Prospective 5-year study with 96 short curved Fitmore™ hip stems shows a high incidence of cortical hypertrophy with no clinical relevance

Thalmann, Caroline; Kempter, Patricia; Stoffel, Karl; Ziswiler, Thea; Frigg, Arno

doi:10.1186/s13018-019-1174-1

Cited by 17 publications

(22 citation statements)

References 44 publications

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“…The examined short stem demonstrated almost 50% of the overall subsidence within the first 3 months and then slowed down markedly. However, there was some subsidence up to the last follow-up, which is in accordance with recent findings of Schaer et al [34], who studied the Optimys short stem (Mathys, Bettlach, Switzerland), and Thalmann et al [14], who studied the Fitmore short stem (Zimmer Inc., Warsaw, IN, USA). In contrast, most previously published data on cementless short stems found stabilization of subsidence during a shorter follow-up of 3 months [21,22], 6 months [20], 12 months [19], or 24 months [15].…”

Section: Discussionsupporting

confidence: 89%

“…Various studies have reported on the subsidence of cementless hip stems, with some suggesting an inferior performance of short stem designs compared to conventional stems [9][10][11][12][13][14][15][16][17][18][19][20][21][22]. This could be detrimental for implant survivorship, as several authors suggested a correlation of early stem subsidence with aseptic loosening [23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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Mid-term subsidence and periprosthetic radiolucency of the AMIStem: a 5-year EBRA-FCA analysis

et al. 2021

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Background There has been an evolution in cementless total hip arthroplasty (THA) with newer short stem designs aimed to preserve metaphyseal bone stock and facilitate implantation through minimally invasive approaches. While early subsidence has been correlated to aseptic loosening in conventional stems, there is a paucity of data regarding short stems. The current study aims to report on stem subsidence and mid-term clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, specifically designed for the direct anterior approach (DAA). Methods Ninety-four consecutive patients (100 hips) with a minimum follow-up of 5 years following cementless THA were included in this single-center retrospective study. Subsidence was evaluated using the “Ein-Bild-Roentgen-Analyse” (EBRA). Periprosthetic radiolucency allocated to the zones of Charnley and Gruen was assessed. Additionally, demographic and implant-related factors potentially associated with increased subsidence and clinical outcomes were evaluated. Results At the last follow-up, the average stem subsidence was 1.98 ± 1.20 mm, with 48% of the implants demonstrating subsidence of > 2 mm. Periprosthetic radiolucency of > 2 mm was found in 26% of the implants in zone 1 and in 9% in zone 7, respectively. Neither the amount of subsidence nor proximal periprosthetic radiolucency was associated with aseptic loosening or worse clinical outcomes. Conclusions Comparable to other proximally fixed short stem designs, the highest subsidence was observed within the first 3 months following implantation. No demographic or implant-related factors were found to have a statistically significant influence on stem subsidence. Periprosthetic radiolucency and subsidence of the AMISstem is not correlated with worse clinical outcomes at 5-year follow-up.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Mid-term subsidence and periprosthetic radiolucency of the AMIStem: a 5-year EBRA-FCA analysis

et al. 2021

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“…The examined short stem demonstrated almost 50% of the overall subsidence within the rst 3 months and then slowed down markedly. However, there was some subsidence up to the last follow-up, which is in accordance with recent ndings of Schaer et al (34), who studied the Optimys short stem (Mathys, Bettlach, Switzerland) and Thalmann et al (14) who studied the Fitmore short stem (Zimmer Inc., Warsaw, Indiana, USA (17).…”

Section: Discussionsupporting

confidence: 87%

“…Although these implants demonstrated good short-to mid-term outcomes (7,8), there are concerns whether all short cementless proximally-xed femoral stems are able to achieve an adequate primary stem xation and stability. Various studies have reported on the subsidence of cementless hip stems, with some suggesting an inferior performance of short stem designs compared to conventional stems (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). This could be detrimental for implant survivorship, as several authors suggested a correlation of early stem subsidence with aseptic loosening (23)(24)(25)(26).…”

Section: Introductionmentioning

confidence: 99%

Mid-term Subsidence and Periprosthetic Radiolucency of the AMIStem: A 5-year EBRA-FCA Analysis

Hasler

Flury

Dimitriou

et al. 2020

Preprint

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Background: There has been an evolution in cementless total hip arthroplasty (THA) with newer short stem designs aim to preserve metaphyseal bone stock and facilitate implantation through minimally invasive approaches. While early subsidence has been correlated to aseptic loosening in conventional stems, there is a paucity of data regarding short stems. The current study aims to report on stem subsidence and midterm clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, specifically designed for the direct anterior approach (DAA).Methods: 94 consecutive patients (100 hips) with a minimum follow-up of 5 years following cementless THA were included in this single-center retrospective study. Subsidence was evaluated using the “Ein-Bild-Roentgen-Analyse” (EBRA). Periprosthetic radiolucency allocated to the Zones of Charnley and Gruen was assessed. Additionally, demographic and implant-related factors potentially associated with increased subsidence and clinical outcomes were evaluated.Results: At the last follow-up, the average stem subsidence was 1.98 ± 1.20 mm, with 48% of the implants demonstrating subsidence of > 2 mm. Periprosthetic radiolucency of > 2 mm was found in 26% of the implants in Zone 1, and in 9% in Zone 7, respectively. Neither the amount of subsidence nor proximal periprosthetic radiolucency was associated with aseptic loosening or worse clinical outcomes. Conclusions: Comparable to other proximally-fixed short stem designs, the highest subsidence was observed within the first 3 months following implantation. No demographic or implant-related factors were found to have a statistically significant influence on stem subsidence. Periprosthetic radiolucency and subsidence of the AMISstem is not correlated with worse clinical outcomes at 5-years follow-up.

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“…With regard to the stem of thicker group in the present study, Maier et al reported that radiolucent lines were confirmed at 11% each in Gruen zones 1 and 7 (proximal), 2% in zone 2 and 3% in zone 6 (middle), and 2% in zone 3 and 9% in zone 5 (distal) during a follow-up of ≥ 2 years [ 13 ]. Thalmann et al reported that radiolucent lines were confirmed at 51% in the anteroposterior image and 35% in the axial image in all zones other than the Gruen zone 2 during the first year, which decreased to 20% in the anteroposterior image and 9% in the axial image 5 years later [ 14 ]. In the present study, “proximal and distal” was the most common pattern of radiolucent lines for the thicker group (35.9% before matching and 40% after matching).…”

Section: Discussionmentioning

confidence: 99%

Comparison of radiographic changes in rectangular curved short stem with thin versus thick porous coating for cementless total hip arthroplasty: a retrospective study with a propensity score matching

et al. 2021

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Background Radiographic changes that appear relatively quickly after fixation of cementless stem in total hip arthroplasty (THA) vary depending on the stem design and fixation style. The present study compared radiographic changes between two types of rectangular curved short stems of similar shape. Methods This retrospective study included 118 hips that underwent primary cementless THA with an anterolateral supine approach using a rectangular, curved, short stem performed by the same surgeon between June 2015 and June 2019. Among the examined hips, 39 had a thicker porous coating stem (thicker group) and 66 had a thinner porous coating and reduced tip stem (thinner group) and at least 12-month follow-up. Radiographs taken during the final course observation were assessed. Propensity score matching was performed based on demographic data and comparisons were made using pairs of 25 hips each. Statistical analysis was performed using chi-square test and p values ≤ 0.05 indicated statistical significance. Results The pattern of the radiolucent lines showed a significant difference after matching (p = 0.0044). A “proximal and distal” pattern was most common in the thicker group and a “distal only” pattern was most common in the thinner group. There was notable and significant difference in cortical hypertrophy in the thicker group after matching (p = 0.024). Conclusions Although the two short stems were similar shapes, the short-term radiographic changes were different. The thinner group showed fewer radiographic changes than the thicker group, making it a more “silent” stem.

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Prospective 5-year study with 96 short curved Fitmore™ hip stems shows a high incidence of cortical hypertrophy with no clinical relevance

Cited by 17 publications

References 44 publications

Mid-term subsidence and periprosthetic radiolucency of the AMIStem: a 5-year EBRA-FCA analysis

Mid-term subsidence and periprosthetic radiolucency of the AMIStem: a 5-year EBRA-FCA analysis

Mid-term Subsidence and Periprosthetic Radiolucency of the AMIStem: A 5-year EBRA-FCA Analysis

Comparison of radiographic changes in rectangular curved short stem with thin versus thick porous coating for cementless total hip arthroplasty: a retrospective study with a propensity score matching

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