Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

Kutzner, Karl Philipp; Pfeil, Joachim

doi:10.3791/56905

Cited by 20 publications

(28 citation statements)

References 16 publications

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“…The principle of implanting the calcar-guided optimys short stem consists of an individual alignment alongside the medial calcar, providing the ability of reconstructing varus and valgus anatomy in a great variety, using individualised levels of osteotomy [14]. This results in a broad range of CCD angles to be reconstructed but also in different types of anchorage [13, 22].…”

Section: Discussionmentioning

confidence: 99%

“…Khanuja et al proposed four categories of short stems: femoral neck only, calcar loading, lateral flare calcar loading and shortened tapered stems [12]. However, short stems of the newest generation cannot be easily classified, since they can be both calcar loading and diaphyseal anchoring, depending on the individual stem alignment according to the patient’s anatomy [13, 14]. Thus, particularly in Europe, the term “calcar-guided” short stems has been established [15].…”

Section: Introductionmentioning

confidence: 99%

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Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases

et al. 2019

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BackgroundIn recent years, a variety of short stems have been introduced. To date, mid- and long-term results of calcar-guided short-stem designs have been rarely available.Materials and methodsTwo hundred and sixteen calcar-guided short stems were included in combination with a cementless cup in a prospective study. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfaction on visual analogue scale (VAS) were assessed during a median follow-up of 61.7 months. Standardised radiographs were analysed at predefined time points regarding radiological alterations such as bone resorption and remodelling, radiolucency, osteolysis and cortical hypertrophy using modified Gruen zones.ResultsAt mid-term follow-up, no revision surgery of the stem had to be performed in the whole collective. At 5 years, HHS was 97.8 (SD 4.7), satisfaction on VAS was 9.7 (SD 0.7), rest pain on VAS was 0.1 (SD 0.5), and load pain on VAS was 0.6 (SD 1.2). Compared to the 2-year results, femoral bone resorption increased significantly at the 5-year follow-up (3.9% versus 42.3%). Rate of femoral cortical hypertrophy remained stable, occurring in a total of 9 hips (4.5%). At the 5-year follow-up, 2 stems (1.0%) showed non-progressive radiolucent lines with a maximum width of 2 mm. Signs of osteolysis were not observed. Compared to the 2-year follow-up, no further subsidence was observed.ConclusionsThe rate of stem revision (0%) at the mid-term follow-up was remarkable and indicates the principle of using a calcar-guided short stem as being a safe procedure. However, signs of bone-remodelling, indicating some amount of stress-shielding, must be acknowledged at 5 years depending on stem alignment and type of anchorage.Level of evidenceIV, Prospective observational studyTrial registration German Clinical Trials Register, DRKS00012634, 07/07/2017 (retrospectively registered)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases

et al. 2019

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“…A great variety of short stems have been introduced to the market in the past decade, providing diverse philosophies and different types of anchoring [ 11 ]. Short stems of the newest generation cannot be easily classified, since they can be both calcar loading with pronounced metaphyseal anchorage, as well as diaphyseal anchoring, depending on the individual stem alignment [ 13 , 14 ]. Thus, particularly in Europe, the term “calcar-guided” short stems have been established [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Primary stability of calcar-guided short-stem total hip arthroplasty in the treatment of osteonecrosis of the femoral head: migration analysis using EBRA-FCA

Afghanyar

Danckwardt

Schwieger

et al. 2020

Arch Orthop Trauma Surg

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Introduction Osteonecrosis of the femoral head (ONFH) is a disabling condition that often results in secondary arthritis necessitating total hip arthroplasty (THA). Short-stem THA has constantly gained popularity. It remains controversial, whether ONFH represents a risk factor for failure after the implantation of short stems with pronounced metaphyseal anchorage. The potential spread of the osteonecrotic area and bone marrow edema into the metaphyseal bone might result in compromised stability. Early implant migration is considered predictive of subsequent aseptic loosening. The purpose of this study was a migration analysis of a modern, calcar-guided short-stem implant in patients with ONFH in a mid-term follow-up. Materials and methods This retrospective analysis investigated the migration pattern of 45 calcar-guided short stems in patients with ONFH, using Einzel-Bild-Roentgen-Analyse Femoral-Component-Analysis (EBRA-FCA). Influencing factors such as ARCO categories, age, gender, body weight and BMI were analyzed. Complications and adverse events were documented. Results At mid-term [48.1 months (SD 20.7 months)], mean axial migration was 1.56 mm (SD 1.77 mm). Mean migration rate stabilized after 2 years. No influence of ARCO categories, age and BMI was found. A tendency of increased axial migration was observed in male patients and in overweight patients. No revision surgeries had to be performed during follow-up. Conclusion The results indicate a migration pattern comparable to that of primary osteoarthritis patients with slight initial migration under full load followed by subsequent stabilization in the metaphyseal femur. The 100% survival rate at mid-term supports the usage of this short-stem design in patients with ONFH.

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“…One of the strengths of the present study is that it evaluates a group of consecutive patients from a single surgeon. All included patients were given a minimally invasive anterolateral approach and implanted with a short-stem implant [6,21,22]. This minimised the effects on the postoperative outcome of the surgical technique or the surgeonʼs experience.…”

Section: Discussionmentioning

confidence: 99%

Outcome of an “Enhanced Recovery” Program in Contemporary Total Hip Arthroplasty in Germany

et al. 2019

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Background An inpatient hospital stay of up to 10 days after total hip arthroplasty (THA) is still common in Germany, mostly followed by inpatient rehabilitation. Internationally already widespread concepts for enhanced recovery are increasingly gaining popularity in Germany. Objectives The presentation of content and results of a newly implemented enhanced recovery concept in THA. Materials and Methods In this single-center, prospective observational study of a consecutive patient collective of a single surgeon, between January 2016 and July 2016, 103 short-stem THA patients were enrolled and treated using a newly introduced enhanced recovery concept. After 6 weeks and 6 months clinical examination was performed regarding function, pain, satisfaction and possible complications. Results The goal of discharge on day 4 after operation was reached in 61.2% of the patients with a mean postoperative inpatient stay of 4.9 days. After 6 weeks and 6 months respectively, excellent clinical results were achieved with high patient satisfaction. The complication rate was found to be low. Mean hemoglobin concentration decreased by 2.1 g/dl. A fissure of the femur below the implant healed conservatively applying no weight bearing for a total of 6 weeks. A pulmonary embolism that occurred during rehabilitation was also successfully treated. After 6 months one case showed a bursitis trochanterica. Conclusions Inpatient length of stay can be reduced by enhanced recovery concepts without increasing the risks to patients. Thus, in Germany these concepts will be applied increasingly.

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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

Cited by 20 publications

References 16 publications

Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases

Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases

Primary stability of calcar-guided short-stem total hip arthroplasty in the treatment of osteonecrosis of the femoral head: migration analysis using EBRA-FCA

Outcome of an “Enhanced Recovery” Program in Contemporary Total Hip Arthroplasty in Germany

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