Aseptic stem loosening in primary THA: migration analysis of cemented and cementless fixation

Kroell, Artur; Beaulé, Paul E.; Krismer, Martin; Behensky, H.; Stoeckl, B.; Biedermann, R.

doi:10.1007/s00264-008-0701-1

Cited by 52 publications

(39 citation statements)

References 21 publications

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“…5). This finding is consistent with those of a previous study in which a decrease in the sensitivity of early migration as a predictor of later failure in the long term was reported [20]. Implants with late aseptic failure rarely showed early-onset migration and would not have been detected even by a very low migration threshold.…”

Section: Discussionsupporting

confidence: 83%

Early Migration Predicts Aseptic Loosening of Cementless Femoral Stems: A Long-term Study

Streit

Haeussler

Brückner

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Excessive early migration of cemented stems and cups after THA has been associated with poor long-term survival and allows predictable evaluation of implant performance. However, there are few data regarding the relationship between early migration and aseptic loosening of cementless femoral components, and whether early migration might predict late failure has not been evaluated, to our knowledge. Einzel-Bild-Röntgen-Analyse-femoral component analysis (EBRA-FCA) is a validated technique to accurately measure axial femoral stem migration without the need for tantalum markers, can be performed retrospectively, and may be a suitable tool to identify poor performing implants before their widespread use. Questions/purposes We asked: (1) Is axial migration within the first 24 months as assessed by EBRA-FCA greater among cementless stems that develop aseptic loosening than those that remain well fixed through the second decade; (2) what is the diagnostic performance of implant migration at 24 months postoperatively to predict later aseptic loosening of these components; and (3) how does long-term stem survivorship compare between groups with high and low early migration? Methods We evaluated early axial stem migration in 158 cementless THAs using EBRA-FCA. The EBRA-FCA measurements were performed during the first week postoperatively (baseline measurement) and at regular followups of 3, 6, and 12 months postoperatively and annually thereafter. The mean duration of followup was 21 years (range, 18-24 years). The stems studied represented 45% (158 of 354) of the cementless THAs performed during that time, and cementless THAs represented 34% (354 of 1038) of the THA practice during that period. No patient enrolled in this study was lost to followup. Multivariate survivorship analysis using Cox's regression model The institution of one or more of the authors (MRS) has received, during the study period, funding from the noncommercial research fund of Deutsche Arthrose-Hilfe e.V (Frankfurt, Germany). The institution of one or more of the authors (TG) has received, during the study period, funding from Biomet Europe (Berlin, Germany) and from Depuy Orthopädie GmbH (Kirkel, Germany). One of the authors certifies that he (TG), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Pfizer Pharma GmbH (Karlsruhe, Germany), and an amount of less than USD 10,000 from MSD Sharp&Dohme (Haar, Germany was performed with an endpoint of aseptic loosening of the femoral component. Loosening was defined according to the criteria described by Engh et al. and assessed by two independent observers. Patients with a diagnosis of prosthetic joint infection were excluded. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance of axial stem migration 1, 2, 3, and 4 years postoperatively as a predictor of aseptic loosening. Survivorship of hips with high (C 2.7 mm) and low (\ 2.7 mm) migration was co...

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Section: Discussionsupporting

confidence: 83%

Early Migration Predicts Aseptic Loosening of Cementless Femoral Stems: A Long-term Study

Streit

Haeussler

Brückner

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Using a lower threshold of 1.5 mm, 29 of 81 stems in our study were considered to have substantial migration, with 14 of the stems having more than 3 mm of migration. Other groups have used EBRA-FCA to study femoral component migration (Table 5), with our overall rate of migration observed with the Accolade 1 stem higher than other stem designs [6,15,29]. In particular, both Radl et al [38] and Kroell et al [29] showed early migration assessed with EBRA-FCA predicted poor long-term clinical performance when greater than 1.5 mm, mirroring the earlier work of Kobayashi et al [26] and Donnelly et al [10].…”

Section: Discussionsupporting

confidence: 73%

“…Other groups have used EBRA-FCA to study femoral component migration (Table 5), with our overall rate of migration observed with the Accolade 1 stem higher than other stem designs [6,15,29]. In particular, both Radl et al [38] and Kroell et al [29] showed early migration assessed with EBRA-FCA predicted poor long-term clinical performance when greater than 1.5 mm, mirroring the earlier work of Kobayashi et al [26] and Donnelly et al [10]. However, we must be careful in the interpretation of any migration study in regard to what represents the true threshold of migration leading to revision.…”

Section: Discussionmentioning

confidence: 87%

“…Initial implant fixation is one of the key elements for a successful THA [21,35]. Consequently, migration analysis presents an early objective assessment of the predicted medium-to long-term performance and minimizes the risk of unexpectedly higher rates of later failure with early identification of at-risk components [10,13,25,28,29]. Having observed some early revisions for aseptic loosening of the Accolade 1 stem at our center, we set out to investigate the potential causes by evaluating initial implant stability using migration analysis.…”

Section: Discussionmentioning

confidence: 99%

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High Incidence of Migration with Poor Initial Fixation of the Accolade® Stem

White

Carsen

Rasuli

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Numerous cementless femoral stem design variations are in clinical use. Because initial implant instability and micromotion are associated with aseptic loosening of the femoral component, migration analysis provides an early assessment of implant survivorship. Questions/purposes We determined the (1) migration pattern of the Accolade 1 cementless femoral stem; (2) clinical factors predisposing to stem migration; (3) selfreported patient outcomes; and (4) our current rate of aseptic stem loosening. Methods We retrospectively analyzed 81 femoral stems for aseptic migration using Ein-Bild-Roentgen-Analysefemoral component analysis. Postoperatively, patients completed the WOMAC and SF-12 questionnaires. We assessed radiographic factors potentially associated with subsidence: indices of bone shape and quality, canal fill of the implant, and radiographic signs of loosening. Minimum followup was 24 months (mean, 29 months; range, 24-48 months). Results The average subsidence at 24 months was 1.3 mm (range, 0-1.5 mm). In the first 2 years, 36% of stems subsided more than 1.5 mm. Large stem size was associated with subsidence. Radiolucent lines ([ 1.5 mm in three zones) were present in 10% of stems and associated with lower questionnaire scores. The 5-year survivorship for aseptic loosening of the 367 stems was 97% with revision as end point and 95% for radiographic failure.

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“…The authors concluded initial subsidence does not always lead to early revision [20]. A similar study by Kroell et al [24] also evaluated the migration patterns of cemented and cementless stems. In contrast to the study by Krismer et al [20], all the stems evaluated were ultimately revised.…”

Section: Discussionmentioning

confidence: 88%

Early migration characteristics of a hydroxyapatite-coated femoral stem: an RSA study

Campbell

Mercer

Nilsson

et al. 2009

International Orthopaedics (SICOT)

102

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Measurement of early stem subsidence can be used to predict the likelihood of long-term femoral component loosening and clinical failure. Data that examines the early migration pattern of clinically proven stems will provide clinicians with useful baseline data with which to compare new stem designs. This study was performed to evaluate the early migration pattern of a hydroxyapatitecoated press-fit femoral component that has been in use for over ten years. We enrolled 30 patients who underwent THA for osteoarthritis. The median age was 70 years (range, 55-80 years). Patients were clinically assessed using the Harris hip score. Radiostereometric analysis was used to evaluate stem migration at three to four days, six months, one year and two years. We observed a mean subsidence of 0.73 mm at six months, 0.62 mm at one year and 0.58 mm at two years and a mean retroversion of 1.82°at six months, 1.90°at one year and 1.59°at two years. This data suggests that subsidence is confined to the first six months after which there was no further subsidence. The results from this study can be compared with those from novel cementless stem designs to help predict the long-term outcome one may expect from new cementless stem designs.

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Aseptic stem loosening in primary THA: migration analysis of cemented and cementless fixation

Cited by 52 publications

References 21 publications

Early Migration Predicts Aseptic Loosening of Cementless Femoral Stems: A Long-term Study

Early Migration Predicts Aseptic Loosening of Cementless Femoral Stems: A Long-term Study

High Incidence of Migration with Poor Initial Fixation of the Accolade® Stem

Early migration characteristics of a hydroxyapatite-coated femoral stem: an RSA study

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