Stable Migration Pattern of an Ultra-Short Anatomical Uncemented Hip Stem: A Prospective Study with 2 Years Radiostereometric Analysis Follow-Up

Mahmoud, Ahmed Nageeb; Kesteris, Uldis; Flivik, Gunnar

doi:10.5301/hipint.5000458

Cited by 16 publications

(14 citation statements)

References 46 publications

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“…Osseointegration can be assumed if an RSA study shows stable migration values after 3 months. Nevertheless, the subsidence was higher than reported in other recent studies, where Y-translation is between -0.03 mm and -0.99 mm at 24 months (Nysted et al 2014, Weber et al 2014, Nebergall et al 2016, Mahmoud et al 2017, Hoornenborg et al 2018, Sesselmann et al 2018, Klein et al 2019, Kruijntjens et al 2020. Nebergall et al (2016) (the Taperloc stem), reported a single outlier of -0.9 mm with the rest of the cohort in a range of -0.1 mm to -0.2 mm.…”

Section: Primary Outcomecontrasting

confidence: 64%

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

et al. 2020

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Background and purpose — Despite the good results after total hip arthroplasty (THA), new implants are continuously being developed to improve durability. The Echo Bi-Metric (EBM) THA stem is the successor to the Bi-Metric (BM) THA stem. The EBM stem includes many of the features of the BM stem, but minor changes in the design might improve the clinical performance. We compared the migration behavior with radiostereometric analysis (RSA) of the EBM stem and the BM stem at 24 months and evaluated the clinical outcome. Patients and methods — We randomized 62 patients with osteoarthritis (mean age 64 years, female/male 28/34) scheduled for an uncemented THA to receive either an EBM or a BM THA stem. We performed RSA within 1 week after surgery and at 3, 6, 12, and 24 months. The clinical outcome was evaluated using Harris Hip Score (HHS) and Oxford Hip Score (OHS). Results — At 24 months, we found no statistically significant differences in migration between the two implants. During the first 3 months both the EBM and the BM stems showed visible subsidence (2.5 mm and 2.2 mm respectively), and retroversion (2.5° and 2.2° respectively), but after 3 months this stabilized. The expected increase in HHS and OHS was similar between the groups. Interpretation — The EBM stem showed a migration at 24 months not different from the BM stem, and both stems display satisfying clinical results.

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Section: Primary Outcomecontrasting

confidence: 64%

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

et al. 2020

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“…15 Early studies of the Proxima stem have focused on surgical technique, 16 migration pattern and bony integration using radiostereometric analysis and/or dual energy X-ray absorptiometry (DXA). [17][18][19] There have been several clinical studies regarding this implant, but they are limited by either the length of follow-up 20 or the patient number. 21 Thigh pain is a common complaint following uncemented hip arthroplasty using conventional stems, with up to one in eight patients affected, some of which eventually require revision.…”

Section: Discussionmentioning

confidence: 99%

The DePuy Proxima™ short stem for total hip arthroplasty – Excellent outcome at a minimum of 7 years

Gombár

Janositz

Friebert

et al. 2019

J Orthop Surg (Hong Kong)

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Metaphyseal, proximally anchored uncemented stems for total hip arthroplasty provide bone preservation and decrease the incidence of proximal stress shielding and thigh pain. Our study investigated the clinical and radiological outcome of the DePuy Proxima™ short stem at a minimum of 7 years. Methods: Eighty-one consecutive patients (86 procedures) under the age of 70 undergoing primary total hip replacement at two arthroplasty centres were enrolled. Follow-up was clinical (Harris Hip Score (HHS), thigh pain and satisfaction) and radiological (subsidence, malalignment and loosening) at 6 months and yearly thereafter. Results: Average age was 50 (range 32-65) with 79% (68 of 86) being male. Preoperative diagnosis included primary osteoarthritis (OA) 36%, avascular necrosis of femoral head 51%, dysplasia 9% and post-traumatic OA 4%. HHS improved 51 points at latest follow-up (from 40 to 91). We had 3.5% (3 of 86) periprosthetic fractures, one requiring revision. We had one dislocation, no infections and no thigh pain. Malalignment rate (5 off neutral) was 12% (10 of 86), not affecting clinical results. Conclusion: Overall stem survival was over 97% at 7 years. The DePuy Proxima provides excellent clinical results at a minimum of 7 years post-operatively.

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“…Mahmoud et al 83 investigated the migration of Proxima in 28 hips followed for two years after surgery. The mean subsidence and varus tilt were low, such as 0.22 ± 0.28 mm and 1.04 ± 0.81.…”

Section: Stem Features and Outcomesmentioning

confidence: 99%

Uncemented short stems in primary total hip arthroplasty

Loppini

Grappiolo

2018

EFORT Open Reviews

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Over the last two decades, several conservative femoral prostheses have been designed. The goals of conservative stems include: the spearing of the trochanteric bone stock; a more physiological loading in the proximal femur reducing the risk of stress shielding; and to avoid a long stem into the diaphysis preventing impingement with the femoral cortex and thigh pain.All stems designed to be less invasive than conventional uncemented stems are commonly named ‘short stems’. However, this term is misleading because it refers to a heterogeneous group of stems deeply different in terms of design, biomechanics and bearing. In the short-term follow-up, all conservative stems provided excellent survivorship. However, variable rates of complications were reported, including stem malalignment, incorrect stem sizing and intra-operative fracture.Radiostereometric analysis (RSA) studies demonstrated that some conservative stems were affected by an early slight migration and rotation within the first months after surgery, followed by a secondary stable fixation. Dual-energy x-ray absorptiometry (DEXA) studies demonstrated an implant-specific pattern of bone remodelling.Although the vast majority of stems demonstrated a good osseointegration, some prostheses transferred loads particularly to the lateral and distal-medial regions, favouring proximal stress shielding and bone atrophy in the great trochanter and calcar regions.Cite this article: EFORT Open Rev 2018;3:149-159. DOI: 10.1302/2058-5241.3.170052

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Stable Migration Pattern of an Ultra-Short Anatomical Uncemented Hip Stem: A Prospective Study with 2 Years Radiostereometric Analysis Follow-Up

Cited by 16 publications

References 46 publications

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

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

The DePuy Proxima™ short stem for total hip arthroplasty – Excellent outcome at a minimum of 7 years

Uncemented short stems in primary total hip arthroplasty

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