Subsidence and perioperative periprosthetic fractures using collarless hydroxyapatite-coated stem for displaced femoral neck fractures according to Dorr type

Song, Jin Ho; Jo, Woo-Lam; Lee, Kee-Haeng; Yoonjoo, Cho; Park, Joonyoung; Oh, Seungbae

doi:10.1177/2309499019877530

Cited by 15 publications

(11 citation statements)

References 31 publications

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“…Our observation that proximal femoral morphology as assessed by Dorr type was related to femoral component subsidence is consistent with previous literature. 22,23 Given the lack of difference in the prevalence of Dorr type B morphology between those with high versus low nicotine or cotinine levels, however, this would not have impacted the results of our study.…”

Section: Discussionmentioning

confidence: 87%

Are Elevated Nicotine and Cotinine Levels Associated with Early Femoral Component Subsidence in Press-Fit, Primary Total Hip Arthroplasty?

Muffly

Jacobs

Duncan

2020

The Journal of Hip Surgery

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Tobacco exposure negatively affects bone mineral density and early osseointegration of surgical implants. We sought to determine if elevated nicotine and/or cotinine levels prior to primary total hip arthroplasty (THA) are associated with early femoral component subsidence. We hypothesize that tobacco users will have higher rates of readmission/reoperation and increased radiographic subsidence. We conducted an institutional review of 75 patients (average age = 52.9 years; 55% females; body mass index = 31.3) who underwent THA from April 2017 to January 2018. Immediate postoperative radiographs were compared with those obtained at 2 to 6 weeks postoperatively to determine early femoral component subsidence. Of the 75 patients, 10 (13.3%) had early radiographic femoral component subsidence ≥ 2 mm. In this group, preoperative nicotine levels were significantly elevated (7.2 vs. 1.5ng/mL; p = 0.04), whereas preoperative cotinine levels did not statistically differ (108.3 vs. 33.8 ng/mL; p = 0.45). A significantly greater magnitude of subsidence was seen in those with elevated preoperative nicotine levels compared with those with normal levels (1.7 vs. 0.5 mm; p = 0.04). The mean time to radiographic follow-up was 2.6 weeks. Surgical approach, implant type, categorical variables, and patient readmission were not associated with ≥ 2 mm of early subsidence. There was a single reoperation for periprosthetic fracture, but none was related to instability from subsidence. Early femoral component subsidence was more prevalent in patients with elevated preoperative nicotine levels. Rates of readmission/reoperation at 90 days did not differ between those with and without elevated tobacco markers. Clinically relevant thresholds of preoperative nicotine and/or cotinine values are needed to better delineate appropriate surgical candidates to achieve optimal surgical outcomes.

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Section: Discussionmentioning

confidence: 87%

Are Elevated Nicotine and Cotinine Levels Associated with Early Femoral Component Subsidence in Press-Fit, Primary Total Hip Arthroplasty?

Muffly

Jacobs

Duncan

2020

The Journal of Hip Surgery

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“…An investigation by Pentlow and Heal showed a signi cantly higher subsidence rate of hydroxyapatite (HA)-coated cementless stem in traumatic patients who mostly had Dorr type C femurs [24]. Song et al reported that Dorr type C femurs had a higher risk of subsidence when using uncemented collarless HA-coated stem [19]. In contrast, Reis et al concluded in their investigation that no anatomic parameter could be detected as a predisposing factor for cementless stem subsidence [12].…”

Section: Discussionmentioning

confidence: 98%

“…who are orthopedic surgeons with extensive diagnostic imaging experience, using digital imaging system (Synapse Digital Imaging System, Fuji lm Medical Imaging, Tokyo, Japan), and only mean values were used for statistical analysis. Subsidence was de ned as a femoral stem distalization in reference to the major trochanter, according to a previous report [19]. The distance between the apex of the major trochanter and the stem shoulder was measured at three different time points (immediately [0 W], one week [1 W], and six weeks [6 W] after surgery) and the degrees of stem subsidence were assessed by comparing the distance at each time point (0 W vs. 1 W, 1 W vs. 6 W, and 0 W vs. 6 W) in both stems (Fig.…”

Section: Methodsmentioning

confidence: 99%

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Tapered wedge stems decrease early postoperative subsidence following cementless total hip arthroplasty in Dorr type C femurs compared to fit-and-fill stems

Ikemura¹,

Motomura²,

Hamai³

et al. 2021

Preprint

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Background: To compare the degree of stem subsidence between two different femoral component designs and to determine the risk factors associated with stem subsidence after cementless total hip arthroplasty (THA) in Dorr type C femurs. Methods: We retrospectively reviewed 91 consecutive hips in 87 patients with Dorr type C proximal femoral morphology who underwent primary cementless THA using a fit-and-fill stem or a tapered wedge femoral stem at our institution between January 2013 and June 2020. A fit-and-fill stem was used in 48 hips and a tapered wedge stem was used in 43 hips. Radiologically, the distance between the apex of the major trochanter and the stem shoulder were measured at three different time points (immediately [0W], one week [1W], and six weeks [6W] after surgery) and the degrees of stem subsidence were assessed by comparing the distance between 0W and 1W, 1W and 6W, and 0W and 6W, respectively. Results: The mean degree of stem subsidence (0W vs. 1W) was 0.25 mm (standard deviation [SD] 0.58) in the fit-and-fill stem group, and 0.24 mm (SD 0.43) in the tapered wedge stem group. There was no significant difference between the two groups (P = 0.4493). However, the mean degrees of subsidence were significantly higher in the fit-and-fill stem group (1W vs. 6W, 0.38 mm [SD 0.81]; 0W vs. 6W, 0.64 mm [SD 1.17]) than in the tapered wedge stem group (1W vs. 6W, 0.17 mm [SD 0.29]; 0W vs. 6W, 0.25 mm [SD 0.35]) (P < 0.05 for both). In addition, the rates of >3 mm subsidence (in which instability can be observed) were 16.7% (8 of 48 hips) and 2.3% (1 of 43 hips), respectively. There was also a significant difference between the two stems (P = 0.0324). Multivariate analysis demonstrated that higher age and fit-and-fill stem were risk factors for >3 mm subsidence after THA in Dorr type C femurs (P = 0.0396 and 0.0227, respectively). Conclusion: Our findings suggest that the tapered wedge stem is more suitable for Dorr type C femurs than the fit-and-fill stem to avoid early postoperative subsidence in cementless THA.

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“…Однако именно это качество требует их осторожного применения в условиях склерозированной кости, поскольку размер устанавливаемой ножки всегда на толщину напыления больше, чем последний рашпиль. Вследствие этого может возникнуть заклинивание бедренного компонента в слишком высоком положении, если последний рашпиль не удалось погрузить на требуемую глубину [86].…”

Section: клиновидные ножки с гидроксиапатитовым покрытиемunclassified

Cementless Hip Implants: History and Current Status of the Issue

Шубняков

Риахи

Шубняков³

et al. 2020

Traumatology and Orthopedics of Russia

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Background. Total hip arthroplasty is an effective type of surgery with excellent survival rates of modern implants. From the very beginning of the widespread introduction of total hip arthroplasty, the cement technique of components fixing prevailed. However, many researchers associated the development of osteolysis and the following loosening with the reaction to cement. The subsequent studies clarified the situation regarding the nature of osteolysis, but there remained the problem of insufficient stability of the cemented stems to withstand the penetration of polyethylene wear particles into the distal part of the stem with the development of loosening. An ideal endoprosthesis should ensure the normal hip biomechanics, joint painless functioning and improve the quality of life of the patient without the need for revision. The optimal results of cementless femoral stems functioning depend on the achievement of initial stability, osseointegration and equable transmission of tension onto the femur. There are many factors that influence osseointegration processes and the subsequent behavior of the implant. Understanding these factors is the key to choosing the optimal implant for a particular patient, taking into account the anatomical features of the femur.The purpose of this article is to discuss upon the literature review the application of cementless femoral components, the possible causes of failure and its prevention from the point of view of the evidence-based practice.Materials. The search was conducted in the PubMed, eLIBRARY databases and through the Web of Knowledge. Survival rates and prevalence of various implants in the structure of primary arthroplasty were estimated on the basis of annual reports of a number of national registries, as well as the hip arthroplasty registry of the Vreden National Medical Research Center of Traumatology and Orthopedics. Among the factors discussed are the properties of the components material, the form of the implants, surface properties, and the influence of the anatomical features of the femur. Additionally, the most used types of cementless femoral components were assessed.Conclusion. Cementless femoral components demonstrated the excellent long-term survival and functional results. The currently prevailing type of the prosthesis intimate attachment to the bone is the biological fixation, especially in groups of young patients. Future studies of cementless implants should necessarily take into account the patient’s age, level of activity, type of bone canal, the presence of deformities, and the friction pair used. This will make it possible to draw clearer conclusions in what clinical situation it is advisable to use the femoral components of a particular design.

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Subsidence and perioperative periprosthetic fractures using collarless hydroxyapatite-coated stem for displaced femoral neck fractures according to Dorr type

Cited by 15 publications

References 31 publications

Are Elevated Nicotine and Cotinine Levels Associated with Early Femoral Component Subsidence in Press-Fit, Primary Total Hip Arthroplasty?

Are Elevated Nicotine and Cotinine Levels Associated with Early Femoral Component Subsidence in Press-Fit, Primary Total Hip Arthroplasty?

Tapered wedge stems decrease early postoperative subsidence following cementless total hip arthroplasty in Dorr type C femurs compared to fit-and-fill stems

Cementless Hip Implants: History and Current Status of the Issue

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