Can a Conical Implant Successfully Address Complex Anatomy in Primary THA? Radiographs and Hip Scores at Early Followup

Zhang, Quoqiang; Goodman, Stuart B.; Maloney, William J.; Huddleston, James I.

doi:10.1007/s11999-015-4480-x

Cited by 25 publications

(9 citation statements)

References 31 publications

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“…Coxarthrosis secondary to DDH leads to pathological bony anatomy and severe biomechanical alterations around the hip joint, increasing the difficulty of THA, which remains the treatment of choice for endstage arthritis of the hip. In such an abnormal proximal femoral morphology, a stem with metaphyseal fitting flat-wedge taper or fit and fill should not be considered appropriate [9,21], while a diaphyseal engaging stem that dials in the desired amount of anteversion is desirable, owing to its capability of adaptation in small femurs, with poor metaphyseal bone quality, and possibly with previous hip surgeries. Its use should therefore minimize the risk of threatening the long-term survival of the prosthetic implant related to aseptic loosening.…”

Section: Discussionmentioning

confidence: 99%

“…The Kaplan Meier curve shows the probability of survival for the Wagner cone femoral stem along the follow-up demonstrated stability of all implants [9]. It has been shown that there are fewer implant-related complications in patients undergoing THA with a dislocated hip classified as Crowe type IV when cylindrical stems 2/3 coated were used to reconstruct a step-cut osteotomized femur compared with tapered stems with 1/3 proximal coating [21].…”

Section: Discussionmentioning

confidence: 99%

“…On the femoral side, the use of a stem with a rounded section, whose design consists of a proximally conical and tapered prosthesis for better load distribution with the sharp longitudinal ribs and the Titanium alloy coarse-blasted surface to enhance stability and osseointegration, should allow immediate fixation in the medullary bony bed and restoration of the proper version angle during insertion, thanks to its narrow round proximal cross-section that facilitates adjustment of the anteversion angle of the stem, especially in patients whose femoral geometry precludes the use of standard-sized implants and for whom metaphyseal engaging stems are not an ideal choice because of DDH [7][8][9]. Finally, being a monoblock, it excludes the theoretical disadvantage of potential for metal corrosion given by modular-designed components that also may be recommended to accommodate the shape of the dysplastic canal [2,10,11].…”

Section: Open Accessmentioning

confidence: 99%

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Total hip arthroplasty for dysplastic coxarthrosis using a cementless Wagner Cone stem

et al. 2021

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Background Total hip arthroplasty (THA) is currently the best surgical option for hip osteoarthritis secondary to developmental hip dysplasia (DDH); it may be extremely challenging, because of the hypoplasic proximal metaphysis, pathological anteversion, and excessive cervico-diaphyseal angle of the neck at the femoral side. The purpose of this retrospective study was to evaluate the long-term survival and clinical and radiological results of Conus uncemented stems, implanted in patients affected by hip osteoarthritis with Crowe not-type IV secondary to DDH. Material and methods We identified 100 consecutive THAs performed for DDH in 63 women and 24 men, with an average age of 53 years in a single center. Thirteen patients underwent bilateral hip replacement. The patients’ mean body mass index was 29.8 kg/m2 (range 27.1–35.6 kg/m2). The main indications for surgery were severe hip pain and considerable functional impairment: the preoperative Harris Hip Score was 29.5 on average (range 22–61). Radiologically, 8 hips were classified as Crowe I, 43 hips as Crowe II, and 49 hips as Crowe III. In all cases, we implanted the Wagner femoral cone prosthesis using the direct lateral approach; in the attempt to reestablish native hip biomechanics, 66 stems were 135° and 34 were 125°. Results The mean follow-up of the study was 11.7 years (range 2.2–21.8 years). Harris Hip Score increased to a mean value of 71.5 points (range 52–93 points). Radiographic evaluation demonstrated osteointegration of the implant with stable bone growth observed at the stem–endosteum interface; signs of bone readaptation and thinning of the femoral calcar were present in nine hips. None of the patients underwent revision for septic or aseptic loosening of the stem; none sustained a periprosthetic fracture. Conclusions This study confirms the theoretical advantages that suggest the choice of the Wagner cone when technical difficulties during prosthetic surgery are expected owing to abnormal proximal femoral anatomy. Level of evidence Level IV, retrospective case study

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Open Accessmentioning

confidence: 99%

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Total hip arthroplasty for dysplastic coxarthrosis using a cementless Wagner Cone stem

et al. 2021

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“…Considering the short-term follow-up, the clinical and radiographic outcomes of the new dual-conical stem are comparable with the results reported in the literature for other conical implants in the treatment of difficult primary or Paprosky I, II, IIIA revision cases. Zhang et al 9 described the use of 49 cone stems utilised on patients whose femoral geometry precluded the use of standard-sized implants (femoral neck retroversion, excessive anteversion of the femoral neck, or small proximal femora). After a minimum of 3 years follow-up, they observed only 1 case of revision surgery as a result of late infection, with HHS that improved from 41 to 85 at last follow-up.…”

Section: Discussionmentioning

confidence: 99%

Double-tapered conical taper in primary and revision surgery: rationale and short-term follow-up

et al. 2018

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Background: The new double-conical tapered stem is a novel cementless modular system, which is indicated for both primary and revision surgeries. It has been designed with different angles at the proximal (5°) and distal sections (1° 36') in order to obtain optimal fixation by proximal and distal fit and fill of the femoral canal. Aim: The aim of this prospective study was to evaluate the short-term clinical and radiographic outcomes of primary and revision hip surgery with the new double-conical stem. Methods: 61 stems were implanted (December 2013 to September 2016) in 42 cases of primary and in 19 cases of revision surgery. The mean age of patients was 64.7 (17-94; standard deviation [SD] 21.9) years. Results: The mean body mass index of the patients was 24.6 (17-34.6). In 3 cases of developmental dysplasia of the hip we performed femoral shortening osteotomy. The mean follow-up was 26 (8-40) months. 3 patients died due to causes unrelated to surgery. Postoperative complications included 3 hip dislocations, 2 infections and 1 case of stem explant for metastatic tumour. For all other cases, at the last follow-up radiographs showed no loosening, no radiolucent lines nor subsidence. The mean Harris Hip Score significantly improved from 45 (range 35-58) preoperatively to 87 (range 75-94). Leg length discrepancy was found in 10% of cases but never >1 cm. Conclusions: Radiographic analysis showed the bone-stem contact full at 2 levels of taper. The double-tapered prosthetic stem can therefore be usefully employed both in primary and in revision surgeries.

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“…19 Specifically designed femoral stems such as the cementless modular implant (S-ROM; DePuy Synthes, Warsaw, IN USA) and cementless conical implant (Wagner Cone; Zimmer Biomet, Warsaw, IN, USA) were developed to provide a better fit in femoral medullary canals with anatomical deformities, and the successful application of these designs has been supported by studies with short-to long-term follow-up. [20][21][22][23][24][25][26][27][28] Nevertheless, complications such as proximal femoral fracture are still reported in patients with DDH. [20][21][22][23][24]29,30 We have found that for some patients with Crowe IV DDH in our clinical practice, it is difficult to insert any on-shelf prostheses (including the specialized designs mentioned above) into the femoral canal at a desirable position.…”

Section: Introductionmentioning

confidence: 99%

Comparison of two different on-shelf femoral stems for Crowe type IV developmental dysplasia of the hip

et al. 2020

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Objective This study was performed to evaluate the proximal anatomical compatibility of stems for treatment of Crowe IV developmental dysplasia of the hip (DDH) using a previously developed three-dimensional comparison technique. Methods Patients with Crowe IV DDH who underwent computed tomography were retrospectively analyzed. The femoral medullary canals were three-dimensionally reconstructed, and models of cementless modular (S-ROM; DePuy Synthes) and conical (Wagner Cone; Zimmer Biomet) implants were used for virtual implantation. The negative point percentages (NPPs) were applied to verify fitting. The average distance (deviation) and the root mean square of the distance (RMSd) were used to quantify geometric compatibilities. Results Four (16.7%) and 12 (50.0%) femoral medullary canals could not be fitted properly with either the modular or conical implant. The NPPs in the distal comparison region were significantly greater in the conical than modular group. The deviation was significantly smaller in the modular than conical group. The RMSd was also significantly smaller in the modular than conical group. Conclusions Compared with conical implants, modular implants might be more effectively used in patients with Crowe type IV DDH. However, some Crowe IV DDH femurs with severe deformity cannot be fitted with either of these two on-shelf implants.

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Can a Conical Implant Successfully Address Complex Anatomy in Primary THA? Radiographs and Hip Scores at Early Followup

Cited by 25 publications

References 31 publications

Total hip arthroplasty for dysplastic coxarthrosis using a cementless Wagner Cone stem

Total hip arthroplasty for dysplastic coxarthrosis using a cementless Wagner Cone stem

Double-tapered conical taper in primary and revision surgery: rationale and short-term follow-up

Comparison of two different on-shelf femoral stems for Crowe type IV developmental dysplasia of the hip

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