The femoral canal fill of two different cementless stem designs

Laine, Heikki-Jussi; Pajamäki, K. J. J.; Moilanen, Teemu; Lehto, Matti

doi:10.1007/s002640100245

Cited by 30 publications

(5 citation statements)

References 17 publications

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“…The canal fill index (CFI) was determined to evaluate the metaphyseal/diaphyseal filling of the femoral canal by the cementless stem implant on 3 different heights (CFI I: at the level of the LT, CFI II: 1 cm below the LT, CFI III: 3 cm below the LT). On each height, the horizontal diameter of the stem implant was measured and divided by the endosteal medullary canal diameter, multiplied by 100 [39,40]. On preoperative X-ray FO, AO, HO and LL were measured.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

A single-surgeon experience in reconstruction of femoro-acetabular offset and implant positioning in direct anterior approach and anterolateral MIS approach with a curved short stem

Luger

Hochgatterer

Klotz

et al. 2021

Arch Orthop Trauma Surg

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Purpose Minimally invasive surgery using short stems in total hip arthroplasty gained more popularity. The differences in change of hip offset and implant positioning in minimally invasive approaches are not fully known. Therefore, this study was conducted to evaluate the difference in reconstruction of hip offset and implant positioning in direct anterior approach (DAA) and minimally invasive anterolateral approach (AL MIS). Methods A single surgeon series of 117 hips (117 patients; mean age 65.54 years ± 11.47; index surgery 2014–2018) were included and allocated into two groups: group A (DAA) with 70 hips and Group B (AL MIS) with 47 patients operated. In both groups the same type of cementless curved short hip stem and press fit cup was used. Results Both groups showed an equal statistically significant increase of femoral (p < 0.001) and decrease of acetabular offset (p < 0.001). Between both groups no statistically significant difference in offset reconstruction, leg length difference or implant positioning could be found. Leg length increased in both groups significantly and leg length discrepancy showed no difference (group A: − 0.06 mm; group B: 1.11 mm; p < 0.001). A comparable number of cups were positioned outside the target zone regarding cup anteversion. Conclusion The usage of a curved short stem shows an equal reconstruction of femoro-acetabular offset, leg length and implant positioning in both MIS approaches. The results of this study show comparable results to the existing literature regarding change of offset and restoration of leg length. Malposition of the acetabular component regarding anteversion poses a risk.

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Section: Radiographic Evaluationmentioning

confidence: 99%

A single-surgeon experience in reconstruction of femoro-acetabular offset and implant positioning in direct anterior approach and anterolateral MIS approach with a curved short stem

Luger

Hochgatterer

Klotz

et al. 2021

Arch Orthop Trauma Surg

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“…Each slice was evaluated for bone-implant contact with use of DotDotGoose software (American Museum of Natural History) 24 , and bone-implant contact was reported as a percentage of the implant surface. Canal fill indices for the middle and distal regions were calculated with use of ImageJ (National Institutes of Health) to assess the stem size in relation to the femoral canal 4 .…”

Section: Methodsmentioning

confidence: 99%

“…Varying degrees of early micromotion from 20 to >150 µm lead to either predominantly bone or predominantly fibrous tissue formation 2 . Since undersizing of the femoral stem has been found to lead to early aseptic loosening or migration, parameters such as bone-implant contact and the canal fill index were established to calculate the correct stem size 3,4 . Stable osseointegration usually takes approximately 4 to 12 weeks and is the main factor responsible for the long-term survival of cementless implants 5 .…”

mentioning

confidence: 99%

Three-Dimensional Osseointegration Patterns of Cementless Femoral Stems

Schwarz,

Synek,

Senck

et al. 2024

Journal of Bone and Joint Surgery

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Background: Osseointegration is essential for the long-term survival of cementless femoral stems and is dependent on periprosthetic bone quality and correct implantation technique. The aim of this study was to evaluate the 3-dimensional long-term fixation patterns of, and bone microarchitecture around, cementless hip stems. Methods: Four specimens with varying degrees of bone quality and fixation characteristics from body donors who had received Alloclassic Zweymüller hip stems during their lifetime (mean time in situ at the time of death: 12.73 years) were evaluated with use of radiographs, high-resolution computed tomography (CT) scans, and hard-tissue histology. The CT voxel size was 85 µm, and the following parameters were calculated: total bone volume, total bone volume fraction, trabecular bone volume, trabecular bone volume fraction, cortical bone volume, cortical bone volume fraction, and cortical thickness. Bone-implant contact and canal fill index values for each Gruen zone of the specimens were calculated with use of histological samples. Results: Femoral stems with apparently good cortical contact on clinical radiographs showed higher values for cortical bone volume, trabecular bone volume, and cortical thickness in the high-resolution CT analysis than femoral stems with apparently weak cortical contact on clinical radiographs. Based on the histological evaluation, the mean bone-implant contact ranged from 22.94% to 57.24% and the mean canal fill index ranged from 52.33% to 69.67% among the specimens. Conclusions: This study demonstrated different osseointegration patterns of cementless femoral stems on the basis of radiographs, high-resolution CT scans, and histological evaluation. Femora with high cortical bone volume and cortical thickness were associated with higher canal fill indices, whereas femora with low cortical bone volume and cortical thickness had lower canal fill indices and showed a characteristic corner-anchorage pattern. Clinical Relevance: Osseointegration patterns and thus the long-term survival of cementless femoral stems are dependent on cortical bone volume and cortical thickness.

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“…Briefly, varus/valgus stem alignment was measured as the difference in degrees between stem axis and proximal femoral shaft axis. The Canal Fill Index (CFI) was determined, to evaluate the meta−/ diaphyseal filling of the femoral canal by the cementless stem three centimeter below the lesser trochanter [21, 22]. Acetabular and femoral offset (AO, FO) were measured as the distance between the center of rotation of the femoral head and ipsilateral teardrop figure and the center of rotation and proximal femoral shaft axis, respectively.…”

Section: Methodsmentioning

confidence: 99%

Fifty-six percent of proximal femoral cortical hypertrophies 6 to 10 years after Total hip arthroplasty with a short Cementless curved hip stem – a cause for concern?

Innmann

Weishorn

Brückner

et al. 2019

BMC Musculoskelet Disord

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Background Thigh pain and cortical hypertrophies (CH) have been reported in the short term for specific short hip stem designs. The purpose of the study was to investigate 1) the differences in clinical outcome, thigh pain and stem survival for patients with and without CHs and 2) to identify patient and surgery-related factors being associated with the development of CHs. Methods A consecutive series of 233 patients with 246 hips was included in the present retrospective diagnostic cohort study, who had received a total hip arthroplasty (THA) between December 2007 and 2009 with a cementless, curved, short hip stem (Fitmore, Zimmer, Warsaw, IN, USA). Clinical and radiographic follow-up, including the radiographic parameters for hip geometry reconstruction, were prospectively assessed 1, 3, and 6 to 10 years after surgery. Results Cortical hypertrophies were observed in 56% of the hips after a mean of 7.7 years, compared to 53% after 3.3 years being mostly located in Gruen zone 3 and 5. There was no significant difference for the Harris Hip Score and UCLA score for patients with and without CHs. Only one patient with a mild CH in Gruen zone 5 and extensive heterotopic ossifications around the neck of the stem reported thigh pain. The Kaplan Meier survival rate after 8.6 years was 99.6% (95%-CI; 97.1–99.9%) for stem revision due to aseptic loosening and no association with CHs could be detected. Postoperative increase in hip offset was the only risk factor being associated with the development of CHs in the regression model (ΔHO; OR 1.1 (1.0–1.2); p = 0.001). Conclusions The percentage of cortical hypertrophies remained almost constant in the mid-term compared to the short-term with the present cementless short hip stem design. The high percentage of cortical hypertrophies seems not be a cause for concern with this specific implant in the mid-term. Level of evidence Diagnostic Level IV

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The femoral canal fill of two different cementless stem designs

Cited by 30 publications

References 17 publications

A single-surgeon experience in reconstruction of femoro-acetabular offset and implant positioning in direct anterior approach and anterolateral MIS approach with a curved short stem

A single-surgeon experience in reconstruction of femoro-acetabular offset and implant positioning in direct anterior approach and anterolateral MIS approach with a curved short stem

Three-Dimensional Osseointegration Patterns of Cementless Femoral Stems

Fifty-six percent of proximal femoral cortical hypertrophies 6 to 10 years after Total hip arthroplasty with a short Cementless curved hip stem – a cause for concern?

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