Still no single gold standard for using cementless femoral stems routinely in total hip arthroplasty

Moskal, Joseph T.; Capps, Susan G.; Scanelli, John

doi:10.1016/j.artd.2016.02.001

Cited by 30 publications

(18 citation statements)

References 48 publications

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“…The use of press-fit cementless femoral implants has increased substantially over the past decades and currently has become the mainstream in primary THA [10,11]. Recent studies showed that the initial fixation and long-term stability of the components were determinants that affect implant survivorship [12,13] and periprosthetic bone remodeling, which encompasses bone resorption as well as increase in bone density as a result of stress shielding or stress concentration, is associated with the long-term fixation of cementless implants [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Short to Midterm Follow-Up of Periprosthetic Bone Mineral Density after Total Hip Arthroplasty with the Ribbed Anatomic Stem

Tian

et al. 2019

BioMed Research International

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Background. Femoral bone remodeling around hip prosthesis after total hip arthroplasty (THA) is definite but unpredictable in time and place. This study aimed to investigate the implant-specific remodeling and periprosthetic bone mineral density (BMD) changes after implantation of the Ribbed anatomic cementless femoral stem. Methods. After power analysis, 41 patients who had undergone primary unilateral THA with the Ribbed anatomic cementless stem were included. BMD of the seven Gruen zones was measured by dual-energy X-ray absorptiometry, and the contact, fitness, and fixation of the femoral stem and proximal femur were analyzed by X-ray. Additional clinical outcome parameters were also recorded. Results. Compared with the contralateral unoperated side, significant reductions of BMD were detected in the distal zone (Gruen zone 4: 1.665±0.198 versus 1.568±0.242 g/cm2, P=0.001) and middle distal zone (Gruen zone 5: 1.660±0.209 versus 1.608±0.215 g/cm2, P=0.026) on the prosthetic side, but no significant differences in BMD were detected in other zones (Gruen zones 1, 2, 3, 6, and 7). Subgroups analyses indicated no significant correlation between periprosthetic BMD changes and clinical factors including primary disease and body mass index. Visible areas of bone ingrowth indicated solid fixation of the femoral stem and there was no case of loosening. Clinical and functional outcome scores were excellent with mean HHS of 93.13 points and mean WOMAC score of 5.20 points, and three patients described intermittent mild thigh pain at the final follow-up. Conclusions. For the Ribbed femoral stem, the periprosthetic BMD was well maintained in the proximal femur, while periprosthetic BMD was significantly reduced in the distal and middle distal zones of the femur. Further clinical investigations are required to examine the efficacy of the Ribbed stem, particularly with regard to long-term survival. This trial is registered with ChiCTR1800017750.

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Section: Introductionmentioning

confidence: 99%

Short to Midterm Follow-Up of Periprosthetic Bone Mineral Density after Total Hip Arthroplasty with the Ribbed Anatomic Stem

Tian

et al. 2019

BioMed Research International

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“…A recent meta-analysis of implant combinations 48 found no association between implant system and risk of revision, although other studies have mixed conclusions. 49–54 These studies relied on structured records of revision and registry data, and thus are complemented by our analysis of real world evidence derived from EHRs. We also found that patients with structured records of revision surgery reported more hip pain in the post replacement, pre-revision period than patients who did not.…”

Section: Discussionmentioning

confidence: 99%

Medical device surveillance with electronic health records

et al. 2019

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Post-market medical device surveillance is a challenge facing manufacturers, regulatory agencies, and health care providers. Electronic health records are valuable sources of real-world evidence for assessing device safety and tracking device-related patient outcomes over time. However, distilling this evidence remains challenging, as information is fractured across clinical notes and structured records. Modern machine learning methods for machine reading promise to unlock increasingly complex information from text, but face barriers due to their reliance on large and expensive hand-labeled training sets. To address these challenges, we developed and validated state-of-the-art deep learning methods that identify patient outcomes from clinical notes without requiring hand-labeled training data. Using hip replacements—one of the most common implantable devices—as a test case, our methods accurately extracted implant details and reports of complications and pain from electronic health records with up to 96.3% precision, 98.5% recall, and 97.4% F1, improved classification performance by 12.8–53.9% over rule-based methods, and detected over six times as many complication events compared to using structured data alone. Using these additional events to assess complication-free survivorship of different implant systems, we found significant variation between implants, including for risk of revision surgery, which could not be detected using coded data alone. Patients with revision surgeries had more hip pain mentions in the post-hip replacement, pre-revision period compared to patients with no evidence of revision surgery (mean hip pain mentions 4.97 vs. 3.23; t = 5.14; p < 0.001). Some implant models were associated with higher or lower rates of hip pain mentions. Our methods complement existing surveillance mechanisms by requiring orders of magnitude less hand-labeled training data, offering a scalable solution for national medical device surveillance using electronic health records.

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“…According to some researchers, a clear consensus on when to use cemented stems is missing (Moskal et al. 2016). This lack of consensus and data was one of the reasons to perform this study.…”

Section: Discussionmentioning

confidence: 99%

“…2014), studies set different thresholds for “older age” patients (Moskal et al. 2016), which affects the results depending on the study population. Since the definition of “elderly” is also unclear in the orthopedic literature (Sabharwal et al.…”

Section: Discussionmentioning

confidence: 99%

Cementing of the hip arthroplasty stem increases load-to-failure force: a cadaveric study

Klasan¹,

Bäumlein²,

Bliemel³

et al. 2019

Acta Orthopaedica

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Background and purpose — To date, there is not a single clinical or mechanical study directly comparing a cemented and a cementless version of the same stem. We investigated the load-to-failure force of a cementless and a cemented version of a double tapered stem.Material and methods — 10 femurs from 5 human cadaveric specimens, mean age 74 years (68–79) were extracted. Bone mineral density (BMD) was measured using peripheral quantitative computed tomography. None of the specimens had a compromised quality (average T value 0.0, –1.0 to 1.4). Each specimen from a pair randomly received a cemented or a cementless version of the same stem. A material testing machine was used for lateral load-to-failure test of up to a maximal load of 5.0 kN.Results — Average load-to-failure of the cemented stem was 2.8 kN (2.3–3.2) and 2.2 kN (1.8–2.8) for the cementless stem (p = 0.002). The cemented version of the stem sustained a higher load than its cementless counterpart in all cases. Failure force was not statistically significantly correlated to BMD (p = 0.07).Interpretation — Implanting a cemented version of the stem increases the load-to-failure force by 25%.

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Still no single gold standard for using cementless femoral stems routinely in total hip arthroplasty

Cited by 30 publications

References 48 publications

Short to Midterm Follow-Up of Periprosthetic Bone Mineral Density after Total Hip Arthroplasty with the Ribbed Anatomic Stem

Short to Midterm Follow-Up of Periprosthetic Bone Mineral Density after Total Hip Arthroplasty with the Ribbed Anatomic Stem

Medical device surveillance with electronic health records

Cementing of the hip arthroplasty stem increases load-to-failure force: a cadaveric study

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