Stable Fixation of Short-stem Femoral Implants in Patients 70 Years and Older

Park

Clinical Orthopaedics &Amp; Related Research

et al. 2014

Background Long-term results of standard total hip arthroplasty (THA) in young patients were not optimal. There are a number of reported disadvantages to longer cementless stems in THA including thigh pain and proximal stress shielding. However, it is unknown whether a short, metaphyseal-fitting anatomic stem without diaphyseal fixation, which represents a possible alternative, will maintain fixation over the longer term. Question/purposes We therefore evaluated long-term (1) clinical results using validated scoring instruments; (2) osseointegration and bone remodeling; (3) complications; and (4) rates of revision and osteolysis in patients younger than 65 years who underwent THA with a short, metaphyseal-fitting anatomic cementless stem.Methods We reviewed 500 patients (630 hips) younger than 65 years (mean age at surgery, 52.7 years) who underwent THA with the Immediate Postoperative Stability stem (IPS; DePuy, Leeds, UK) by one surgeon (Y-HK) from January 1995 to March 2002. Demographic data, Harris hip score, WOMAC score, UCLA activity score, and radiographic data were recorded. All patients underwent dual-energy x-ray absorptiometry scanning of the acetabulum and proximal femur at 2 weeks after the operation and at final followup to determine stress shielding. Thigh pain was specifically investigated and scored by patients on a visual analog scale. Other complications were recorded. We determined component survival rates at 15 years using revision and aseptic loosening as end points. Minimum followup was 11 years (mean, 15.8 years; range, 11-18 years). Results The clinical and functional results improved significantly for the Harris hip score, WOMAC, and UCLA activity scores (p \ 0.001). At latest followup, mean Harris hip, WOMAC, and UCLA activity scores were 94 (range, 71-100), 15 (range, 5-29), and 7.9 (range, 6-9) points, respectively. All hips had osseous integration of the acetabular and femoral components. No patients had thigh pain. Four hips (0.6%) had deep infection and four (0.6%) had a recurrent dislocation. No patients had Grade 3 stress shielding. Fifteen-year survival rates were 98.7% (95% confidence interval [CI], 0.95-1.00) for the acetabular component and 99.4% (95% CI, 0.97-1.00) for the femoral component with revision as the end point and 100% (95% CI, 0.98-1.00) for both components with aseptic loosening as the end point. Conclusions The short, metaphyseal-fitting anatomic cementless femoral stem provided stable fixation without relying on diaphyseal fixation in younger patients, suggesting metaphyseal fitting alone is sufficient in young

Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Long-term Results and Bone Remodeling After THA With a Short, Metaphyseal-fitting Anatomic Cementless Stem

Park

Clinical Orthopaedics &Amp; Related Research

et al. 2014

International Orthopaedics (SICOT)

“…Short stems potentially preserve more bone stock, improve proximal load transfer, optimize bone remodeling especially in the older population and decrease stress shielding [15,16]. Furthermore, short stems may be easier to insert through smaller, minimally invasive incisions.…”

Section: Discussionmentioning

confidence: 99%

Does stem design influence component positioning in total hip arthroplasty using a minimal invasive posterolateral approach?

Waldstein

Merle

Schmidt-Braekling

et al. 2014

Purpose Limited data exist for the reconstructive potential of short bone-preserving stems in THA using a minimal invasive posterolateral approach. Our study aim was to assess the effect of stem design on the reconstruction of hip offset and leg length in MIS posterolateral THA. Methods This retrospective consecutive single-surgeon study compares hip offset and leg length, as well as acetabular component positioning (cup anteversion; inclination) of 129 THAs with a cementless standard-length stem (Synergy®) and 143 THAs with a cementless short bone-preserving stem (Trilock®). Results In reference to the contralateral side, the mean difference in hip offset was 0.9 mm (p=0.067) for the standard stem and 0.1 mm (p=0.793) for the short stem, respectively. Leglength discrepancy was 0.7 mm (Synergy®) and 0.9 mm (Trilock®), respectively. A total of 233 (86 %) acetabular components fell within the target zone for anteversion and inclination. Conclusion Accurate component positioning in MIS posterolateral approach THA is possible and is not influenced by the type of stem.

Ortop Traumatol Rehabil

“…Przy pra wi dło wej kwa li fi ka cji, im plan ty te mo gą być rów nież sto so wa ne u cho rych po 70 ro ku ży cia, za pew nia jąc sta bil ne osa dze nie im plan tu i do bre wyni ki kli nicz ne [18]. Jak wy ka zał ostat nio To ma szew ski i wsp.…”

Section: Wstępunclassified

Postoperative Migration of Short Stem Prosthesis of the Hip Joint

Kaminski¹,

Szmyd²,

Ambroży³

et al. 2015

STRESZCZENIEWstęp. Alo pla sty ka sta wu bio dro we go jest po wszech nie sto so wa ną pro ce du rą da ją cą prze wi dy wal ne, dłu go trwałe do bre wy ni ki. En do pro te zy krót ko trz pie nio we po zwa la ją za cho wać nie na ru szo ną ja mę szpi ko wą oraz część bli ż -szą trzo nu. Wy ka za no, że w po rów na niu do en do pro tez ze stan dar do wym trzpie niem, da ją lep sze wy ni ki kli nicz ne. Ce lem pra cy by ła oce na mi gra cji trzpie nia en do pro te zy sta wu bio dro we go Pro xi ma. Mi gra cję okre śla no ja ko zmianę ką ta po ło że nia trzpie nia w kie run ku szpo ta wo ści.Ma te riał i me to dy. Do ba da nia włą czo no gru pę 164 cho rych (83 ko bie ty, 81 mę żczyzn) ope ro wa nych w latach 2007-2012 w Kra kow skim Cen trum Re ha bi li ta cji i Or to pe dii, u któ rych wy ko na no alo pla sty ki przy uży ciu 185 en do pro tez ty pu Pro xi ma.Wy ni ki. Pod da no ana li zie ra dio lo gicz nej se rię trzech zdjęć wy ko na nych u ka żde go cho re go w do bie "0", po 6 i po 12 mie sią cach. Stwier dzo no mi gra cję w kie run ku szpo ta we go usta wie nia trzpie nia w okre sie ob ser wa cji. Wy kaza no ko re la cję po mię dzy zmia ną ką ta szpo ta we go po ło że nia en do pro te zy a cza sem ob ser wa cji. Po 12 mie sią cach śred nia zmia na ką ta szpo ta wo ści wy no si ła 8,21º. Wy ka za no istot ną sta ty stycz nie ró żni cę w ką cie szpo ta we go po ło -że nia en do pro te zy w za le żno ści od płci pa cjen ta. Po 12 mie sią cach, zmia na łącz na wy no si ła u ko biet 6,82º, a u męż -czyzn 9,65º. Nie wy ka za no istot nej ko re la cji po mię dzy BMI pa cjen ta, wie kiem pa cjen ta oraz su ma rycz ną dłu go ścią szyj ki sto so wa ne go im plan tu a pro gre sją ką ta szpo ta we go po ło że nia en do pro te zy.Wnio ski. 1. Im plant krót ko trz pie nio wy Pro xi ma ule ga naj więk sze mu prze miesz cze niu w kie run ku szpo ta wo ści w okre sie pierw szych 6 mie się cy od za ło że nia. 2. Zmia na ką ta szpo ta we go po ło że nia en do pro te zy za le żna jest od wyj ścio we go osa dze nia en do pro te zy oraz płci. 3. Zmia na ką ta szpo ta we go po ło że nia en do pro te zy nie jest za le żna od wie ku cho re go oraz BMI.Słowa kluczowe: endoproteza krótkotrzpieniowa, całkowita aloplastyka stawu biodrowego, migracja trzpienia endoprotezy SUMMARY Background. Hip replacement surgery is a popular procedure that provides predictable, long-lasting and good effects. The use of short stem prostheses helps preserve an intact medullary cavity and proximal diaphysis. It has been demonstrated that the use of short stem prostheses leads to better clinical results compared to standard stem prostheses. The study aimed to assess the migration of the stem of the Proxima hip prosthesis. Migration was defined as a change in the angle of stem position towards a varus deformity.Material and methods. The study involved 164 patients (83 women, 81 men) who underwent hip replacement surgery with a total of 185 Proxima prostheses in the Cracow Rehabilitation Centre between 2007 and 2012.Results. Radiographic analysis included a ...