Cementless Tapered Wedge Femoral Stems Decrease Subsidence in Obese Patients Compared to Traditional Fit-and-Fill Stems

Grant, Tanner W.; Lovro, Luke R.; Licini, David J.; Warth, Lucian C.; Ziemba-Davis, Mary; Meneghini, R. Michael

doi:10.1016/j.arth.2016.09.023

Cited by 40 publications

(22 citation statements)

References 32 publications

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“…A previous study reported that the intraclass correlation coefficient for absolute agreement between two independent observers was 92.1% for CFI. 27 It is reported that intrarater reliability in the determination of Dorr classification was 92%. 26…”

Section: Discussionmentioning

confidence: 99%

“…The intraobserver and interobserver variability is a potential source of measurement errors in radiographic analyses. 27 To exclude the impact of this confounding factor, all radiographic measurements in the present study were performed by a single observer. A previous study reported that the intraclass correlation coefficient for absolute agreement between two independent observers was 92.1% for CFI.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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“…Two reference parameters, namely total hip BMD (measured by DXA) and the density index (measured by pulse-echo ultrasonometry), were also tested. A stem subsidence threshold of 2 mm was adopted from the literature [14].…”

Section: Methodsmentioning

confidence: 99%

Bone Mineral Density and Cortical-Bone Thickness of the Distal Radius Predict Femoral Stem Subsidence in Postmenopausal Women

Nazari-Farsani

Vuopio

Aro

2020

The Journal of Arthroplasty

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Background: The distal radius is an optional site for evaluation of bone quality in postmenopausal women before cementless total hip arthroplasty. We hypothesized that dual-energy X-ray absorptiometry (DXA) and pulse-echo ultrasonometry of the distal radius may help discriminate subjects at high risk of femoral stem subsidence. Methods: A prospective cohort of postmenopausal women with primary hip osteoarthritis underwent total hip arthroplasty with implantation of a parallel-sided femoral stem. Postoperative stem migration was measured using radiostereometric analysis. Preoperatively, subjects had multisite DXA measurement of bone mineral density (BMD) and pulse-echo ultrasonometry of the cortical-bone thickness. The diagnostic abilities of these methods to discriminate <2 mm and !2 mm femoral stem subsidence were tested. Results: The accuracy of the distal radius BMD and cortical-bone thickness of the distal radius were moderate (area under the curve, 0.737 and 0.726, respectively) in discriminating between <2 mm and !2 mm stem subsidence. Women with low cortical-bone thickness of the radius were more likely (odds ratio ¼ 6.7; P ¼ .002) to develop stem subsidence !2 mm. These subjects had lower total hip BMD (P ¼ .007) and reduced thickness of the medial cortex of the proximal femur (P ¼ .048) with lower middle (P < .001) and distal (P ¼ .004) stem-to-canal fill ratios. Conclusion: Femoral stem stability and resistance to subsidence are sensitive to adequate bone stock and unaltered anatomy. DXA and pulse-echo ultrasonometry of the distal radius may help discriminate postmenopausal women at high risk of stem subsidence.

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“…13,14 The majority of this subsidence is thought to occur within the early perioperative period (4-6 weeks). 15,16 Femoral stem subsidence ! 2 mm has been shown to correlate with worse clinical outcomes.…”

mentioning

confidence: 99%

“…2 mm has been shown to correlate with worse clinical outcomes. 15,17,18 The purpose of this study was to determine if preoperative nicotine and/or cotinine levels prior to THA are elevated for those with early femoral component subsidence. We hypothesized that those with tobacco exposure would have increased radiographic subsidence and higher rates of postoperative complications, readmission, and reoperation within 90 days.…”

mentioning

confidence: 99%

Are Elevated Nicotine and Cotinine Levels Associated with Early Femoral Component Subsidence in Press-Fit, Primary Total Hip Arthroplasty?

Muffly

Jacobs

Duncan

2020

The Journal of Hip Surgery

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Tobacco exposure negatively affects bone mineral density and early osseointegration of surgical implants. We sought to determine if elevated nicotine and/or cotinine levels prior to primary total hip arthroplasty (THA) are associated with early femoral component subsidence. We hypothesize that tobacco users will have higher rates of readmission/reoperation and increased radiographic subsidence. We conducted an institutional review of 75 patients (average age = 52.9 years; 55% females; body mass index = 31.3) who underwent THA from April 2017 to January 2018. Immediate postoperative radiographs were compared with those obtained at 2 to 6 weeks postoperatively to determine early femoral component subsidence. Of the 75 patients, 10 (13.3%) had early radiographic femoral component subsidence ≥ 2 mm. In this group, preoperative nicotine levels were significantly elevated (7.2 vs. 1.5ng/mL; p = 0.04), whereas preoperative cotinine levels did not statistically differ (108.3 vs. 33.8 ng/mL; p = 0.45). A significantly greater magnitude of subsidence was seen in those with elevated preoperative nicotine levels compared with those with normal levels (1.7 vs. 0.5 mm; p = 0.04). The mean time to radiographic follow-up was 2.6 weeks. Surgical approach, implant type, categorical variables, and patient readmission were not associated with ≥ 2 mm of early subsidence. There was a single reoperation for periprosthetic fracture, but none was related to instability from subsidence. Early femoral component subsidence was more prevalent in patients with elevated preoperative nicotine levels. Rates of readmission/reoperation at 90 days did not differ between those with and without elevated tobacco markers. Clinically relevant thresholds of preoperative nicotine and/or cotinine values are needed to better delineate appropriate surgical candidates to achieve optimal surgical outcomes.

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Cementless Tapered Wedge Femoral Stems Decrease Subsidence in Obese Patients Compared to Traditional Fit-and-Fill Stems

Cited by 40 publications

References 32 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

Bone Mineral Density and Cortical-Bone Thickness of the Distal Radius Predict Femoral Stem Subsidence in Postmenopausal Women

Are Elevated Nicotine and Cotinine Levels Associated with Early Femoral Component Subsidence in Press-Fit, Primary Total Hip Arthroplasty?

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