Progressive proximal loosening of initially well-fixed bilateral Corail stems: a case report and review of the literature

Johnston, Michael G; Eppich, Kade E; Gray, Celeste; Porter, Matt; Scott, David F.

doi:10.2340/17453674.2022.3037

Cited by 3 publications

(2 citation statements)

References 18 publications

(23 reference statements)

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“…Limited reports have supported that a potential protective collar function can significantly reduce the AL incidence in a longterm follow-up [8,43]. However, AL is a multifactorial process that may be influenced by various factors throughout the stem lifespan [24,[43][44][45]; therefore, it cannot be thoroughly evaluated in the long-term follow-up. Our study found no AL risk difference between collared and collarless Corail stems, indicating the need for further studies.…”

Section: Overall Complicationsmentioning

confidence: 99%

Collared versus collarless hydroxyapatite-coated stems for primary cementless total hip arthroplasty; a systematic review of comparative studies. Is there any difference in survival, functional, and radiographic outcomes?

Giovanoulis,

Kenanidis,

Aïm

et al. 2024

SICOT-J

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Introduction: This systematic review aims to critically assess the literature comparative studies investigating collared and collarless Corail stem in primary total hip arthroplasty (THA) to find differences in revision rates, radiographic and clinical outcomes, and postoperative complications between these two types of the same stem. Methods: Eligible studies were found by searching PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews from conception till May 2023. The PRISMA guidelines were followed. The investigation encompassed randomized controlled trials, case series, comparative, cohort, and observational studies that assessed at least one comparative outcome or complication between collared and collarless Corail stems. Results: Twelve comparative studies with 90,626 patients undergoing primary THA were included. There were 40,441 collared and 58,543 collarless stems. The follow-up ranged from 12 to 360 months. Our study demonstrated no significant difference in stem revision relative risk (RR = 0.68; 95% confidence interval (CI), 0.23, 2.02; p = 0.49), number of radiolucent lines (RR = 0.3; 95% CI, 0.06, 2.28; p = 0.29) and overall complication risk (RR = 0.62; 95% CI, 0.22, 1.76; p = 0.37) between collared and collarless stems. The collared stems demonstrated significantly lesser subsidence (mean difference: 1.01 mm; 95% CI, −1.77, −0.25; p = 0.009) and risk of periprosthetic fractures (RR = 0.52; 95% CI, 0.29, 0.92; p = 0.03). Conclusion: The comparative studies between collared and collarless stem groups showed similar survival and overall complication rates and functional outcomes. The similar revision rates between groups make the impact of higher subsidence for collarless stems uncertain. The lower risk of periprosthetic fractures in the collared stems group must be clarified further but could be related to increased rotational stability.

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Section: Overall Complicationsmentioning

confidence: 99%

Collared versus collarless hydroxyapatite-coated stems for primary cementless total hip arthroplasty; a systematic review of comparative studies. Is there any difference in survival, functional, and radiographic outcomes?

Giovanoulis,

Kenanidis,

Aïm

et al. 2024

SICOT-J

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“…The one Corail stem with more than 8 mm of subsidence was a typical example of a failed implantation with metaphyseal-diaphyseal mismatch in a femur of Dorr type A of an undersized stem (red circles in Fig 9 ) [ 11 , 12 , 48 ]. In the clinical situation such a large subsidence would probably have required a revision surgery.…”

Section: Discussionmentioning

confidence: 99%

Small design modifications can improve the primary stability of a fully coated tapered wedge hip stem

Glismann,

Konow,

Lampe

et al. 2024

PLoS ONE

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Increasing the stem size during surgery is associated with a higher incidence of intraoperative periprosthetic fractures in cementless total hip arthroplasty with fully coated tapered wedge stems, especially in femurs of Dorr type A. If in contrast a stem is implanted and sufficient primary stability is not achieved, such preventing successful osseointegration due to increased micromotions, it may also fail, especially if the stem is undersized. Stem loosening or periprosthetic fractures due to stem subsidence can be the consequence. The adaptation of an established stem design to femurs of Dorr type A by design modifications, which increase the stem width proximally combined with a smaller stem tip and an overall shorter stem, might reduce the risk of distal locking of a proximally inadequately fixed stem and provide increased stability. The aim of this study was to investigate whether such a modified stem design provides improved primary stability without increasing the periprosthetic fracture risk compared to the established stem design. The established (Corail, DePuy Synthes, Warsaw, IN, US) and modified stem designs (Emphasys, DePuy Synthes, Warsaw, IN, US) were implanted in cadaveric femur pairs (n = 6 pairs) using the respective instruments. Broaching and implantation forces were recorded and the contact areas between the prepared cavity and the stem determined. Implanted stems were subjected to two different cyclic loading conditions according to ISO 7206–4 using a material testing machine (1 Hz, 600 cycles @ 80 to 800 N, 600 cycles @ 80 to 1600 N). Translational and rotational relative motions between stem and femur were recorded using digital image correlation. Broaching and implantation forces for the modified stem were up to 40% higher (p = 0.024), achieving a 23% larger contact area between stem and bone (R2 = 0.694, p = 0.039) resulting in a four times lower subsidence during loading (p = 0.028). The slight design modifications showed the desired effect in this in-vitro study resulting in a higher primary stability suggesting a reduced risk of loosening. The higher forces required during the preparation of the cavity with the new broaches and during implantation of the stem could bare an increased risk for intraoperative periprosthetic fractures, which did not occur in this study.

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Radiographic Outcomes using a Diaphyseal Engaging Femoral Stem for Revision Total Hip Arthroplasty

Coden,

Zink,

Fang

et al. 2023

Journal of Orthopaedic Experience &Amp; Innovation

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Introduction Diaphyseal engaging femoral stems are often required for revision total hip arthroplasty (THA) due to complex anatomy. However, no studies have been performed to identify the best implant or intraoperative radiographic parameters of stability. We sought to evaluate the rate of complications and radiographic parameters of an uncemented diaphyseal engaging femoral stem in revision THA. Methods We retrospectively reviewed 54 patients who underwent revision THA using an uncemented diaphyseal engaging modular femoral stem between 2012 and 2019 with mean follow-up of 1.4 years. Mean age was 66.3 years (range 23-90), and 47.2% of patients were female. 36 (73.5%) hips were classified as a Paprosky 3a and 13 (26.5%) patients were classified as a Paprosky 3b. We calculated the radiographic subsidence, canal fill ratio, and complete cortical contact percentage, defined as the sum of anterior, posterior, medial, and lateral cortical contact. Chi-square related-samples t-test, and Pearson’s correlation coefficient were used to compare values. Significance was set at <0.05. Results Postoperative periprosthetic infection occurred in 4 patients (7.41%) and was the most common complication. There were no revisions for aseptic loosening or failure of the diaphyseal engaging femoral stem. Canal fill ratio (mean=85.85%, p<0.001) and complete cortical contact (mean=71.74%, p<0.001) were less than the expected, while subsidence was higher than the expected (mean=2.07mm, p<0.001). Complete cortical contact was not associated with canal fill ratio (p=0.07) or subsidence (p=0.50). Discussion This uncemented diaphyseal engaging femoral stem had a low complication rate (11.11%) when used for revision THA. While canal fill ratio and complete cortical contact was less than the expected mean of 100%, it was not correlated with subsidence. It is important for surgeons to know that this uncemented diaphyseal engaging femoral stem can be well fitting despite low canal fill ratio and cortical contact.

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Progressive proximal loosening of initially well-fixed bilateral Corail stems: a case report and review of the literature

Cited by 3 publications

References 18 publications

Collared versus collarless hydroxyapatite-coated stems for primary cementless total hip arthroplasty; a systematic review of comparative studies. Is there any difference in survival, functional, and radiographic outcomes?

Collared versus collarless hydroxyapatite-coated stems for primary cementless total hip arthroplasty; a systematic review of comparative studies. Is there any difference in survival, functional, and radiographic outcomes?

Small design modifications can improve the primary stability of a fully coated tapered wedge hip stem

Radiographic Outcomes using a Diaphyseal Engaging Femoral Stem for Revision Total Hip Arthroplasty

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