Subsidence in Collarless Corail Hip Replacement

Abstract

The purpose of this study was to assess whether subsidence occurs in collarless Corail hip replacement (CCHR) and to ascertain the extent and timing of subsidence if present. Retrospective case notes analysis was performed. Sixty eight patients who had CCHR were identified from our database. Male to female ratio was 32:36. Their mean age was 74.2 years (range 37-95 years). Indications for surgery were osteoarthritis in 64 (94%) patients, rheumatoid arthritis in two (3%) patients and avascular necrosis in two (3%) patients. Subsidence was measured at 6 weeks, 6 months and 1 year post-op compared to initial post-op x-rays. At 6 weeks x-ray 21 patients did not have any subsidence, 18 patients had 1 millimeter (mm) subsidence, 10 patients had 2mms subsidence, 4 patients had 3mms subsidence, 5 patients had 4mms subsidence, 1 patient had 5mms subsidence, 4 patients had 6 mms subsidence and 1 patient each had subsidence of 7mms, 9mms, 11mms, 13mms and 26 mms respectively. When compared with 6 months x-rays only 2 patients had a further subsidence of 2mms while another patient had 3mms subsidence. No further subsidence occurred at 1 year follow up x-rays. One patient had revision surgery due to symptomatic subsidence (29mms) at 6 months follow up. Subsidence does occur in the first 6 weeks in collarless Corail hip replacement, and to a lesser extent until 6 months postoperatively, but does not progress further.

Fixation, sex, and age: highest risk of revision for uncemented stems in elderly women — data from 66,995 primary total hip arthroplasties in the Norwegian Arthroplasty Register

“…Thus, any malpositioning of the cup cannot always be sufficiently adjusted for with the stem. Also, the uncemented stem may subside in the femur more often than cemented ones (Selvaratnam et al 2015). It may be that these factors lead to suboptimal position of the THA components, and thus to a higher risk of revision due to dislocation.…”

The Actis and Corail Femoral Stems Provide for Similar Clinical and Radiographic Outcomes in Total Hip Arthroplasty

“…The collared options were designed with the goal of limiting subsidence and providing rotational stability [7]. In addition, it is entirely coated with hydroxyapatite to block the release of metal ions and promote osseointegration with the endosteal surface [24].…”

Risk of subsidence and peri-prosthetic fractures using collared hydroxyapatite-coated stem for hip arthroplasty in the elderly

“…6 Campbell et al reported a mean subsidence of 0.58 mm using collarless corail stems in a cohort of 30 patients using radiostereometric analysis, 7 whereas Selvaratnam et al reported more than 2 mm subsidence in 28% of their sample at 6 weeks post operatively, using the same stem. 8 Another parameter of interest is the risk of intraoperative femoral fracture, which has been reported ranging in 2.7-11% of cases. [9][10][11][12] Bonnin et al looked at the preoperative morphology of femur using CT scan in 100 cases of uncemented THA.…”

“…6 Campbell et al reported a mean subsidence of 0.58 mm using collarless corail stems in a cohort of 30 patients using radiostereometric analysis, 7 whereas Selvaratnam et al reported more than 2 mm subsidence in 28% of their sample at 6 weeks post operatively, using the same stem. 8…”