Twenty-year Followup of an Uncemented Stem in Primary THA

Meding, John B.; Ritter, Merrill A.; Keating, E. Michael; Berend, Michael E.

doi:10.1007/s11999-014-3763-y

Cited by 35 publications

(12 citation statements)

References 22 publications

(52 reference statements)

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“…In the retrospective short term (1–3 years), no clinical difference was found between patients with or without CH [10, 16]. The results may have started a competition between the new short stems and the conventional straight stems that have provided good results for three decades [18, 19]. This study aims to evaluate for the first time prospectively in a cohort with a follow-up of 5 years the clinical relevance of CH after implantation of the short curved Fitmore hip stem and to assess the effect of patient, surgical, and implant factors on the occurrence of CH.…”

Section: Introductionmentioning

confidence: 99%

Prospective 5-year study with 96 short curved Fitmore™ hip stems shows a high incidence of cortical hypertrophy with no clinical relevance

et al. 2019

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Background An increased occurrence of cortical hypertrophy (CH) was observed 1–2 years after implanting short curved Fitmore hip stems. There are no published data about either the clinical relevance or the progression of CH over the long term. Methods Ninety-six primary total hip arthroplasties were performed between 2008 and 2010 using the Fitmore hip stem. Clinical and radiological parameters were recorded preoperatively and at 1, 2, 3, and 5 year follow-up. Results CH appeared mainly on antero-posterior radiographs in Gruen Zones 2, 3, 5, and 6. After 1 year, the diameter was 10 ± 2 mm and remained constant thereafter. The CH rate after 1 year was 69% and after 5 years 71%. Subsidence after 1 year was 1.6 ± 1.55 mm and 1.93 ± 1.72 mm after 5 years. Cortical thinning was 46% after 1 year and 56% after 5 years, mainly in Gruen Zones 7 and 8. In the first year radiolucencies were found in 51% in all Gruen Zones, and in 20% after 5 years. Patient, implant, and surgical factors did not correlate with radiological outcomes except that larger stems had more CH. After 5 years, the Harris Hip Score had improved from 59 to 94 and the Oxford Hip Score from 22 to 41. Radiographic parameters, notably CH, were not associated with clinical outcomes except that cortical thinning correlated with lower outcome scores. Conclusions CH correlated neither with clinical outcome nor with patient, surgical or implant factors, except for a positive correlation with stem size. The Fitmore hip stems settled within the first year to a stable fixation and then remained almost unchanged. However, cortical thinning is common in Gruen Zone 7 and 8 meaning that there is stress-shielding.

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Section: Introductionmentioning

confidence: 99%

Prospective 5-year study with 96 short curved Fitmore™ hip stems shows a high incidence of cortical hypertrophy with no clinical relevance

et al. 2019

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“…Mäkelä et al 21 performed a follow-up study of 5379 patients from Finnish Arthroplasty Register, and reported the high survival for aseptic loosening of 99.0, 99.0, 96.0% at 7, 10, 15years, respectively. Meding et al 22 showed the 100% survivorship for aseptic loosening at mean follow-up of 20 years after 157 primary THAs. Sueyoshi et al 23 also reported 100% survivorship with stem revision as the endpoint for more than 20 years (range, 0-26 years; mean, 7.9 years).…”

Section: Discussionmentioning

confidence: 99%

Effect of stem alignment on long-term outcomes of total hip arthroplasty with cementless Bi-Metric femoral components

Shishido

Tateiwa

Takahashi

et al. 2018

Journal of Orthopaedics

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We investigated the effects of varus-valgus alignment on the long-term outcomes after cementless total hip arthroplasty (THA) using a porous coated version of Bi-Metric femoral stems. The Kaplan-Meier survival analysis was performed in 71 hips. The survival rate with femoral revision for aseptic loosening as the end point was 100% at 17 years. Nevertheless, the initial stem alignment was more valgus in patients with the Engh grade III-IV stress shielding than patients with the Engh grade I-II. Our results suggest that valgus misalignment of cementless Bi-Metric stem might be a potential risk factor for the progression of stress shielding.

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“…Previously, the authors reported excellent outcomes with a proximally porous plasma-sprayed titanium stem, the Bi-Metric stem, at 10 and 20 years postoperatively. 4,7 This femoral stem was updated in 2007, and the authors have been using the updated stem, the Echo Bi-Metric stem. The current study showed 100% survivorship and equally good clinical scores at short-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 It is often seen with distal or diaphyseal fixation stems and may be seen with proximal or metaphyseal fixation stems as well. 4,14,15 Although distal cortical hypertrophy is not a direct cause of revision hip surgery and does not cause symptoms such as thigh pain, it is an adaptive bone remodeling response to mechanical stress, and therefore a lower rate is preferred. 16 Recently, proximal stabilizing short stems showed lower rates of adaptive bone remodeling, including distal cortical hypertrophy.…”

Section: Discussionmentioning

confidence: 99%

Short-term Outcomes With a Second-Generation Uncemented Stem in Total Hip Arthroplasty

Sueyoshi¹,

Meding²,

Berend³

et al. 2016

Orthopedics

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An uncemented stem has been used successfully in total hip arthroplasty for 2 decades, and some implants have been updated. The authors have used second-generation uncemented proximal porous coating stems, the Echo Bi-Metric Full Proximal Profile stem (Echo FPP; Biomet, Warsaw, Indiana) and the Echo Reduced Proximal Profile stem (Echo RPP; Biomet). This article reports short-term outcomes with these stems compared with their predecessor, the Bi-Metric stem (Biomet). The authors reviewed 1280 Echo FPP stems, 366 Echo RPP stems, and 1497 Bi-Metric stems. With more than 5 years of follow-up, both the Echo FPP and the Echo RPP stems had 100% survivorship with stem revision as the endpoint, and the Bi-Metric stems also had 100% survivorship for more than 20 years. Average Harris Hip Scores for the Echo FPP, the Echo RPP, and the Bi-Metric stems were 53.3, 49.7, and 51.5 preoperatively, 93.8, 94.6, and 95.2 at 1 year, and 94.0, 95.8, and 95.4 at 3 years postoperatively, respectively. Dislocation after surgery was significantly lower with the Echo FPP and the Echo RPP stems than with the Bi-Metric stems, but this was more relevant to the surgical approach and head size. All radiographs of the Echo FPP, the Echo RPP, and the Bi-Metric stems showed proximal femoral remodeling consistent with osseous ingrowth. Distal cortical hypertrophy around the implanted stem and spot-welding were comparably observed in all 3 cohorts. The short-term outcomes of the updated uncemented stems were as excellent as the previously used stem regarding survivorship, complications, and radiographic assessment.

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Twenty-year Followup of an Uncemented Stem in Primary THA

Abstract: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Cited by 35 publications

References 22 publications

Prospective 5-year study with 96 short curved Fitmore™ hip stems shows a high incidence of cortical hypertrophy with no clinical relevance

Prospective 5-year study with 96 short curved Fitmore™ hip stems shows a high incidence of cortical hypertrophy with no clinical relevance

Effect of stem alignment on long-term outcomes of total hip arthroplasty with cementless Bi-Metric femoral components

Short-term Outcomes With a Second-Generation Uncemented Stem in Total Hip Arthroplasty

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