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

Abstract

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...

Effect of impaction energy on dynamic bone strains, fixation strength, and seating of cementless acetabular cups

“…Good apposition between bone and implant is also required for the bone to fill any gaps and anchor the implant securely . Gaps of more than 2 mm have been shown to contribute to early migration, a possible contributor to aseptic loosening, the most common cause of THA implant revision…”

“…30 Good apposition between bone and implant is also required for the bone to fill any gaps and anchor the implant securely. 31 Gaps of more than 2 mm have been shown to contribute to early migration, 32 a possible contributor to aseptic loosening, 33,34 the most common cause of THA implant revision. 4 Therefore, to maximize chances of success, a surgeon should seek to maximize fixation and implant seating whilst minimizing the risk of fracture.…”

Die radiologische Verlaufskontrolle von primären Hüft- und Knieendoprothesen – Empfehlung der Deutschen Gesellschaft für Endoprothetik (AE)

“…Eine aktuelle Arbeit von Streit et al untersuchte den Einfluss der frühen Schaftmigration nach zementfreier Hüfttotalendoprothese [16]. Die Gruppe beobachtete 158 Hüfttotalendoprothesen über 21 Jahre und konnte feststellen, dass eine Migration innerhalb der ersten 24 Monate nach Im-plantation mit einem erhöhten Risiko für eine aseptische Prothesenlockerung verbunden ist.…”

Healing in peri‐implant gap with BMP‐2 and systemic bisphosphonate is dependent on BMP‐2 dose—A canine study

“…Even after several years, areas exist where in‐ and on‐growth of new bone will be absent or limited, effectively reducing implant osseointegration and implant fixation . This can leave implants at an increase risk for early subsidence and later failure . Introduction of a bone anabolic stimulus to increase new bone formation, in areas of close but not intimate bone implant contact, should in theory improve osseointegration and thus implant fixation .…”

“…This can leave implants at an increase risk for early subsidence and later failure . Introduction of a bone anabolic stimulus to increase new bone formation, in areas of close but not intimate bone implant contact, should in theory improve osseointegration and thus implant fixation . Several bone morphogenetic proteins (BMPs) belonging to the transforming growth factor‐βeta (TGF‐ß) superfamily are known.…”