic assistance is not available when using this stem design, we recommend an intraoperative x-ray to verify correct implant positioning in patients with a CTA under 20° or above 30°.

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“…Increased distal cortical hypertrophy in association with uncemented implants, accompanied by pain in the thigh, has been reported for varus alignment. Increased stress-shielding of the proximal femur is evident secondary to valgus alignment [14]. Both varus and valgus malalignment can affect the long-term survival rate of total hip arthroplasty [14,15] and is thus an important indicator of outcome quality.…”

Section: Complicationmentioning

confidence: 99%

“…Increased stress-shielding of the proximal femur is evident secondary to valgus alignment [14]. Both varus and valgus malalignment can affect the long-term survival rate of total hip arthroplasty [14,15] and is thus an important indicator of outcome quality. Even though the differences in the Groups were not significant, there were less deviations from neu-tral stem alignment in Groups 2 and 3 using the certified operative standards.…”

Section: Complicationmentioning

confidence: 99%

Retrospective Comparative Study of the Influence on Quality of Primary Total Hip Arthroplasty by the EndoCert-Certification System in a Communal Hospital

et al. 2020

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The EndoCert®-Initiative system sets specific requirements for the structural, process and result quality in certified Arthroplasty Centers in Germany. However, it remains unclear to what extent the certification process can increase the quality in total hip and knee arthroplasty. Aim of the comparative retrospective study is to analyse the change in quality of total hip arthroplasty in a communal hospital before and after the certification process. All primary total hip arthroplasties (n = 366) between 2013 and 2016 were included in the study retrospectively and grouped by treatment period. Treatment was performed in group 1 without clinical pathways, in group 2 pathway-controlled without a valid certificate and in group 3 pathway-controlled after final completion of the certification process. Outcome quality was analysed using quality indicators defined by the EndoCert-Initiative and further predefined indicators. Results show quality improvement under certified pathway-controlled treatment, e.g. time of surgery, cup and stem positioning, blood transfusion rate, periprosthetic fractures. However, improvements were not significantly in all cases and limitations must be recognized. Positive effects of the certification process legitimate capital investment and efforts. Further quality indicators may be implemented in the certification process to improve quality of treatment in arthroplasty.

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Effect of stem alignment on long-term outcomes of total hip arthroplasty with cementless Bi-Metric femoral components

Cited by 17 publications

References 34 publications

Peroperative Complications and Postoperative Alignment Problems in Patients with Primary Total Hip Replacement

Peroperative Complications and Postoperative Alignment Problems in Patients with Primary Total Hip Replacement

The ‘critical trochanter angle’: a predictor for stem alignment in total hip arthroplasty

Retrospective Comparative Study of the Influence on Quality of Primary Total Hip Arthroplasty by the EndoCert-Certification System in a Communal Hospital

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