Increased Persistent Mid-Thigh Pain After Short-Stem Compared With Wedge-Shaped Straight-Stem Uncemented Total Hip Arthroplasty at Medium-Term Follow-Up: A Randomized Double-Blinded Cross-Sectional Study

Gielis, Willem Paul; Oldenrijk, Jakob van; Cate, Nick ten; Scholtes, Vanessa A.; Geerdink, Carel H; Poolman, Rudolf W.

doi:10.1016/j.arth.2019.01.014

Cited by 13 publications

(17 citation statements)

References 37 publications

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“…[ 49 ] 2018 Mobile vs fixed-bearing TKA 167 82 2 3 Lachiewicz and O'Dell [ 50 ] 2019 Standard vs highly crosslinked polyethylene 265 56 5 8 MacDessi et al. [ 51 ] 2020 Kinematic vs mechanical alignment 128 0 21 9 CORR Hernández-Vaquero et al. [ 52 ] 2011 Navigation vs jig-based TKA 97 24 5 7 Charoencholvanich et al.…”

Section: Appendixmentioning

confidence: 99%

Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review

et al. 2021

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Background: The Fragility Index (FI) and Reverse Fragility Index are powerful tools to supplement the P value in evaluation of randomized clinical trial (RCT) outcomes. These metrics are defined as the number of patients needed to change the significance level of an outcome. The purpose of this study was to calculate these metrics for published RCTs in total joint arthroplasty (TJA). Methods: We performed a systematic review of RCTs in TJA over the last decade. For each study, we calculated the FI (for statistically significant outcomes) or Reverse Fragility Index (for nonstatistically significant outcomes) for all dichotomous, categorical outcomes. We also used the Pearson correlation coefficient to evaluate publication-level variables. Results: We included 104 studies with 473 outcomes; 92 were significant, and 381 were nonstatistically significant. The median FI was 6 overall and 4 and 7 for significant and nonsignificant outcomes, respectively. There was a positive correlation between FI and sample size (R ¼ 0.14, P ¼ .002) and between FI and P values (R ¼ 0.197, P ¼ .000012). Conclusions: This study is the largest evaluation of FI in orthopedics literature to date. We found a median FI that was comparable to or higher than FIs calculated in other orthopedic subspecialties. Although the mean and median FIs were greater than the 2 recommended by the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines to demonstrate strong evidence, a large percentage of studies have an FI < 2. This suggests that the TJA literature is on par or slightly better than other subspecialties, but improvements must be made. Level of Evidence: Level I; Systematic Review.

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Section: Appendixmentioning

confidence: 99%

Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review

et al. 2021

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“…Thigh pain has been reported in cementless stems. Gielis et al [11] compared mid-thigh pain results using short stem design vs wedge design. They reported lower rates of mid-thigh pain using short stems 14% as compared to 24% in wedge design.…”

Section: Discussionmentioning

confidence: 99%

New Cementless Total Hip Arthroplasty. A Multicentre Prospective Minimum 2 Year Follow-up Clinical Outcomes Study.

2021

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Background: Cementless implants were introduced approximately three decades ago in order to address aseptic loosening of cemented hip prostheses with the aim of early mobilisation, better functional result and bone stock preservation. The primary objective of this study is to introduce a new cementless HA coated implant and report its minimum 2 year follow up results. Material & method: This is a prospective, multi-centre, consecutive series, clinical outcomes study with 75 patients. Inclusion criteria for the study were age 21- 85 years, BMI <40, osteoarthritis of the hip. Patients were operated using a standard posterolateral approach. The Paragon stem and the Global cup were implanted in a cementless method. Patients were reviewed at 6 weeks, 6 months and two years postoperative. At each visit AQoL 6D, VAS Pain, Oxford Hip Score were recorded. Post-operative X-Rays were reviewed at immediate post-operative, 6 months and two years. Results: Mean duration of surgery was 63.1 min with range of 40-120 min. AQoL over time changed from pre-op mean 50.51, at 6 weeks and at 2 years mean 35.06. Oxford hip score had upward trend from pre-op to post-op 6wks assessments and a plateau in following assessments. VAS pain trajectories, showing a clear downward trend from pre-op to post-op 6wks and a plateau in the following postoperative assessments. Discussion & conclusion: The combination of Paragon stem and Global cup incorporates proven features of successful implants. The unique feature of lateral tension grooves and progressive neck dimension with dual offset options. This combination has shown promising early results with early follow up of a minimum of 2 years, with a 100% survivorship of the stem and 98.7% survivorship overall for any reason and is a good cementless option in THA.

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“…For Asian patients with short stature, and femoral bow angle in the proximal with suitable cases, shorter creature type femoral line handle THA may be bene cial. However, Gielis et al [29][30][31] have found that using short shank primary total hip replacement, thigh pain would follow the surgery, which would not be signi cantly reduced. [29][30][31] In addition, Boese et al [32] have also reported that the mismatch between femoral morphology and femoral prosthesis geometry in total hip arthroplasty not only increases the surgical di culty, but also bring serious implant-related complications.…”

Section: Discussionmentioning

confidence: 99%

“…However, Gielis et al [29][30][31] have found that using short shank primary total hip replacement, thigh pain would follow the surgery, which would not be signi cantly reduced. [29][30][31] In addition, Boese et al [32] have also reported that the mismatch between femoral morphology and femoral prosthesis geometry in total hip arthroplasty not only increases the surgical di culty, but also bring serious implant-related complications. The selection of too large prosthesis during femoral stem implantation would lead to the di culty of femoral stem implantation.…”

Section: Discussionmentioning

confidence: 99%

Impact of Femoral Stem Prosthesis Tip On Femoral Cortex After Primary Total Hip Arthroplasty (THA)

Zhang

Wang

Cheng

et al. 2021

Preprint

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Background: The mechanisms of pain after total hip arthroplasty (THA) is not clear, which may be related to its impact on the femoral cortex caused by improper prosthesis placement. This study was to explore the the impact of the femoral stem prosthesis on the femoral cortex after implantation, and its relationship with postoperative thigh pain. Methods: Totally 172 patients who underwent primary THA were retrospectively analyzed, who were divided into the impact (n=25) and non-impact (n=147) groups. Contact or penetration of the femoral stem prosthesis tip with the distal femoral cortex was defined as impingement. Patients were followed up and recorded.Results: In the patients undergoing primary THA, 25 patients (14.5%) had impact, including 7 males and 18 females. Most of the patients in the impact group were women of small stature. In the impact group, the postoperative thigh pain was more obvious, and the Harris Hip score (HHS) was lower, compared with the non-impact group (P < 0.05). The regression analysis showed that height (OR=1.196; 95%CI: 1.059-1.351; P=0.004) and prosthesis implant angle (PIA) (OR=0.208; 95%CI: 0.074-0.584; P=0.003) were important risk factors for distal femoral cortical impingement in patients who underwent THA. Conclusions: Patients with short stature should have adequate preoperative planning for primary THA, to prevent increased risk of postoperative thigh pain due to impinging femoral stem implants.

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Increased Persistent Mid-Thigh Pain After Short-Stem Compared With Wedge-Shaped Straight-Stem Uncemented Total Hip Arthroplasty at Medium-Term Follow-Up: A Randomized Double-Blinded Cross-Sectional Study

Cited by 13 publications

References 37 publications

Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review

Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review

New Cementless Total Hip Arthroplasty. A Multicentre Prospective Minimum 2 Year Follow-up Clinical Outcomes Study.

Impact of Femoral Stem Prosthesis Tip On Femoral Cortex After Primary Total Hip Arthroplasty (THA)

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