Mid-term results of a custom-made short proximal loading femoral component

Santori, F. S.; Santori, N.

doi:10.1302/0301-620x.92b9.24605

Cited by 101 publications

(84 citation statements)

References 29 publications

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“…Short stems are thought to preserve more native host bone and optimize proximal load transfer, and while not a novel concept, they have become increasingly utilized with the advent of less invasive surgery and rapid-recovery protocols [15,24,40,56,62,66]. There are several proposed advantages of short stems, including easier insertion through smaller incisions and less invasive techniques, simpler femoral preparation with a ''broach only'' system, and their basic inherent bone-conserving nature allowing for more favorable conditions in the potential revision setting.…”

Section: Introductionmentioning

confidence: 99%

A Short Tapered Stem Reduces Intraoperative Complications in Primary Total Hip Arthroplasty

Molli¹,

Lombardi²,

Berend³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

153

112

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Background While short-stem design is not a new concept, interest has surged with increasing utilization of less invasive techniques. Short stems are easier to insert through small incisions. Reliable long-term results including functional improvement, pain relief, and implant survival have been reported with standard tapered stems, but will a short taper perform as well? Questions/purposes We compared short, flat-wedge, tapered, broach-only femoral stems to standard-length, double-tapered, ream and broach femoral stems in terms of intraoperative complications, short-term survivorship, and pain and function scores. Patients and Methods We retrospectively reviewed the records of 606 patients who had 658 THAs using a less invasive direct lateral approach from January 2006 to March 2008. Three hundred sixty patients (389 hips) had standardlength stems and 246 (269 hips) had short stems. Age averaged 63 years, and body mass index averaged 30.7 kg/m 2 . We recorded complications and pain and function scores and computed short-term survival. Minimum followup was 0.8 months (mean, 29.2 months; range, 0.8-62.2 months). Results We observed a higher rate of intraoperative complications with the standard-length stems (3.1%; three trochanteric avulsions, nine femoral fractures) compared with the shorter stems (0.4%; one femoral fracture) and managed all complications with application of one or more cerclage cables. There were no differences in implant survival, Harris hip score, and Lower Extremity Activity Scale score between groups. Conclusions Fewer intraoperative complications occurred with the short stems, attesting to the easier insertion of these devices. While longer followup is required, our early results suggest shortened stems can be used with low complication rates and do not compromise the survival and functional outcome of cementless THA.

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Section: Introductionmentioning

confidence: 99%

A Short Tapered Stem Reduces Intraoperative Complications in Primary Total Hip Arthroplasty

Molli¹,

Lombardi²,

Berend³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

153

112

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“…It differs from other neck-preserving prostheses in that its resection level runs through the middle of the femoral head rather than the head-neck junction. This design sought to overcome the problems of other short-stemmed hip implants, especially proximal femoral neck stress-shielding [7,18,23,30,35,36,38,45]. In this study we set out to assess the performance of BMHR at mid-term followup.…”

Section: Discussionmentioning

confidence: 99%

“…Patients' median OHS (using the 48-point OHS) improved from 26 (range, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] preoperatively to 46 (range, [35][36][37][38][39][40][41][42][43][44][45][46][47][48], and UCLA score improved from 5 (range, 2-8) to 8 (range, 4-10) at latest review (paired t-test p \ 0.001 for both). There was no difference in median [35][36][37][38][39][40][41][42][43][44][45][46][47][48] or in the median postoperative UCLA scores between males (8; range, 5-10) and females (8; range, 4-10) (Mann-Whitney U p = 0.293 and p = 0.115, respectively).…”

Section: Survivorship and Hip Scoresmentioning

confidence: 99%

“…There was no difference in median [35][36][37][38][39][40][41][42][43][44][45][46][47][48] or in the median postoperative UCLA scores between males (8; range, 5-10) and females (8; range, 4-10) (Mann-Whitney U p = 0.293 and p = 0.115, respectively).…”

Section: Survivorship and Hip Scoresmentioning

confidence: 99%

“…It differs from other neck-preserving prostheses in that its resection level runs through the middle of the femoral head rather than the head-neck junction. Allowing the load to go through the conically shaped headneck junction would theoretically prevent stress shielding in the femoral neck [15,35,36], a complication reported in other neck-preserving hip implants [7,18,23,30,38,45].…”

Section: Introductionmentioning

confidence: 99%

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Frequent Femoral Neck Osteolysis With Birmingham Mid-head Resection Resurfacing Arthroplasty in Young Patients

Asaad

Hart

Khoo

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Mid-head resection total hip resurfacing arthroplasty was promoted as an alternative to traditional total hip resurfacing for patients with poor femoral head bone quality or abnormal femoral head morphology, because those patients are at high risk of failure with traditional total hip resurfacing. It is a large-headed metal-onmetal device that uses a short, bone-conserving stem. Good performance of the implant has been reported at short-term followup, but no information on the implant performance in the mid-or long-term is available. Questions/purposes In this study, we report (1) on the mid-term implant survivorship and hip scores in a single nondesigner surgeon series. Because of the occurrence of femoral neck osteolysis and pseudotumor in a subgroup of patients, we also investigated the following: (2) Were there any preoperative parameters that are associated with osteolysis? (3) Could we differentiate the osteolysis group from the others on the basis of implant component sizes, positions, and radiologic parameters? (4) Could we differentiate the osteolysis group from the others on the basis of metal ion levels? Methods Between 2006 and 2011, one surgeon performed a total of 49 Birmingham Mid-head Resection total hip resurfacing arthroplasties in 47 patients. The general indications for this procedure were young patients who were considered suitable for hip resurfacing arthroplasty but had avascular necrosis, large cysts, or severe deformity of the femoral head. Clinical followup including Oxford Hip Score (OHS) and UCLA hip scores were available preoperatively and at a mean of 6 years (range, 3-8 years) on all patients (100%), radiographic followup on 45 of 47 (96%), MRIs on 18 (38%), and metal ion levels on 37 (79%). Mean age at surgery was 50 years. Spearman's correlation was used to test the association between femoral neck osteolysis and preoperative parameters, implant component sizes and positions, and blood metal ion levels. Results We found 100% survival. Patients' median OHS was 46 of 48 (range, 35-48) and UCLA 8 of 10 (range, 4-10). However, 16% of the hips (seven of 45) demonstrated osteolysis in the femoral neck. Of the preoperative parameters, the osteolysis was associated with low weight (r = À0.337, p = 0.031) and to a lesser degree with female sex (r = 0.275, p = 0.067). Radiologically, the osteolysis was strongly associated with the presence of a

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Femoral antetorsion after calcar‐guided short‐stem total hip arthroplasty: A cadaver study

Hochreiter

Böhm²,

Fierlbeck

et al. 2021

Journal Orthopaedic Research

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Calcar-guided short stems in total hip arthroplasty (THA) permit surgeons to successfully reconstruct postoperative femoroacetabular offset, accurately restore leg length, and adequately re-establish a wide range of caput-collum-diaphyseal angles.However, their effect on femoral antetorsion is less known. Indeed, controlling antetorsion of the femoral stem can be challenging because of the differences in individual femoral geometry and curvature. Therefore, we investigated if calcarguided short-stem THA alters femoral antetorsion and compared it with conventional-stem THA. Using 12 Thiel-fixed, full-body cadaver specimens from donors without known hip disorders, we compared an uncemented calcar-guided femoral short-stem prosthesis with an uncemented conventional straight-stem prosthesis. In a paired study setup, each specimen received a calcar-guided short stem on one side and a conventional stem on the other. On the acetabular side, all specimens received a press-fit, monobloc acetabular cup. Femoral antetorsion angles were measured using the Waidelich method, and pre-and post-operative angles of both sides were recorded. The mean preoperative femoral antetorsion angles were similar in both groups (24.8°± 7.5°vs. 23.8°± 6.1°, p = 0.313). Mean postoperative femoral antetorsion angles were 23.0°± 5.5°in short-stem and 13.5°± 7.1°in conventional-stem hips. Short-stem hips had a small but nonsignificant difference in femoral antetorsion angles pre-and post-operatively (1.8°± 3.2°, p = 0.109), while the difference for conventional-stem hips was much larger and highly significant (10.3°± 5.8°, p < 0.001). Calcar-guided short-stem THA effectively restores femoral antetorsion. However, how this affects long-term clinical outcomes and complications warrants further exploration.

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Mid-term results of a custom-made short proximal loading femoral component

Cited by 101 publications

References 29 publications

A Short Tapered Stem Reduces Intraoperative Complications in Primary Total Hip Arthroplasty

A Short Tapered Stem Reduces Intraoperative Complications in Primary Total Hip Arthroplasty

Frequent Femoral Neck Osteolysis With Birmingham Mid-head Resection Resurfacing Arthroplasty in Young Patients

Femoral antetorsion after calcar‐guided short‐stem total hip arthroplasty: A cadaver study

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