Migration characteristics of the Corail hydroxyapatite-coated femoral stem—a retrospective clinical evaluation and migration measurement with EBRA

Abstract

Purpose Uncemented stem migration analysis by EBRA-FCA (Einzel-Bild-Roentgen Analyse, Femoral Component Analysis) has been seen to be a good predictive indicator for early implant failure. In this study, we investigated the migration behavior of a cementless press-fit stem after two years follow-up. Stem type and postoperative gap between collar and femur were evaluated as a risk factor. Methods Applying a retrospective study design, we reviewed all consecutive patients who between 2013 and 2017 received a cementless press-fit Corail stem (DePuy Orthopaedics Inc., Warsaw, IN, USA) at our Department. We reviewed medical histories and performed radiological measurements using EBRA-FCA software. Results A total of 109 stems in 105 patients (female: 60; male: 45) fulfilled our inclusion criteria. Mean age at surgery was 67.8 (range, 21.6–90.5) years. EBRA migration analysis showed a mean subsidence of 1.8 mm (range, 0.0–12.1) at final follow-up. At 18 months mean subsidence of collared stems was significantly lower than in the collarless group [1.3 mm (range, 0.0–7.6) vs. 3.2 mm (range, 0.5–10.7), p = 0.0104]. Collared stems resting on the femoral cut presented a tendency to less subsidence than did collared stems showing a postoperative gap between collar and femur (1.3 vs. 2.0 mm) without finding statistical significance (p > 0.05). Conclusions Low subsidence and the migration pattern of the cementless press-fit stem may predict a good long-term result. Collared stems investigated in our study provide good stability and are able to prevent significant subsidence. Trial registration number and date of registration: Number: 20181024-1875; Date: 2018-10-24

Outcomes of total hip arthroplasty using collared versus collarless uncemented HA-coated stems: a meta-analysis

“…Mean subsidence was reported in four studies; meta-analysis on pooled data favored collared stems (MD = −1 mm; 95% CI = −1.6–−0.3) ( 9 , 11 , 51 , 56 ) ( Fig. 5 ).…”

“…Full-text screening left eight eligible studies ( 5 , 9 , 10 , 11 , 12 , 13 , 49 , 50 ), and by checking their references, two more relevant studies were identified ( 51 , 52 ). These two studies did not appear in the original search; one was not indexed in any of the databases searched ( 52 ), while the other did not contain the keywords ‘hip replacement’ or ‘hip arthroplasty’ ( 51 ).…”

“… Range Mean ± s.d. Range Surgical approach Type pf stem Dammerer et al ( 49 ) 105 60 (57%) 68 22–91 27 17–51 Collared 85 Direct anterior or Corail (KA, KHOA, KLA) Collarless 24 Anterolateral (KS, KHO) Melbye et al ( 5 ) Collared 10 335 7352 (71%) 67 ± 11 Anterior, lateral Corail (KA) Collarless 20 871 …”

“…Presence of pedestal formation was reported in one study, which found no difference (0% vs 0%) ( 52 ).

Figure 5 Forest plot presenting mean differences in postoperative subsidence for collared versus collarless stems, including studies by Dammerer et al ( 49 ), Wirries et al ( 11 ), Perelgut et al ( 9 ), and Al-Najjim et al ( 51 ).

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Mid-Term Migration Behavior of an Uncemented Proximally Anchored Straight Stem—A Retrospective EBRA Migration Analysis

“…In a prospective randomized trial, Reiner et al calculated a mean migration of 1.08 mm (SD 0.93 mm) by RSA for the SL-PLUS MIA stem (Smith & Nephew Orthopaedics AG, Baar, Switzerland) after two years with subsidence mainly occurring during the first six weeks after surgery [32]. While an EBRA-FCA by Stihsen et [16,33]. Ström et al identified a mean subsidence of 1.2 mm for the cementless CLS stem (Centerpulse, Bern, Switzerland) after two years by RSA [34].…”