Early radiological and functional outcomes for a cementless press-fit design modular femoral stem revision system

Hancock, Douglas S.; Sharplin, Paul; Larsen, Peter; Phillips, Fredrick

doi:10.1177/1120700018760277

Cited by 14 publications

(5 citation statements)

References 16 publications

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“…Hancock at al. reported in their paper no cases with subsidence over 8 mms [52]. Our average subsidence was 3.5 mms, with only one of 20 patients (5%) having more than 10 mms of stem migration.…”

Section: Discussion Of the Study With The Wagner Sl Stemcontrasting

confidence: 44%

Radiological assessment of bone quality and bone remodeling after primary and revision hip replacement

Friebert

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The minimum follow-up was two years. Follow-up was carried out at 6 weeks, 3 months, 6 months 1 year postoperatively and yearly thereafter. Radiological assessments were performed for stability of the cage, graft and component loosening, and for bony remodeling on the graft-host/cage-host/cage-graft interfaces. Main functional outcomes were the Oxford Hip Score (OHS) values. Complications were noted.Our third study included revision THA cases operated between January 2015 and December 2017 using the Wagner Self-Locking (SL) monoblock stem, which is a tapered and fluted titanium stem, well suited for use in both AL and periprosthetic femoral fracture (PFF) cases of the proximal femur. A thorough follow-up was performed at 3, 6, 12 and 24 months after surgery and yearly thereafter. Main radiological result was an objective evaluation of bone stock via Secondary Bone Stock (SBS) and Osteointegration and Secunder Stability (O-SS) scores merged in Global Radiological Score (GRxS). Functional status followed by OHS. Results:We found perfect bone contact around the Proxima stem in every cases immediately after the procedure. The bony integration continued, and was maintained for all cases, except one. The overall malalignment rate reached 12% for all cases. A 7-year Kaplan-Meier survival rate of 97.6% was determined for stem revision. HHS increased an average of 51 points between preoperative test and last follow-up.Around the anti-protrusion cage (APC) we found contact at the graft and the host bones, and satisfactory trabecular formation was observed at the graft-host interface after 24 months. On two occasions there was loosening of the ischial screws, not affecting the overall stability of the implant. OHS values increased significantly.With the use of Wagner SL stem, we found a significant difference between the GRxS results at each 5 timepoints (Friedman x 2 = 70.812; p < 0.001; KendallW = 0.88515/large/). Except immediately after the operation, we found a significant difference between the PFF and AL groups at each timepoint. We observed 89% (17.7/20 points) of bony architecture remodeling after 6 months in the PFF group, whilst the AL cases needed 2 years to reach almost this level of reconstruction (86%, 17.1/20 points). There was no difference in functional outcomes between the groups. Conclusions:The bone preserving Proxima uncemented metaphyseal short stem provides excellent radiological and clinical results in the medium term. To our knowledge this is the

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Section: Discussion Of the Study With The Wagner Sl Stemcontrasting

confidence: 44%

Radiological assessment of bone quality and bone remodeling after primary and revision hip replacement

Friebert

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“…Several studies do report outcomes of using several different stems within the same cohort, making it difficult to draw conclusions about any singe stem (Katakam et al 2021;Parry et al 2018;Wood et al 2019). Hancock et al retrospectively reviewed 48 revision THAs using the same femoral stem as our study with mean 1 year follow-up (Hancock et al 2018). Compared to our study, Hancock et al found a higher incidence of postoperative periprosthetic infections (7.41% vs 10.42%), dislocations (0.0% vs 4.2%), revision for subsidence (0.0% vs 2.08%), and lower mean subsidence (2.07mm vs 1.1mm) (Hancock et al 2018).…”

Section: Radiographic Analysismentioning

confidence: 99%

“…Hancock et al retrospectively reviewed 48 revision THAs using the same femoral stem as our study with mean 1 year follow-up (Hancock et al 2018). Compared to our study, Hancock et al found a higher incidence of postoperative periprosthetic infections (7.41% vs 10.42%), dislocations (0.0% vs 4.2%), revision for subsidence (0.0% vs 2.08%), and lower mean subsidence (2.07mm vs 1.1mm) (Hancock et al 2018). Pawar et al found a lower rate of reoperation for recurrent infection (3.51% vs 7.41%), but a higher rate of dislocation (5.26% vs 0.0%, Table 2) and higher subsidence (4.5 mm vs 2.07mm) (Pawar et al 2022).…”

Section: Radiographic Analysismentioning

confidence: 99%

Radiographic Outcomes using a Diaphyseal Engaging Femoral Stem for Revision Total Hip Arthroplasty

Coden,

Zink,

Fang

et al. 2023

Journal of Orthopaedic Experience &Amp; Innovation

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Introduction Diaphyseal engaging femoral stems are often required for revision total hip arthroplasty (THA) due to complex anatomy. However, no studies have been performed to identify the best implant or intraoperative radiographic parameters of stability. We sought to evaluate the rate of complications and radiographic parameters of an uncemented diaphyseal engaging femoral stem in revision THA. Methods We retrospectively reviewed 54 patients who underwent revision THA using an uncemented diaphyseal engaging modular femoral stem between 2012 and 2019 with mean follow-up of 1.4 years. Mean age was 66.3 years (range 23-90), and 47.2% of patients were female. 36 (73.5%) hips were classified as a Paprosky 3a and 13 (26.5%) patients were classified as a Paprosky 3b. We calculated the radiographic subsidence, canal fill ratio, and complete cortical contact percentage, defined as the sum of anterior, posterior, medial, and lateral cortical contact. Chi-square related-samples t-test, and Pearson’s correlation coefficient were used to compare values. Significance was set at <0.05. Results Postoperative periprosthetic infection occurred in 4 patients (7.41%) and was the most common complication. There were no revisions for aseptic loosening or failure of the diaphyseal engaging femoral stem. Canal fill ratio (mean=85.85%, p<0.001) and complete cortical contact (mean=71.74%, p<0.001) were less than the expected, while subsidence was higher than the expected (mean=2.07mm, p<0.001). Complete cortical contact was not associated with canal fill ratio (p=0.07) or subsidence (p=0.50). Discussion This uncemented diaphyseal engaging femoral stem had a low complication rate (11.11%) when used for revision THA. While canal fill ratio and complete cortical contact was less than the expected mean of 100%, it was not correlated with subsidence. It is important for surgeons to know that this uncemented diaphyseal engaging femoral stem can be well fitting despite low canal fill ratio and cortical contact.

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“…The majority of re‐revisions are caused by aseptic loosening—potentially introduced by excessive micromotion between stem and bone 14–17 . In particular, stem subsidence occurs frequently with cementless revision stems 18,19 . Postoperative stem subsidence less than 2 mm 20 and micromotions of less than 30 µm are considered harmless, 21,22 while micromotions >150 µm are considered an unfavorable condition for osseointegration 23 …”

Section: Introductionmentioning

confidence: 99%

“…with cementless revision stems. 18,19 Postoperative stem subsidence less than 2 mm 20 and micromotions of less than 30 µm are considered harmless, 21,22 while micromotions >150 µm are considered an unfavorable condition for osseointegration. 23 Patient-related factors such as femur shape or bone quality but also upper femoral curvature (UFC) may have an impact on the primary stability of cementless revision stems.…”

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confidence: 99%

Influence of bone morphology and femur preparation method on the primary stability of hip revision stems

Konow

Schlieker

Lampe

et al. 2022

Journal Orthopaedic Research

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Aseptic loosening is one of the major reasons for re-revisions of cementless revision stems. Insufficient primary stability is associated with bone characteristics and the surgical process. This study aimed to investigate how femur morphology and preparation methods influence the primary stability of revision stems. The Femur morphology was described by the upper femoral curvature (UFC) and an individualized Dorr type classification based on the ratio between the canal-to-calcar ratio (CCR*) and the cortical index (CI*) introduced as the cortical-canal shape (CCS). Manual and powered reaming in combination with helical and straight reamers were used to prepare the bone cavity of 10 cadaveric human femur pairs. Forces during stem impaction were recorded (Reclaim, Depuy Synthes). Micromotion at the bone-implant interface during cyclic axial loading and torsional load to failure was determined. The CCS and impaction forces (R 2 = 0.817, p < 0.001) or torsional strength (R 2 = 0.577, p < 0.001) are inversely related. CCS did not correlate with micromotion during axial loading (R 2 = 0.001, p > 0.999), but proximal femoral curvature did (R 2 = 0.462, p = 0.015). Powered reaming and straight reamers led to an improved torsional strength (both: p = 0.043). The Individualized Dorr classification CCS and UFC allows a good estimation of the primary stability of revision stems. For severely curved Dorr type-C femurs, an alternative anchorage method should be considered clinically.

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Early radiological and functional outcomes for a cementless press-fit design modular femoral stem revision system

Abstract: Early radiological and functional outcomes for the RECLAIM revision system showed very low levels of subsidence and good functional outcomes. There was an association with smaller diameter femoral stems and greater levels of subsidence.

Cited by 14 publications

References 16 publications

Radiological assessment of bone quality and bone remodeling after primary and revision hip replacement

Radiological assessment of bone quality and bone remodeling after primary and revision hip replacement

Radiographic Outcomes using a Diaphyseal Engaging Femoral Stem for Revision Total Hip Arthroplasty

Influence of bone morphology and femur preparation method on the primary stability of hip revision stems

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