Femoral stem subsidence in cementless total hip arthroplasty: a retrospective single-centre study

Ries, Christian; Boese, Christoph Kolja; Dietrich, Florian; Miehlke, Wolfgang; Heisel, Christian

doi:10.1007/s00264-018-4020-x

Cited by 70 publications

(76 citation statements)

References 26 publications

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“…Early stem subsidence following a cementless THA is correlated with aseptic loosening of the femoral component [9, 12–14]. Despite the excellent short- to midterm outcomes of several short stem designs [7, 8], it remains unclear whether all cementless short femoral stems could achieve an adequate stem fixation.…”

Section: Discussionmentioning

confidence: 99%

Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence

Schaer

Finsterwald

Holweg

et al. 2019

BMC Musculoskelet Disord

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BackgroundEarly femoral stem subsidence following a cementless THA is correlated with aseptic loosening of the femoral component. The short femoral stems allow bone sparing and implantation through a minimally invasive approach; however, due to their metaphyseal anchoring, they might demonstrate different subsidence pattern than the conventional stems.MethodsIn this prospective single-center study, a total of 68 consecutive patients with an average age of 63 years, and a minimum follow-up of 5 years following a cementless THA with a metaphyseal-anchored short femoral stem were included. The femoral stem subsidence was evaluated using “Ein Bild Roentgen Analyse” (EBRA).ResultsAverage stem migration was 0.96 +/− 0.76 mm at 3 months, 1.71 +/− 1.26 mm at 24 months, and 2.04+/− 1.42 mm at last follow-up 60 months postoperative. The only factor that affected migration was a stem size of 6 or more (r2 = 5.74; p = 0.039). Subdivision analysis revealed, that only in females migration appeared to be affected by stem size irrespective of weight but not in men (female stem size of 6 or more vs. less (Difference = − 1.48 mm, R2 = 37.5; p = 0.001). Migration did not have an impact on clinical outcome measures.ConclusionsThe examined metaphyseal-anchored short femoral stem showed the highest subsidence within the first 3 months postoperative, the implant began to stabilize at about 24 months but continued to slowly migrate with average total subsidence of 2.04 mm at 5 years following the THA. The amount of stem subsidence was not associated with worse clinical outcomes such as HHS, patient satisfaction, or pain.

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Section: Discussionmentioning

confidence: 99%

Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence

Schaer

Finsterwald

Holweg

et al. 2019

BMC Musculoskelet Disord

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“…18 While this study found that increased ML fill was correlated with an increased peak load for collared stems, CFI and canal fill were not found to influence risk of subsidence for collared stems in humans. 26 The biomechanical data for the collared group in this study may have been impacted, however, by small gaps between the collar and calcar; stems that are not seated with the collar in direct contact with the calcar will experience a limited amount of subsidence that closes the small gap during loading. 14,18 However, no collared implants in this study had a measured gap of > 0.68 mm, and all gaps between the collar and calcar were likely closed during loading protocols.…”

Section: Discussionmentioning

confidence: 78%

Radiographic and Biomechanical Assessment of Three Implant Designs for Canine Cementless Total Hip Replacement

Worden

Ash

Ordway

et al. 2020

Vet Comp Orthop Traumatol

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Objective The aim of this study was to evaluate the relationship between radiographic fit/fill measurements and biomechanical performance of three canine cementless total hip implant designs using an in vitro biomechanical testing protocol that replicates compression and torsion. Study Design Eighteen (six/group) canine cadaveric femurs were implanted with one of three cementless total hip implant designs: (1) collarless, (2) collared or (3) lateral bolt stems. Femoral length, canal flare index (CFI), canal fill, stem fit, stem level and stem angle were measured as independent variables. Biomechanical performance was tested using physiological, non-destructive gait loading (loading protocols) and destructive testing (failure protocols). Results During loading protocols, compressive stiffness was influenced by stem level (p < 0.05) and torsional stiffness was influenced by stem level and CFI for collarless stems (p < 0.05). During failure protocols, peak load was influenced by mediolateral (ML) stem angle (p < 0.05) and CFI (p < 0.01) for collarless stems and CFI for lateral bolt stems (p < 0.05). Peak torque was influenced by ML stem angle, craniocaudal stem angle and CFI for collarless stems (p < 0.05) and average ML fill for collared stems (p < 0.05). Conclusion Biomechanical performance of collarless stems in cementless hip arthroplasty is more impacted by radiographic fit/fill than lateral bolt and collared stems. As a result, collarless stems may be more dependent on preoperative fit and intraoperative precision.

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“…Most recently, there has been an increased trend towards the use of collared femoral stems in preference to collarless stems, due to reported superiority in lowering risks of subsidence and intraoperative fractures [ 21 , 22 ]. The present study retrospectively revealed a high incidence of IPI (7.3%) in THA patients using a collared femoral prosthesis.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for iliopsoas impingement after total hip arthroplasty using a collared femoral prosthesis

Qiu

Chen

et al. 2020

J Orthop Surg Res

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Background The relationship between collar design of a femoral component and iliopsoas impingement (IPI) after total hip arthroplasty (THA) is still underrecognized. The purpose of our study was to determine the possible risk factors for IPI related to the femoral component, when using a collared femoral prosthesis. Methods A total of 196 consecutive THA patients (206 hips) using a collared femoral prosthesis were reviewed retrospectively after exclusion of the factors related to acetabular component and femoral head. The patients were divided into +IPI and −IPI group according to the presence of IPI. Radiological evaluations were performed including femoral morphology, stem positioning, and collar protrusion length (CPL). Multivariate regression analysis was performed to assess the risk factors for IPI. Results At a minimum follow-up of 1 year, IPI was observed in 15 hips (7.3%). Dorr type C proximal femur was found in nine hips (60%) in the +IPI group and in 28 hips in the −IPI group (14.7%, p < 0.001). The mean stem anteversion in the +IPI group was significantly greater than that in the −IPI group (19.1° vs. 15.2°, p < 0.001), as well as the mean CPL (2.6 mm vs. − 0.5 mm, p < 0.001). The increased stem anteversion ( OR = 1.745, p = 0.001) and CPL ( OR = 13.889, p = 0.001) were potential risk factors for IPI. Conclusions The incidence of IPI after THA is higher than expected when using a collared femoral prosthesis. Among the factors related to collared femoral prosthesis, excessively increased stem anteversion and prominent collar protrusion are independent predictors for IPI. In addition, high risk of IPI should be carefully considered in Dorr type C bone, despite that femoral morphology is not a predictive factor. Level of evidence Level IV, clinical cohort study

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Femoral stem subsidence in cementless total hip arthroplasty: a retrospective single-centre study

Abstract: Retrospective therapeutic study, Level IV.

Cited by 70 publications

References 26 publications

Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence

Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence

Radiographic and Biomechanical Assessment of Three Implant Designs for Canine Cementless Total Hip Replacement

Risk factors for iliopsoas impingement after total hip arthroplasty using a collared femoral prosthesis

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