Distal Femoral Cortical Hypertrophy after Hip Arthroplasty Using a Cementless Double-Tapered Femoral Stem

Cho, Yoon Je; Chun, Young Soo; Rhyu, Kee Hyung; Baek, Jong Hun; Liang, Hongyin

doi:10.1177/1602400309

Cited by 25 publications

(21 citation statements)

References 35 publications

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“…Subsidence was significantly higher (≤ 2 mm) in the presence of CH than in its absence (≤ 1 mm). Our findings contrast with Cho et al [29] who report subsidence to have been lower in hips with CH compared to hips without CH (1.5 versus 3.4 mm). We explain the increased CH in case of subsidence with the primary stability of the Fitmore stem: in case of an optimal press-fit after reaming, the stem has a 3-point fixation (proximal calcar, lateral cortex, medial tip) while if the press-fit was not optimal, the Fitmore stem subsides and locks distally with a 2-point load transfer causing CH.…”

Section: Discussioncontrasting

confidence: 99%

“…We found that CH affects neither the clinical outcome nor thigh pain, which is in line with other findings [27, 29, 31–33].…”

Section: Discussionsupporting

confidence: 93%

“…After settling down with some subsidence, it has a 2-point bone contact distally with increased load transfer, whereas straight stems have a larger total bone contact surface. Therefore, the Fitmore stems have a different distribution of CH than straight stems which also show CH in Gruen Zone 6 in addition to 2, 3 and 5 [3, 29, 30].…”

Section: Discussionmentioning

confidence: 99%

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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: Discussioncontrasting

confidence: 99%

“…We found that CH affects neither the clinical outcome nor thigh pain, which is in line with other findings [27, 29, 31–33].…”

Section: Discussionsupporting

confidence: 93%

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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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“…According to previous studies, a high canal flare index has been associated with a higher incidence of cortical hypertrophy. 2,30 Although in the current study a great number of patients were classified as Dorr A, thus high canal flare type, there were not statistically more patients scoring Dorr A in the group of patients with cortical hypertrophy compared to those without cortical hypertrophy. Thus, we do not suspect that the Dorr classification A depicts a higher probability of developing cortical hypertrophy in the current study.…”

Section: Discussioncontrasting

confidence: 57%

“…Distal femoral cortical hypertrophy in short-stem THA is an issue often mentioned in the literature. 2,18,[27][28][29][30][31][32][33] The reported incidences are between 0-63% after a minimum 2 years follow-up. Our reported incidence of cortical hypertrophy at 5 years is higher, with 71% of the hips showing cortical hypertrophy with no significant progression over time.…”

Section: Discussionmentioning

confidence: 99%

An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem

et al. 2019

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Background: Although reported results on short stems sound very promising, the occurrence of distal femoral cortical hypertrophy is often observed. The aim of the present study was to report 5-year survival data of a commercially available trochanter sparing short stem and investigate the clinical impact of distal femoral cortical hypertrophy on the outcome. Methods: 123 total hip arthroplasties were performed on 120 patients from April 2008 to May 2010 (mean age 62, range 29–89 years; 71 hips from male patients, 58%). Clinical and radiological data were collected preoperative, at 6 weeks, 1, 2, 3, and 5 years postoperative to assess the outcome. Radiographs taken immediately postoperative as well as 1 and 5 years postoperative were used to identify and assess cortical hypertrophy. Results: 1 stem had to be revised due to aseptic loosening, resulting in a Kaplan-Meier survival analysis with endpoint for stem revision of 99.2% (95% Confidence Interval 94.1–99.9) at 5 years. 96 radiological and 95 clinical follow-ups were analysed 5 years postoperative. 68 (71%) hips showed distal femoral cortical hypertrophy after 5 years. The average Harris Hip Score and Oxford Hip Score improved 33 (standard deviation (SD) 15.1, range 2–70), 18 (SD 12.1, range -10–43) points, respectively. Overall 16% of the patients reported thigh pain, unrelated to the presence of cortical hypertrophy. Discussion: This short stem shows an excellent 5-year survival rate and good clinical outcome despite a high incidence of cortical hypertrophy. However, the question of the mechanism of load transfer arises.

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Bone Remodeling and Stress Shielding

Shimizu,

Nagoya

2024

Advances in Total Hip Arthroplasty

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Distal Femoral Cortical Hypertrophy after Hip Arthroplasty Using a Cementless Double-Tapered Femoral Stem

Abstract: The incidence of DFCH in hips withthe Accolade TMZF stem was 6.2%. Patients with a higher canal flare index and younger age had a higher incidence of DFCH. Nonetheless, DFCH did not affect clinical outcome or femoral stem stability.

Cited by 25 publications

References 35 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

An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem

Bone Remodeling and Stress Shielding

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