Does Proximally Coated Single-Wedge Cementless Stem Work Well in Dorr Type C Femurs? Minimum 10-year Followup

Abstract

Background: Total hip arthroplasty (THA) with a proximally coated single-wedge (PSW) cementless stem had been generally considered not to be suitable for Dorr Type C femurs. This study compares the long term outcomes of PSW stem according to the type of proximal femoral geometry. Materials and Methods: 307 primary THAs in 247 patients were performed with PSW cementless stem and followed up for over 10 years in this retrospective study. According to Dorr's criteria, 89 femurs were classified as Type A, 156 as Type B, and 62 as Type C. They were followed up for an average of 13.2 years (range 10.0–17.3 years). All the hips were evaluated clinically and radiologically. Results: There was no significant difference in stem survivorship and clinical outcomes including the incidence of thigh pain and the mean postoperative Harris hip score (HHS) in all three groups. No significant differences were observed in osteolysis, pedestal formation, or cortical hypertrophy among the groups. Radiolucent lines <2 mm in thickness in Gruen zone 4 and 7 ( P = 0.003 and P = 0.044, respectively), spot-weld ( P < 0.001), and stress shielding ( P = 0.010) of proximal femur were more pronounced in Dorr C type femora than in Type A or B. Fifty-six intraoperative fractures were identified among 307 hips with PSW stems. The incidence of intraoperative or postoperative femoral fractures was not significantly different among the groups. Conclusions: From over a 10-year followup, the PSW stem provided a recommendable option with satisfactory outcomes and excellent stem survivorship regardless of the Dorr type.

A high risk of postoperative periprosthetic femoral fracture in Dorr type C femurs: a retrospective cohort study with ten-year follow-up data and a preliminary monochromatic image analysis

“…We systematically reviewed the revision rate of stems in studies focused on Dorr type C femurs 7 , 15 , 18 , 22 , 24 , 40 – 46 (Table 3 ). The survival rate of Corail stems in our study (97%) is consistent with that in previous studies on other standard-length stems in Dorr type C femurs (93 to 100%).…”

“…We speculated that ABG II stems have a high revision rate (22.2%) according to Gkagkalis’ study, which similarly reported the mid-term results of short stems in Dorr type C femurs 14 . The revision rate of Corail stems was estimated as 0.05%, which was a weighted average from previous reports on the long-term survival of standard-length stems in Dorr type C femurs 18 – 22 . The type I error rate was set as 0.05, and the type II error rate was set as 0.2.…”

Comparison of Short Curved Stems and Standard-length Single Wedged Stems for Cementless Total Hip Arthroplasty

“…Because excellent mid-term or long-term results have been achieved with use of standard-length single wedged stems [7][8][9][10][11][12] , critical evaluation of newly introduced short-stem designs for their clinical and radiographic outcomes is needed. Since 2006, uncemented standard-length single wedged stems (M/L taper ® ; Zimmer) (Fig.…”

Intraoperative Periprosthetic Fractures in Total Hip Arthroplasty in Patients With Sickle Cell Disease at King Fahad Hospital Hofuf: A Cross-Sectional Study

“…Some studies have found that the incidence of periprosthetic fracture is higher in whites with low BMIs [ 1 - 5 ]. Proximal femoral morphology can be radiologically classified before reconstruction according to the Dorr classification [ 15 , 16 ]. Dorr type C is more commonly associated with periprosthetic hip fracture than types A and B [ 15 , 16 ].…”

“…Proximal femoral morphology can be radiologically classified before reconstruction according to the Dorr classification [ 15 , 16 ]. Dorr type C is more commonly associated with periprosthetic hip fracture than types A and B [ 15 , 16 ]. In addition, many studies have found that uncemented implant fixation is associated with more pain and risk of fracture compared to cemented implant fixation [ 17 , 18 ].…”