Migration of the uncemented Echo Bi-Metric and Bi-Metric THA stems: a randomized controlled RSA study involving 62 patients with 24-month follow-up

Dyreborg, Karen; Andersen, Martin J.; Winther, Nikolaj; Solgaard, Søren; Flivik, Gunnar; Petersen, Michael Mørk

doi:10.1080/17453674.2020.1802682

Cited by 6 publications

(11 citation statements)

References 26 publications

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“…Few studies have investigated migration of the Bi-Metric stem, although it is a widely used cementless stem in Nordic countries. 9 , 23 We found that stem group migrations primarily occurred within the first six weeks, which is in accordance with the current literature. 9 , 23 It has been suggested that early stem subsidence (< two years) increases the risk of later aseptic stem loosening in various cementless femoral stem types.…”

Section: Discussionsupporting

confidence: 92%

“… 9 , 23 We found that stem group migrations primarily occurred within the first six weeks, which is in accordance with the current literature. 9 , 23 It has been suggested that early stem subsidence (< two years) increases the risk of later aseptic stem loosening in various cementless femoral stem types. 5 In the present study, both stem groups showed a stable migration pattern both in the short term and long term, with no group differences.…”

Section: Discussionsupporting

confidence: 92%

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Ten-year comparison of two different techniques for femoral bone cavity preparation—broaching versus compaction in patients with cementless total hip arthroplasty

et al. 2021

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Aims Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. Methods A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. Results Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. Conclusion Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Ten-year comparison of two different techniques for femoral bone cavity preparation—broaching versus compaction in patients with cementless total hip arthroplasty

et al. 2021

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“…It has been suggested that migration thresholds are specific to the design of the stem, and that it is the pattern of migration of cementless stems that predicts their failure in THA. 24 Thus, if early stabilization is obtained and stems remain stable at follow-up, the risk of loosening and revision decreases.…”

Section: Discussionmentioning

confidence: 99%

Electrochemically applied hydroxyapatite on the cementless porous surface of Bi-Metric stems reduces early migration and has a lasting effect

Knudsen

Thillemann

Jørgensen

et al. 2022

The Bone & Joint Journal

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Aims BoneMaster is a thin electrochemically applied hydroxyapatite (HA) coating for orthopaedic implants that is quickly resorbed during osseointegration. Early stabilization is a surrogacy marker of good survival of femoral stems. The hypothesis of this study was that a BoneMaster coating yields a fast early and lasting fixation of stems. Methods A total of 53 patients were randomized to be treated using Bi-Metric cementless femoral stems with either only a porous titanium plasma-sprayed coating (P group) or a porous titanium plasma-sprayed coating with an additional BoneMaster coating (PBM group). The patients were examined with radiostereometry until five years after surgery. Results At three months, the mean total translation (TT) was 0.95 mm (95% confidence interval (CI) 0.68 to 1.22) in the P group and 0.57 mm (95% CI 0.31 to 0.83) in the PBM group (p = 0.047). From two to five years, the TT increased by a mean of 0.14 mm (95% CI 0.03 to 0.25) more in the P group than in the PBM group (p = 0.021). In osteopenic patients (n = 20), the mean TT after three months was 1.61 mm (95% CI 1.03 to 2.20) in the P group and 0.73 mm (95% CI 0.25 to 1.21) in the PBM group (p = 0.023). After 60 months, the mean TT in osteopenic patients was 1.87 mm (95% CI 1.24 to 2.50) in the P group and 0.82 mm (95% CI 0.30 to 1.33) in the PBM group (p = 0.011). Conclusion There was less early and midterm migration of cementless stems with BoneMaster coating compared with those with only a porous titanium plasma-sprayed coating. Although a BoneMaster coating seems to be important for stem fixation, especially in osteopenic patients, further research is warranted . Cite this article: Bone Joint J 2022;104-B(6):647–656.

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“…All patients included took part in a prospective randomized clinical RSA trial with 2-year follow-up, where the patients were randomly allocated to receive 1 of 2 uncemented femoral stems (Dyreborg et al. 2020 ).…”

Section: Methodsmentioning

confidence: 99%

“…Our study is partly based on secondary endpoint data from a randomized controlled trial (RCT) (Dyreborg et al. 2020 ). The main aim of the present study was to evaluate whether preoperative BMD of 3 regions in the femoral bone is related to femoral stem subsidence in uncemented THA.…”

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confidence: 99%

Preoperative BMD does not influence femoral stem subsidence of uncemented THA when the femoral T-score is > –2.5

et al. 2021

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Background and purpose — It is believed that in uncemented primary total hip arthroplasty (THA) the anchorage of the stem is dependent on the level of bone mineral density (BMD) of the femoral bone. This is one of the reasons for the widely accepted agreement that a cemented solution should be selected for people with osteoporosis or age > 75 years. We evaluated whether preoperative BMD of the femur bone is related to femoral stem migration in uncemented THA. Patients and methods — We enrolled 62 patients (mean age 64 years (range 49–74), 34 males) scheduled for an uncemented THA. Before surgery we undertook DEXA scans of the proximal femur including calculation of the T- and Z-scores for the femoral neck. Evaluation of stem migration by radiostereometric analysis (RSA) was performed with 24 months of follow-up. In 56 patients both preoperative DEXA data and RSA data were available with 24 months of follow-up. Results — None of the patients had a T-score below –2.5. We found no statistically significant relationship between preoperative BMD and femoral stem subsidence after 3 or 24 months. When comparing the average femoral stem subsidence between 2 groups with T-score > –1 and T-score ≤ –1, respectively, we found no statistically significant difference after either 3 or 24 months when measured with RSA. Interpretation — In a cohort of people ≤ 75 years of age and with local femur T-score > –2.5 we found no relationship between preoperative BMD and postoperative femoral stem subsidence of a cementless THA.

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Migration of the uncemented Echo Bi-Metric and Bi-Metric THA stems: a randomized controlled RSA study involving 62 patients with 24-month follow-up

Cited by 6 publications

References 26 publications

Ten-year comparison of two different techniques for femoral bone cavity preparation—broaching versus compaction in patients with cementless total hip arthroplasty

Ten-year comparison of two different techniques for femoral bone cavity preparation—broaching versus compaction in patients with cementless total hip arthroplasty

Electrochemically applied hydroxyapatite on the cementless porous surface of Bi-Metric stems reduces early migration and has a lasting effect

Preoperative BMD does not influence femoral stem subsidence of uncemented THA when the femoral T-score is > –2.5

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