Proximal femoral anatomy and collared stems in hip arthroplasty: is a single collar size sufficient?

Bonin, Nicolas; Gedouin, J E; Pibarot, Vincent; Bejui-Hughues, Jacques; Bothorel, Hugo; Saffarini, Mo; Batailler, Cécile

doi:10.1186/s40634-017-0107-3

Cited by 8 publications

(3 citation statements)

References 27 publications

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“…Since the collared femoral stem improves stability and promotes better transfer of stress to the calcar bone 39 , we believe that Stem B can, potentially, behave in the same manner as the collared stem. It is possible that femoral Stem B, due to its larger proximal portion (bulging), would adapt better to the anatomy of the proximal femur, preventing femoral displacement and contributing to adequate filling and osteointegration after implantation 1 , 40 , 41 .…”

Section: Discussionmentioning

confidence: 99%

Biomechanical evaluation of a new femoral stem design for total hip replacement in a canine model

et al. 2021

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Purpose To evaluate the biomechanical properties of a novel total hip replacement femoral stem. Methods Eight pairs of femurs from dog cadavers were used. The femurs were separated into different groups. A novel femoral stem with a convex proximal portion (Stem B) was biomechanically evaluated and compared to awell-known veterinary collared stem (Stem A). Femoral stems were inserted into the contralateral femurs from the same dog, forming 16 constructs. A flexo-compression load was applied on the axial axis of each sample. Maximum strength, deflection, stiffness, and energy absorption were analysed. Results Group B constructs showed significantly higher values (p ? 0.05) for the variables, except stiffness. The mean maximum strength was 1,347 ± 357 N for Group A and 1,805 ± 123 N for Group B (p ? 0.0069). The mean deflection was5.54 ± 2.63 mm for Group A and 10.03 ± 3.99 mm for Group B (p ? 0.0056). For the energy variable, the force was 6,203 ± 3,488 N/mm for Group A and 12,885 ± 5,056 N/mm for Group B (p ? 0.0054). Stem B had greater maximum strength, deflection, and energy. Conclusions The new stem was effective in neutralizing the impact of axial flexion-compression stresses during biomechanical tests in cadaveric models.

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Section: Discussionmentioning

confidence: 99%

Biomechanical evaluation of a new femoral stem design for total hip replacement in a canine model

et al. 2021

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“…In contrast to Dorr types A and B femurs, Dorr type C femur commonly indicates a requirement of bigger size stem. Bonin et al digitally analyzed CT scans of 204 healthy hips and found that according to native proximal femoral anatomy, a single collar size was not sufficient to ensure outstanding performance of collared stems [ 27 ]. Therefore, as an increase in stem size is inevitably associated with the increases in collar length, it can explain in our study why a majority of IPI were observed in Dorr type C femur.…”

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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“…However, the utility of collars has remained controversial since their development, with inconclusive evidence regarding their advantages in both short-and long-term clinical results when contrasted with non-collared stems [25,26]. Moreover, there have been concerns regarding the potential of under-sizing of the femoral stem while relying on the collar for stability [27], which can potentially lead to stem micro-motion and loosening [16]. Nevertheless, currently, there is a lack of evidence assessing the association between the utilization of a collared stem and proper stem sizing.…”

Section: Introductionmentioning

confidence: 99%

Radiological Comparison of Canal Fill between Collared and Non-Collared Femoral Stems: A Two-Year Follow-Up after Total Hip Arthroplasty

Ashkenazi,

Benady,

Ben Zaken

et al. 2024

J. Imaging

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Collared femoral stems in total hip arthroplasty (THA) offer reduced subsidence and periprosthetic fractures but raise concerns about fit accuracy and stem sizing. This study compares collared and non-collared stems to assess the stem–canal fill ratio (CFR) and fixation indicators, aiming to guide implant selection and enhance THA outcomes. This retrospective single-center study examined primary THA patients who received Corail cementless stems between August 2015 and October 2020, with a minimum of two years of radiological follow-up. The study compared preoperative bone quality assessments, including the Dorr classification, the canal flare index (CFI), the morphological cortical index (MCI), and the canal bone ratio (CBR), as well as postoperative radiographic evaluations, such as the CFR and component fixation, between patients who received a collared or a non-collared femoral stem. The study analyzed 202 THAs, with 103 in the collared cohort and 99 in the non-collared cohort. Patients’ demographics showed differences in age (p = 0.02) and ASA classification (p = 0.01) but similar preoperative bone quality between groups, as suggested by the Dorr classification (p = 0.15), CFI (p = 0.12), MCI (p = 0.26), and CBR (p = 0.50). At the two-year follow-up, femoral stem CFRs (p = 0.59 and p = 0.27) were comparable between collared and non-collared cohorts. Subsidence rates were almost doubled for non-collared patients (19.2 vs. 11.7%, p = 0.17), however, not to a level of clinical significance. The findings of this study show that both collared and non-collared Corail stems produce comparable outcomes in terms of the CFR and radiographic indicators for stem fixation. These findings reduce concerns about stem under-sizing and micro-motion in collared stems. While this study provides insights into the collar design debate in THA, further research remains necessary.

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Proximal femoral anatomy and collared stems in hip arthroplasty: is a single collar size sufficient?

Cited by 8 publications

References 27 publications

Biomechanical evaluation of a new femoral stem design for total hip replacement in a canine model

Biomechanical evaluation of a new femoral stem design for total hip replacement in a canine model

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

Radiological Comparison of Canal Fill between Collared and Non-Collared Femoral Stems: A Two-Year Follow-Up after Total Hip Arthroplasty

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