Is there an increased stem migration or compromised osteointegration of the Mayo™ short-stemmed prosthesis following cerclage wiring of an intrasurgical periprosthetic fracture?

Zeh, Alexander; Radetzki, Florian; Diers, V.; Bach, Dirk; Röllinghoff, Marc; Delank, K.-S.

doi:10.1007/s00402-011-1342-1

Cited by 14 publications

(8 citation statements)

References 18 publications

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“…This indicates that the stem size for SHA can as accurately be templated as the stem size for THA. This finding is relevant, as it had been discussed that SHA may cause a higher rate of femoral neck fractures during insertion [21]. However, a biomechanical study could demonstrate that the fracture risk with a proper implant size is equal for SHA and THA [22].…”

Section: Discussionmentioning

confidence: 86%

“…Therefore, it can be speculated that some of the reported intra-operative fractures might be related to the use of an oversized SHA implant. This is underscored by a study of Zeh et al [21] who reported a high rate of femoral neck fractures during the learning curve for implantation of the Mayo stem. As the present study demonstrates that the stem size for SHA can exactly be determined in about 50 % of the cases and within one size margin in 89 %, this shows that a pre-operative templating is a useful tool to predict the proper implant size and thereby might be able to reduce intraoperative complications.…”

Section: Discussionmentioning

confidence: 98%

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The accuracy of digital templating: a comparison of short-stem total hip arthroplasty and conventional total hip arthroplasty

Schmidutz

Steinbrück

Wanke-Jellinek

et al. 2012

International Orthopaedics (SICOT)

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Purpose Selection of the correct femoral stem size is crucial in total hip arthroplasty for an uncomplicated implantation and good initial stability. Pre-operative templating has been shown to be a valuable tool in predicting the correct implant size. For short-stem total hip arthroplasty (SHA), which recently is increasingly used, it is unknown if templating can be performed as reliable as conventional total hip arthroplasty (THA). Methods A total of 100 hip arthroplasties, 50 with SHA and 50 with THA, were templated by four orthopaedic surgeons each. The surgeons had different levels of professional experience and performed a digital template of the acetabular and femoral component on the pre-operative radiographs. The results were compared with the truly inserted implant size. Results For the femoral stems the average percentage of agreement (±1 size) was 89.0 % in SHA and 88.5 % in THA. There was no significant difference among surgeons in the accuracy of templating the correct stem size and no significant difference between templating SHA and THA. For the acetabular component the average percentage of agreement (±1 size) was 75.8 %. However, the more experienced surgeons showed a significant higher accuracy for templating the correct cup size than the less experienced surgeons. Conclusion Digital templating of SHA can predict the stem sizes as accurately as conventional THA. Therefore digital templating is also recommendable for SHA, as it helps to predict the implant size prior to surgery and thereby might help to avoid complications.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 98%

The accuracy of digital templating: a comparison of short-stem total hip arthroplasty and conventional total hip arthroplasty

Schmidutz

Steinbrück

Wanke-Jellinek

et al. 2012

International Orthopaedics (SICOT)

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“…The radiological measurement of stem migration and angulation was not performed using an established method like EBRA [ 38 ]. However, the method used in this study has been validated and successfully performed in other similar investigations [ 15 , 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

A prospective randomized radiographic and dual-energy X-ray absorptiometric study of migration and bone remodeling after implantation of two modern short-stemmed femoral prostheses

Brinkmann

Radetzki

Delank

et al. 2015

J Orthopaed Traumatol

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BackgroundThe aim of this prospective randomized study was to analyze migration and strain transmission of the Metha™ and Nanos™ femoral prostheses.Materials and methodsBetween 1 January 2011 and 2 April 2013, 50 patients were randomized to receive short-stemmed femoral prostheses. Metha™ stems were implanted in 24 patients (12 female, 12 male; mean age 58.7 years; mean body mass index [BMI] 27.4) and Nanos™ stems in 26 patients (10 female, 16 male; mean age 59.7 years; mean BMI 27.1). Longitudinal stem migration, varus−valgus alignment, changes of center of rotation (COR), femoral offset and caput-collum-diaphyseal angle, leg length discrepancy, periprosthetic radiolucent lines incidence, and dual-energy X-ray absorptiometry (DEXA) scans were analysed after an average of 98 and 381 days.ResultsThere was no significant change of varus−valgus alignment or clinically relevant migration of the Metha™ or Nanos™ prostheses during postoperative follow-up. After 12.3 months, the DEXA scans showed small but significant differences of bone mineral density in Gruen zones 1 (minus ~8 %) and 6 (plus ~9 %) for the Metha™ and in Gruen zone 1 (minus ~14 %) for the Nanos™ (paired t test). Visual analog scale (VAS) and Harris Hip Score (HHS) improved significantly for both implants (Nanos™/Metha™ 12.3 months postoperatively HSS 96.5/96.2; VAS 0.7/0.8, respectively). COR or offset did not change significantly after surgery.ConclusionsNeither implant showed signs of impaired osseointegration. DEXA demonstrated proximally located load transfer with only moderate proximal stress shielding.Level of evidenceII.

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“…Afterwards, patients were treated without weight bearing for 3 or 6 weeks, and after this 20 kg partial weight bearing before transition to full weight bearing. Another recent study showed that patients treated similarly to ours after intraoperative fracture using a mayo short stem prosthesis, had no disadvantages referring stem migration or alignment [23]. …”

Section: Discussionmentioning

confidence: 88%

The Mayo conservative hip: complication analysis and management of the first 41 cases performed at a University level 1 department

Arnholdt

Gilbert

Blank

et al. 2017

BMC Musculoskelet Disord

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BackgroundTo prevent bone loss in hip arthroplasty, several short stem systems have been developed, including the Mayo conservative hip system. While there is a plethora of data confirming inherent advantages of these systems, only little is known about potential complications, especially when surgeons start to use these systems.MethodsIn this study, we present a retrospective analysis of the patients’ outcome, complications and the complication management of the first 41 Mayo conservative hips performed in 37 patients. For this reason, functional scores, radiographic analyses, peri- and postoperative complications were assessed at an average follow-up of 35 months.ResultsThe overall HHS improved from 61.2 pre-operatively to 85.6 post-operatively. The German Extra Short Musculoskeletal Function Assessment Questionnaire (XSFMA-D) improved from 30.3 pre-operatively to 12.2 post-operatively. The most common complication was an intraoperative non-displaced fracture of the proximal femur observed in 5 cases (12.1%). Diabetes, higher BMI and older ages were shown to be risk factors for these intra-operative periprosthetic fractures (p < 0.01). Radiographic analysis revealed a good offset reconstruction in all cases.ConclusionIn our series, a high complication rate with 12.1% of non-displaced proximal femoral fractures was observed using the Mayo conservative hip. This may be attributed to the flat learning curve of the system or the inherent patient characteristics of the presented cohort.

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Is there an increased stem migration or compromised osteointegration of the Mayo™ short-stemmed prosthesis following cerclage wiring of an intrasurgical periprosthetic fracture?

Cited by 14 publications

References 18 publications

The accuracy of digital templating: a comparison of short-stem total hip arthroplasty and conventional total hip arthroplasty

The accuracy of digital templating: a comparison of short-stem total hip arthroplasty and conventional total hip arthroplasty

A prospective randomized radiographic and dual-energy X-ray absorptiometric study of migration and bone remodeling after implantation of two modern short-stemmed femoral prostheses

The Mayo conservative hip: complication analysis and management of the first 41 cases performed at a University level 1 department

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