Femoral Stem Survivorship in Dorr Type A Femurs After Total Hip Arthroplasty Using a Cementless Tapered Wedge Stem: A Matched Comparative Study With Type B Femurs

Park, Chanwoo; Eun, Hyeon-Jun; Oh, Sunghak; Kim, Hyun-Jun; Lim, Seung‐Jae; Park, Youn-Soo

doi:10.1016/j.arth.2018.11.004

Cited by 35 publications

(22 citation statements)

References 25 publications

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“…This early loosening in Dorr A femurs when using an anterior approach is more likely to be related to a metaphyseal crowding defect than to the approach itself. Indeed, as Park et al showed, the survival rate of uncemented stems is lower in Dorr A femurs than in B femurs [21]. It appears that the determining factor in the survival of the femoral implant is primarily metaphyseal canal fill, which is mainly related to the design of the femoral implant.…”

Section: Discussionmentioning

confidence: 99%

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Does the Surgical Approach Influence the Canal Fill of the Proximal Femur for Hip Arthroplasty?

et al. 2021

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Background Choosing the right size of the stem is crucial for uncemented hip arthroplasty. Undersizing can lead to early loosening, peri-prosthetic fracture due to femoral implant insertion, and/or osteointegration failure. The main objective of this study was to find a correlation between the surgical approach and the intramedullary prosthetic canal fill ratio (CFR) of the uncemented femoral implant. The hypothesis of this work was that the surgical approach does not influence the stem sizing during hip arthroplasty. Methods In this consecutive series, we analyzed the radiological images of 183 patients who underwent primary hip arthroplasty with 4 different surgical approaches. Dimensions of the implant were evaluated by radiographic measurement of the CFR. In order to assess the shape of the femur, we measured the canal flare index on the preoperative radiographs, and the canal calcar ratio was also measured to establish the shape of the femur according to Dorr's classification. Results No significant difference was found between the surgical approach and the CFR measured at 4 different levels (CFR 1, 2, 3, and 4) on the postoperative radiograph. When the shape of the femur was assessed by canal flare index, there was no significant difference in implant, whether the femur had a stovepipe canal shape or a champagne-fluted canal shape. Conclusion This study showed that the surgical approach in hip arthroplasty does not influence the canal fill. Therefore, the surgical approach does not factor in undersizing the femoral implant. Despite some difficulties in the exposure of the medullary shaft described by some authors, the anterior approach is not a risk factor for undersizing an anatomical femoral stem. Level of evidence 4

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Section: Discussionmentioning

confidence: 99%

“…Indeed, as Park et al. showed, the survival rate of uncemented stems is lower in Dorr A femurs than in B femurs [ 21 ]. It appears that the determining factor in the survival of the femoral implant is primarily metaphyseal canal fill, which is mainly related to the design of the femoral implant.…”

Section: Discussionmentioning

confidence: 99%

Does the Surgical Approach Influence the Canal Fill of the Proximal Femur for Hip Arthroplasty?

et al. 2021

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“…The calcar-to-canal ratio was calculated by dividing the canal width, measured at 10 cm below the lesser trochanter, by the calcar width, measured at the middle level of the lesser trochanter, as previously described [17]. Femurs with a ratio of 0-0.5 were considered type A, 0.5-0.75 as type B, and 0.75-1 as type C [18,19].…”

Section: Methodsmentioning

confidence: 99%

Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty

2021

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Background In the last decade, the increase in the use of the direct anterior approach to the hip has contributed to the diffusion of the use of short stems in orthopedic surgery. The aim of the study is to verify the medium-term clinical and radiographic results of a cementless anatomic short stem in the anterior approach to the hip. We also want to verify whether the use of the standard operating room table or the leg positioner can affect the incidence of pre- and postoperative complications. Materials and methods All total hip arthroplasty patients with a 1-year minimum follow-up who were operated using the MiniMAX stem between January 2010 and December 2019 were included in this study. Clinical evaluation included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC) Score, and Short Form-36 (SF-36) questionnaires. Bone resorption and remodeling, radiolucency, osteolysis, and cortical hypertrophy were analyzed in the postoperative radiograph and were related to the final follow-up radiographic results. Complications due to the use of the standard operating room table or the leg positioner were evaluated. Results A total of 227 patients (238 hips) were included in the study. Average age at time of surgery was 62 years (range 38–77 years). Mean follow-up time was 67.7 months (range 12–120 months). Kaplan–Meier survivorship analysis after 10 years revealed 98.2% survival rate with revision for loosening as endpoint. The mean preoperative and postoperative HHS were 38.35 and 94.2, respectively. The mean preoperative and postoperative WOMAC Scores were 82.4 and 16.8, respectively. SF-36 physical and mental scores averaged 36.8 and 42.4, respectively, before surgery and 72.4 and 76.2, respectively, at final follow-up. The radiographic change around the stem showed bone hypertrophy in 55 cases (23%) at zone 3. In total, 183 surgeries were performed via the direct anterior approach (DAA) on a standard operating room table, and 44 surgeries were performed on the AMIS mobile leg positioner. Comparison between the two patient groups did not reveal significant differences. Conclusion In conclusion, a short, anatomic, cementless femoral stem provided stable metaphyseal fixation in younger patients. Our clinical and radiographic results support the use of this short stem in the direct anterior approach. Level of evidence IV.

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“…1 ) [ 30 ]. Therefore, the geometry of proximal femur was divided into type A (0–0.500), type B (0.501–0.750), and type C (0.751–1.000) according to the calcar-to-canal ratio [ 31 ]. Other radiographic parameters were measured and calculated, including FO, acetabular offset (AO), HO, HO difference, and LLD in the AP pelvic radiograph preoperatively and second day postoperatively (Fig.…”

Section: Methodsmentioning

confidence: 99%

Clinical and radiological results of high offset tri-lock bone preservation stem in unilateral primary total hip arthroplasty at a minimum follow-up of 3 years

Peng

Zeng

et al. 2021

J Orthop Surg Res

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Background Although the high offset Tri-Lock bone preservation stem (BPS) was used widely, few studies explored the clinical and radiological results. The purpose of this study was to determine the clinical and radiological results of high offset Tri-Lock BPS in unilateral primary total hip arthroplasty (THA) at a minimum follow-up of 3 years. Methods 55 patients who underwent cementless THA with high offset Tri-lock BPS from 2017 to 2018 were followed for a minimum follow-up of 3 years. Patients were assessed clinically for complications, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Oxford Hip Score (OHS). Femoral offset (FO), acetabular offset (AO), hip offset (HO), HO difference, and leg length discrepancy (LLD) were measured on the anteroposterior (AP) pelvic radiograph. Standard pelvic AP and lateral radiographs were used to evaluate for evidence of bone ingrowth, stem subsidence, stem alignment, radiolucent line around the stem, osteolysis, loosening, ectopic ossification, and femoral stress shielding. Results No patients reported complications during hospitalization nor the follow-up period. At a mean follow-up of 42.5 months, the mean HHS, WOMAC, and OHS scores showed a significant improvement from preoperative to the latest follow-up. No patients reported thigh pain. No revision nor sign of radiographic loosening had been detected. The high offset Tri-Lock BPS significantly improved the FO and HO postoperatively. HO difference and LLD were balanced postoperatively. No sign of stem subsidence, radiolucent line, osteolysis, loosening, ectopic ossification, nor severe stress shielding (more than grade 3–4) were observed at the latest follow-up. Conclusion The high offset Tri-Lock BPS demonstrated excellent clinical and radiographic outcomes at a minimum follow-up of 3 years. HO difference and LLD between legs decreased significantly and achieved balance postoperatively. Long-term follow-up is required for a definitive conclusion.

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Femoral Stem Survivorship in Dorr Type A Femurs After Total Hip Arthroplasty Using a Cementless Tapered Wedge Stem: A Matched Comparative Study With Type B Femurs

Cited by 35 publications

References 25 publications

Does the Surgical Approach Influence the Canal Fill of the Proximal Femur for Hip Arthroplasty?

Does the Surgical Approach Influence the Canal Fill of the Proximal Femur for Hip Arthroplasty?

Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty

Clinical and radiological results of high offset tri-lock bone preservation stem in unilateral primary total hip arthroplasty at a minimum follow-up of 3 years

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