The Accolade TMZF stem fulfils the demands of modern stem design: Minimum 5-year survival in a cohort of 937 patients

Hout, Joost Aam van den; Koenraadt, Koen L. M.; Wagenmakers, Robert; Bolder, Stefan B T

doi:10.1177/2309499018807747

Cited by 5 publications

(10 citation statements)

References 29 publications

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“…To our knowledge, the present study comprises the largest cohort of patients with intermediate to long-term follow-up after THA with use of the Accolade TMZF stem. The current study demonstrated excellent survivorship, which was comparable with the intermediate-term results of smaller studies by other groups who have utilized this stem 9,23,24 . The survival of the Accolade TMZF stem is comparable with that of other proximally coated tapered-wedge cementless stems at similar follow-up 25,26 .…”

Section: Discussionsupporting

confidence: 86%

“…The Accolade TMZF (Stryker Orthopaedics) is a tapered-wedge cementless hydroxyapatite-coated (metaphyseal) low-modulus-of-elasticity metal alloy (titanium-molybdenum-zirconium-iron) stem that was introduced with the aims of improved early fixation and improved stress transfer to bone 9 . However, in recent years, there have been reports of early and often catastrophic failure of the Accolade TMZF stem 4,10 .…”

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confidence: 99%

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Intermediate to Long-Term Outcomes and Causes of Aseptic Failure of an At-Risk Femoral Stem

Gazendam

Ekhtiari

Wood

2022

Journal of Bone and Joint Surgery

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Background: The Accolade TMZF is a tapered-wedge cementless metaphyseal-coated femoral stem that was widely utilized from 2002 to 2012. In recent years, there have been reports of early catastrophic failure of this implant. The purposes of the present study were to establish the long-term survival of this stem and to analyze patients who underwent aseptic revision to understand the causes and risk factors for failure.Methods: We retrospectively reviewed the records of all patients who had undergone primary total hip arthroplasty with use of an Accolade TMZF stem at a high-volume arthroplasty center. The causes and timing of revision surgery were documented. Survivorship analysis was performed with use of Kaplan-Meier curves to determine the overall and aseptic survival rates at the time of the latest follow-up. Patient and implant factors commonly associated with aseptic failure were extracted, and a Cox proportional hazards model was used.Results: A consecutive series of 2,609 patients who had undergone unilateral primary total hip arthroplasty with use of an Accolade TMZF femoral stem were included. The mean time from the primary procedure was 11.3 years (range, 0 days to 19.4 years). The cumulative survival rate was 95.5% ± 0.1% at the time of the latest follow-up. One hundred and seven patients underwent revision surgery, with aseptic loosening of the femoral component being the most common cause of aseptic failure in this cohort (33 of 2,609; 1.3%). Smaller femoral size and larger femoral head offset were independent risk factors for aseptic failure.Conclusions: To our knowledge, this is the largest series representing the longest follow-up of this tapered-wedge cementless femoral implant. Despite early concerns, the Accolade TMZF stem had excellent survivorship in this cohort. Trunnionosis as the cause for revision surgery was rare.

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Section: Discussionsupporting

confidence: 86%

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confidence: 99%

Intermediate to Long-Term Outcomes and Causes of Aseptic Failure of an At-Risk Femoral Stem

Gazendam

Ekhtiari

Wood

2022

Journal of Bone and Joint Surgery

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“…24 Further, while gross trunnion failure of the femoral component of interest has been noted, additional reports have documented the implant's success. 25,26 This divergence in implant performance warrants additional investigation especially in the setting of non-trunnionosis revision. Therefore, the purpose of this retrieval study was to evaluate for taper MACC among a single manufacturer femoral component design.…”

Section: Introductionmentioning

confidence: 99%

Quantification of trunnion damage in a series of intact total hip arthroplasty femoral stems previously identified to be at risk of catastrophic failure

Lanting,

Sogbein,

MacDonald

et al. 2023

HIP International

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Background: Corrosion at the head-neck junction of femoral stems is a rare complication of total hip arthroplasty (THA) with manifestations ranging from subclinical wear to failure. Prior studies have identified a single femoral component design with an increased propensity for catastrophic trunnion failure. The purpose of the present study was to quantify trunnion damage of this femoral component retrieved from patients undergoing revision THA for non-trunnionosis indications. Methods: 24 femoral components from a single manufacturer were identified for study inclusion. Each prosthesis underwent stereomicroscopic inspection. Corrosion and fretting scores were assigned per the Goldberg criteria to quadrants of the trunnion. Material loss was calculated based on cone angles across trunnion quadrants. This was carried out using a coordinate measuring machine that digitised each trunnion surface. Stems were compared to a series of femoral stems with the same trunnion design. Results: 20 of the 24 (83%) trunnions demonstrated corrosion, all 24 trunnions demonstrated fretting. Corrosion scores did not statistically differ with respect to trunnion zone ( p = 0.53), while fretting scores were higher in the inferior compared to the superior zones ( p < 0.001). There was no significant difference in cone angles assessing material loss between stems ( p = 0.25). Conclusions: Evidence of trunnion damage was observed in each stem retrieved for non-trunnionosis revision. Fretting occurred more frequently about the inferior quadrants. However, digitised trunnion shapes were similar between compared stems exhibiting no material loss. Therefore, it is possible that previous reports of trunnion failures for this implant are not a systemic issue, and that further investigation is required.

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“…Clinical studies have looked at different surgical approaches, 19 interface conditions, 20 and commercially available stem designs having different geometries, sizes, coatings, and materials. 6,17,[19][20][21][22][23][24][25][26][27][28][29][30][31] Only a few of these studies report on both tapered and cylindrical cementless implant designs for use in more challenging revision THA procedures. 6,17,23,31 From these remaining studies, different implant manufacturers were used and therefore different overall stem designs were tested.…”

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confidence: 99%

“…Despite clinical success of each of these stem designs and their wide adoption, 6,17,19,20,23,[25][26][27][28][29][30][31] a direct mechanical comparison between cylindrical and tapered stems, controlling for distal taper as a singled out implant design variable, with more severe Type III-B bone defects is lacking in the literature. Experimental studies have tested cylindrical 32,33 and compared tapered with cylindrical THA stem designs with both Type III-A 7,34 and Type III-B bone defects.…”

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confidence: 99%

Tapered stem geometry provides superior initial fixation stability to cylindrical stem geometry in the setting of severe bone loss: A finite element analysis

Kosmopoulos

Russell

Rodrigues

et al. 2020

Engineering Reports

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Initial stability of cementless stems used in total hip arthroplasty (THA) is critical for subsequent osseointegration at the bone/implant interface. In the setting of revision THA, there is frequently less intact femoral bone available for fixation of the new stem. This study aims to compare the initial fixation stability between a cylindrical and tapered stem, designed for diaphyseal fixation in a revision THA setting, with increasing bone defect severity. Using finite element analysis, severe Paprosky Type III femoral bone defects were simulated. The cylindrical stem had a 13.3% higher construct stiffness as compared to the tapered stem for the least severe bone defect modeled. In contrast, for the most severe bone defect, the tapered stem showed a 12.3% higher construct stiffness than the cylindrical stem. At the bone/implant interface, the tapered design resulted in less than 20 μm of maximum tangential micromotion for all the bone defect models, whereas the cylindrical stem exceeded 20 μm for all and was as high as 70 μm in the most severe case. Given the limitations of the models presented, the results suggest the tapered stem obtained superior initial fixation as compared to cylindrical stem with increasing bone defect severity.

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The Accolade TMZF stem fulfils the demands of modern stem design: Minimum 5-year survival in a cohort of 937 patients

Cited by 5 publications

References 29 publications

Intermediate to Long-Term Outcomes and Causes of Aseptic Failure of an At-Risk Femoral Stem

Intermediate to Long-Term Outcomes and Causes of Aseptic Failure of an At-Risk Femoral Stem

Quantification of trunnion damage in a series of intact total hip arthroplasty femoral stems previously identified to be at risk of catastrophic failure

Tapered stem geometry provides superior initial fixation stability to cylindrical stem geometry in the setting of severe bone loss: A finite element analysis

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