Observed effect of femoral component undersizing and a collarless design in the development of radiolucent lines in cementless total hip arthroplasty

Abstract

Background: The objective of this study was to determine the prevalence of radiolucent lines (RLLs) around the femoral component in a cohort of patients who underwent well-functioning cementless total hip arthroplasty (THA). Methods: A cohort of unrevised Corail (DePuy Synthes, Raynham, MA) femoral components (n ¼ 636) were analyzed at a median follow-up of 6.0 years (interquartile range: 5.2-6.8) with the Oxford Hip Score (OHS) and radiographs. Two independent observers assessed the radiographs for the presence of RLLs. Results: The overall prevalence of RLLs in zone 7 was 13% (83/636). Patients with RLLs in zone 7 had an average OHS of 40.3 (15-48), and those who did not have RLLs in zone 7 had an average OHS of 38 (6-48), P ¼ .07. Both groups had an average pain score of 1.6 out of 5, P ¼ .5. The prevalence of RLLs in zone 7 was much less in the collared femoral components (2.6% prevalence) than in the collarless components (23.6% prevalence), but there was heterogeneity between these 2 groups preventing comparison. Logistic regression analysis of only the collarless components identified undersizing as the only predictive (odds ratio ¼ 2.6) factor for RLL development in zone 7. Conclusions: Undersizing the Corail stem is strongly predictive of developing RLLs in zone 7. Preoperative templating for the appropriate size is critical. We observed more RLLs in zone 7 with the collarless design Corail, but a comparison study with the same bearing couple is needed to investigate this further.

Progressive proximal loosening of initially well-fixed bilateral Corail stems: a case report and review of the literature

“…Other studies of fully HA-coated stems of a comparable design ( 10 ) as well as proximally coated stems ( 11 , 12 ) reveal similar findings. Additionally, Magill et al ( 13 ) and Karayiannis et al ( 14 ) both report a statistical relationship between under-sizing the Corail stem and the development of radiolucent lines in zone 7.…”

Cementless Hip Implants: History and Current Status of the Issue

“…На основании анализа более 41 000 наблюдений из австралийского регистра артропластики W. Hoskins с соавторами установили, что частота ревизий ножки на протяжении 13 лет составила 7,7% для двух минимальных размеров и 3,0% -для остальных размеров, что может быть связано с недостаточной подготовкой костного лажа и оседанием слишком маленьких для соответствующей кости бедренных компонентов [88]. Другая группа авторов отметила, что 13% пациентов имеют рентгенопрозрачные линии в 7-й зоне Груэна, что, однако, не влияет на общие функциональные результаты и удовлетворенность пациентов [89].…”

Survival and performance of a dual tapered-wedge fully HA-coated press fit femoral stem

“…Magill et al provided a recent analysis of the Corail stem with median 6-year follow-up including a collared and collarless variant, concluding that the presence of radiolucencies in zone 7 was the most prominent radiographic finding. Collarless femoral stems were found to have a much higher prevalence of radiolucencies compared to collared stems (23.6% vs. 2.6%, respectively), but a full comparison was unable to be performed due to heterogeneity [17]. The authors did not include revision cases in their cohort and thus could not provide any survival data.…”