Uncemented total hip arthroplasty in octogenarian and nonagenarian patients

Toro, Giuseppe; Bothorel, Hugo; Saffarini, Mo; Jacquot, Laurent; Chouteau, Julien; Rollier, Jean-Charles

doi:10.1007/s00590-018-2242-7

Cited by 16 publications

(20 citation statements)

References 27 publications

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“…CFI and CTI have been reported to decrease with age. 20,21 In our study, younger age was related to decreasing CCR. Higher CFI increases the risk of clinically detectable postoperative leg length discrepancy in single-wedge femoral stems with cementless metaphyseal fixation.…”

Section: Discussionsupporting

confidence: 54%

An increase in the risk of excessive femoral anteversion for relatively younger age and types of femoral morphology in total hip arthroplasty with direct anterior approach

Watanabe¹,

Mitsui²,

Usuda³

et al. 2019

J Orthop Surg (Hong Kong)

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Background: Direct anterior approach (DAA) is known to diminish a dislocation risk and widely used for total hip arthroplasty (THA). On the other hand, anterior dislocation due to increasing stem anteversion and cup anteversion is an important complication. Methods: A retrospective analysis of 140 (male/female: 10/130) consecutive patients with 149 hips who had undergone primary THA in the period between 2011 and 2015 was conducted. Factors including age, gender, body mass index (BMI), and primary diagnosis were examined. Radiographic parameters including the Dorr proximal femoral types, cortical thickness index (CTI), canal flare index (CFI), and canal to calcar index were measured. To investigate relationships of combined anteversion (CA) with other factors, a stepwise regression analysis was performed. Results: The mean age, BMI, and the follow-up period were 69.5 ± 10.3 years old, 23.4 ± 3.4 kg/m2, and 48.2 ± 13.6 months, respectively. The proximal femurs of the 149 hips were categorized as Dorr type A (n = 33), type B (n = 110), and type C (n = 6). The mean CTI, CFI, and canal to calcar index were 0.56 ± 0.08, 4.15 ± 0.83, and 0.46 ± 0.09, respectively. The mean stem varus angle, radiographic inclination, and radiographic anteversion of the cup were 0.19 ± 1.63, 40.9 ± 6.0°, and 12.7 ± 3.5°, respectively. Stem anteversion measured by computed tomography (CT) axial image was 17.7 ± 12.0°. The mean radiographic inclination, radiographic anteversion (CTRA), and anatomical anteversion analyzed by Kyocera 3-D template were 40.8 ± 7.2°, 19.8 ± 6.6°, and 28.8 ± 10.0°, respectively. Mean CA defined as the sum of stem anteversion and CTRA was 37.5 ± 14.5°. To investigate relationships of CA with other factors, a stepwise regression analysis was performed and resulted in a model with age (p < 0.001). In the same way, stem anteversion and CTRA were analyzed; only for the stem anteversion, the stepwise selection process resulted in a model with age (p < 0.001) and the Dorr types (p = 0.047). Conclusion: The risk of excessive femoral anteversion increases for relatively younger age and for types of femoral morphology according to the Dorr classification, moreover with an increase of CA in DAA-THA with cementless tapered-wedge stem.

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Section: Discussionsupporting

confidence: 54%

An increase in the risk of excessive femoral anteversion for relatively younger age and types of femoral morphology in total hip arthroplasty with direct anterior approach

Watanabe¹,

Mitsui²,

Usuda³

et al. 2019

J Orthop Surg (Hong Kong)

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“…Interestingly, functional outcomes of our population with APFF were worse compared to an elderly population with THA (OHS: 34.3 vs. 19.2, respectively), 34 but close to that reported for hip PFF treated using similar techniques (OHS 34.3 vs. 32, respectively). 54…”

Section: Discussionsupporting

confidence: 79%

“…12,19 This latter might be the preferred modality in APFF, considering the possibility of metal artefacts that could obscure the fracture, especially if metal artefact reduction (MAR) sequences for MRI are not considered. 19 Interestingly, functional outcomes of our population with APFF were worse compared to an elderly population with THA (OHS: 34.3 vs. 19.2, respectively), 34 but close to that reported for hip PFF treated using similar techniques (OHS 34.3 vs. 32, respectively). 54 In conclusion, the orthopaedic surgeon must consider APFF as a separate entity resembling AFF more than PFF.…”

Section: In 2005supporting

confidence: 73%

“…Even though this latter finding was observed in all patients, qualitative and morphological bone indexes (CBR, CFI and CCR) of our cohort were all far above or approximately in line with the cut-off values reported in patients affected by osteoporosis. 34,35 Compared to a population of octogenarians who underwent THA 34 and to healthy patients operated on for femoral neck fracture, 44 our cohort presented a higher CBR (0.59 vs. 0.47) and a lower CFI (2.33 vs. 2.94) suggesting that poor bone quality and wider femur diameter might differentiate APFF patients from the general elderly population.…”

Section: In 2005mentioning

confidence: 75%

“…33 Radiological features included femur morphology and bone quality evaluated by the Calcar Bone Ratio (CBR), the Canal Flare Index (CFI) and the Canal Calcar Ratio (CCR) as previously reported. 34,35 PFF were classified according to the Vancouver classification. 36 The type of stem fixation was recorded and the stem shape was classified as previously reported.…”

Section: Methodsmentioning

confidence: 99%

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Atypical periprosthetic femoral fractures of the hip: characterisation of three cases

et al. 2020

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Introduction: Long-term use of bisphosphonates (BPs) has been associated with a specific type of tensile side femoral stress fracture known as Atypical Femoral Fracture (AFF). Theoretically periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, emerging evidence correlates prolonged BPs use with the occurrence of a type of PFF with an atypical pattern (atypical PFF, APFF). The aim of the present study is to report 3 cases of APFF treated at a single centre. Methods: Clinical and radiographic records of PFF that occurred between January 2016 and August 2018 were retrospectively reviewed. All patients meeting the American Society for Bone and Mineral Research (ASBMR) criteria for definition of PFF were included. Management strategies for APFF and patient outcomes, including fracture healing and hip function (assessed by the Oxford Hip Score [OHS]) were collected. Results: 3 patients in the study period were identified as APFF (1 incomplete, 2 complete). All patients were females with a mean age of 83.3 years. All patients were treated with lateral plating. The application of a contralateral strut allograft resulted in fracture healing in cases of complete fractures. Mean OHS at final follow-up was 34.3. Conclusions: Despite occurring around a hip stem like PFF, APFF had peculiar clinical and radiographic features, making them more similar to AFF. Therefore, the orthopaedic surgeon should also consider the natural history and healing problems associated with AFF prior in order to choose the most appropriate management for APFF.

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Influence of bone morphology and femur preparation method on the primary stability of hip revision stems

Konow

Schlieker

Lampe

et al. 2022

Journal Orthopaedic Research

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Aseptic loosening is one of the major reasons for re-revisions of cementless revision stems. Insufficient primary stability is associated with bone characteristics and the surgical process. This study aimed to investigate how femur morphology and preparation methods influence the primary stability of revision stems. The Femur morphology was described by the upper femoral curvature (UFC) and an individualized Dorr type classification based on the ratio between the canal-to-calcar ratio (CCR*) and the cortical index (CI*) introduced as the cortical-canal shape (CCS). Manual and powered reaming in combination with helical and straight reamers were used to prepare the bone cavity of 10 cadaveric human femur pairs. Forces during stem impaction were recorded (Reclaim, Depuy Synthes). Micromotion at the bone-implant interface during cyclic axial loading and torsional load to failure was determined. The CCS and impaction forces (R 2 = 0.817, p < 0.001) or torsional strength (R 2 = 0.577, p < 0.001) are inversely related. CCS did not correlate with micromotion during axial loading (R 2 = 0.001, p > 0.999), but proximal femoral curvature did (R 2 = 0.462, p = 0.015). Powered reaming and straight reamers led to an improved torsional strength (both: p = 0.043). The Individualized Dorr classification CCS and UFC allows a good estimation of the primary stability of revision stems. For severely curved Dorr type-C femurs, an alternative anchorage method should be considered clinically.

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Uncemented total hip arthroplasty in octogenarian and nonagenarian patients

Abstract: Clinical outcomes of uncemented THA do not depend on patient age per se, but on more specific preoperative characteristics such as ASA score, BMI and bone quality/morphology.

Cited by 16 publications

References 27 publications

An increase in the risk of excessive femoral anteversion for relatively younger age and types of femoral morphology in total hip arthroplasty with direct anterior approach

An increase in the risk of excessive femoral anteversion for relatively younger age and types of femoral morphology in total hip arthroplasty with direct anterior approach

Atypical periprosthetic femoral fractures of the hip: characterisation of three cases

Influence of bone morphology and femur preparation method on the primary stability of hip revision stems

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