Primary Collared Uncemented Total Hip Arthroplasties in the Elderly: A Safe and Reliable Treatment Option

Schaller, Gavin; Black, Jonathon; Asaad, Asaad; Harper, N.J.N.; Webb, Stuart; Muirhead-Allwood, Sarah

doi:10.1016/j.arth.2014.10.004

Cited by 12 publications

(8 citation statements)

References 31 publications

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“…Radiographic evidence of osteolysis was detected in both the CFP and ribbed groups. Both the stems are collared prostheses, which can effectively prevent the subsidence of the stem, and may also lead to osteolysis in Gruen zone 7 due to stress shielding [ 27 ]. Another reason is the generation of wear particles [ 28 ], depending on implant design and manufacturing materials.…”

Section: Discussionmentioning

confidence: 99%

Comparison of collum femoris-preserving stems and ribbed stems in primary total hip arthroplasty

Xie

et al. 2018

J Orthop Surg Res

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BackgroundThis retrospective study investigated the relative benefits of using a collum femoris-preserving prosthesis or ribbed stem during total hip arthroplasty (THA).MethodsThe clinical results were compared of patients who underwent THA, between January 2010 and December 2012, with either a CFP prosthesis or a ribbed stem (66 and 75 patients, respectively, aged 43.4 ± 10.8 and 42.3 ± 9.8 years). Patients were assessed using the Harris Hip Score (HHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 12-Item Short Form Health Survey (SF-12), and physical component summary (PCS) score. Intraoperative and postoperative complications and leg-length differences were noted.ResultsThe mean follow-up times of the CFP and ribbed groups were 67.2 ± 7.5 and 68.3 ± 7.2 months, respectively. The HHS, SF-12 MCS, SF-12 PCS, and WOMAC scores of the two groups were similar. The rates of periprosthetic femoral fractures and leg-length differences > 10 mm in the CFP group (10.6% and 13.6%, respectively) were significantly higher than those in the ribbed group (1.3% and 2.7%). The groups were similar regarding complications of osteolysis, ectopic ossification, dislocation, deep infection, deep venous thrombosis, thigh pain, and aseptic loosening. The survival rates of the CFP and ribbed groups were comparable (98.5% and 97.8%).ConclusionThe clinical results of the CFP and ribbed prostheses in young patients given THA were similar for Chinese patients. However, the CFP stem should be used with caution, given the high incidence of technical problems associated with implantation especially for Chinese patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of collum femoris-preserving stems and ribbed stems in primary total hip arthroplasty

Xie

et al. 2018

J Orthop Surg Res

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“…The remaining concerns are that the long-term outcomes of UTR are not as robust as those of CTR, that UTR does not decrease the need for early revision (less than 5 years), and that UTR requires excessive intervention to uphold conventional hip function [6,14]. For UTR, the risks of early prosthesis revision or excessive interventions, as well as the disproportionate expense associated with these procedures, may offset some of its initial benefits [13,15].…”

Section: Introductionmentioning

confidence: 99%

“…Indecision as to which type of endoprosthesis is optimal (CTR or UTR) for the treatment of FNFs in elderly patients results in noteworthy variation in the use of each intervention internationally. Several studies have indicated the benefits of UTR over CTR with respect to complication rates and operation times [ 11 – 13 ]. The remaining concerns are that the long-term outcomes of UTR are not as robust as those of CTR, that UTR does not decrease the need for early revision (less than 5 years), and that UTR requires excessive intervention to uphold conventional hip function [ 6 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up

et al. 2020

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Background Cemented or uncemented total hip replacement (CTR or UTR) for femoral neck fractures (AO/OTA type 31B/C) is a relatively common procedure in elderly individuals. The recent literature is limited regarding long-term outcomes following CTR versus UTR in the Asian population. Methods Using our institutional database, we performed long-term outcome analysis on 268 patients with femoral neck fractures (AO/OTA type 31B/C) who had undergone a primary UTR or CTR (CTR: n = 132, mean age, 67.43 ± 6.51 years; UTR: n = 136, mean age, 67.65 ± 6.13 years) during 2007–2014, and these patients were followed until 2019. Follow-up occurred 1, 3, 6, and 12 months postoperatively and yearly thereafter. The primary endpoint was the Harris hip score (HHS); the secondary endpoint was the incidence of orthopaedic complications. Results The mean follow-up time was 62.5 months (range, 50.1–76.1 months). At the final follow-up, the HHS was 79.39 ± 16.92 vs 74.18 ± 17.55 (CTR vs UTR, respectively, p = 0.011). Between-group significant differences were observed regarding the incidence of prosthesis revision, prosthesis loosening, and periprosthetic fracture (7.6% [95% CI, 6.4–8.2] for CTR vs 16.9% [95% CI, 14.7–17.3] for UTR, p = 0.020; 9.8% [95% CI, 8.3–10.7] for CTR vs 19.9% [95% CI, 18.2–20.9] for UTR, p = 0.022; 5.3% [95% CI, 4.4–6.7] for CTR vs 13.2% [95% CI, 12.1–13.8] for UTR, p = 0.026, respectively). Conclusion CTR showed superiority to UTR by improving the HHS and decreasing the incidence of orthopaedic complications. Our findings need to be confirmed in a prospective, randomized controlled study to verify whether they can be applicable to a broader population.

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“…There is evidence that in OP bone a cementless stem with a collar should be used. 58 The surgical technique of stem fixation is of paramount importance, since poor bone quality is an adverse risk factor for implant loosening regardless of the fixation method.…”

Section: Resultsmentioning

confidence: 99%

“…57 The use of conventional collared cementless stems is also an option but their implantation is technically challenging depending on proximal femoral morphology (initial stability should be achieved with both adequate proximal metaphyseal and calcar fixation) (Figure 4). 58 Other options include the use of hydroxyapatite cementless stems in order to enhance ingrowth, and the use of double tapered stems. 59 Unfortunately, the insertion of a cementless proximally coated press-fit stem into an osteoporotic femur is technically demanding due to the development of increased hoop stress and the increased risk of intraoperative fracture ( Figure 5).…”

Section: Long-term Survival Of Tha In Osteoporotic Patientsmentioning

confidence: 99%

Total hip arthroplasty in patients with osteoporosis

2019

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There is a high prevalence of osteoporosis in patients undergoing total hip arthroplasty. There are several clinically relevant questions related to the management of such cases: the effect of ageing; the initial osseointegration of implants, especially when cementless THA is used; the effect of medical osteoporosis treatment on bone-implant interface; the incidence of intraoperative and late periprosthetic fractures, and the long-term survival of both cemented and cementless total hip arthroplasty performed for proximal femoral fractures and hip osteoarthritis. A critical review of the literature is presented in an attempt to draw practical conclusions.

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Primary Collared Uncemented Total Hip Arthroplasties in the Elderly: A Safe and Reliable Treatment Option

Cited by 12 publications

References 31 publications

Comparison of collum femoris-preserving stems and ribbed stems in primary total hip arthroplasty

Comparison of collum femoris-preserving stems and ribbed stems in primary total hip arthroplasty

Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up

Total hip arthroplasty in patients with osteoporosis

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