Subsidence of collarless uncemented femoral stems in total hips replacements performed for trauma

Pentlow, A.; Heal, J

doi:10.1016/j.injury.2011.11.011

Cited by 12 publications

(10 citation statements)

References 29 publications

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“…The authors concluded that in trauma patients who have increased incidence of osteoporosis the use of cementless collarless THA may not be appropriate and suggested the utilisation of cemented or collared cementless THA. 59 In a similar study, with a mean follow-up of 5 years, using radiostereometric analysis (RSA) and DXA scans, cementless stems (double tapered collared HA coated used for femoral neck fractures) were associated with a high number of late periprosthetic fractures (12%). 73 RSA studies showed stable fixation and no migration after 2 years but DXA showed increasing bone loss in all Gruen zones (especially in zone 1 and 7) throughout the study period and this might explain the increased periprosthetic fracture rate.…”

Section: Revision Of 1 Stem Due To Infectionmentioning

confidence: 97%

“…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). 60 Moreover, the insertion of a large size cementless stem into a wide osteoporotic canal can lead to leg length discrepancy if appropriate measures (like low neck cut) are not taken into account.…”

Section: Long-term Survival Of Tha In Osteoporotic Patientsmentioning

confidence: 99%

“…72 While cementless stems have shown good results in elective THA in patients with osteoporosis, this may not be true for trauma patients undergoing THA for fractures with an osteoporotic neck of the femur. Pentlow and Heal, 59 compared the subsidence of cementless press fit hydroxyapatite coated stems in matched elective and trauma patients. 59 Most trauma patients had osteopenia or OP and Dorr type C femoral morphology.…”

Section: Long-term Survival Of Tha In Osteoporotic Patientsmentioning

confidence: 99%

“…Pentlow and Heal, 59 compared the subsidence of cementless press fit hydroxyapatite coated stems in matched elective and trauma patients. 59 Most trauma patients had osteopenia or OP and Dorr type C femoral morphology. Revision and dislocation rates at 6 months were higher in trauma patients (both 8.7% compared to 0%).…”

Section: Long-term Survival Of Tha In Osteoporotic Patientsmentioning

confidence: 99%

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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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Section: Revision Of 1 Stem Due To Infectionmentioning

confidence: 97%

Section: Long-term Survival Of Tha In Osteoporotic Patientsmentioning

confidence: 99%

Section: Long-term Survival Of Tha In Osteoporotic Patientsmentioning

confidence: 99%

Section: Long-term Survival Of Tha In Osteoporotic Patientsmentioning

confidence: 99%

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Total hip arthroplasty in patients with osteoporosis

2019

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“…However, uncemented femoral stems with noncircumferential porous coating and designs coupled with inferior ultrahigh-molecular-weight polyethylene manufacturing or sterilization methods have been complicated by high rates revision resulting from osteolysis, loosening, and failure of bony ingrowth [8,21,29]. Iatrogenic fracture [2], thigh pain [25], and subsidence [4,24] also occur more frequently in uncemented stems.…”

Section: Introductionmentioning

confidence: 99%

Improved Survival of Uncemented versus Cemented Femoral Stems in Patients Aged < 70 Years in a Community Total Joint Registry

Wechter

Comfort

Tatman

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Aseptic loosening of the femoral stem remains a significant reason for revision in total hip arthroplasty (THA). Although stem fixation methods have changed over time, there is relatively little evidence supporting cemented or uncemented stems as more durable constructs. Questions/purposes We examined whether there was a difference in survival to revision between cemented and uncemented THA stems (1) for any reason; (2) for aseptic loosening or loosening related to wear/osteolysis; (3) based on patient age groupings (as a proxy for patient activity level); and (4) based on procedural timeframe groupings between cemented and uncemented stems. Methods A total of 6498 primary cemented and uncemented THAs were registered in our community total joint replacement registry between 1991 and 2011. Analysis was performed to compare age, sex, procedural timeframe, and diagnosis for both groups. Our primary outcome was revision of the stem component for aseptic loosening or loosening secondary to wear/osteolysis. Analyses were done using Wilcoxon rank sum tests, Pearson's chi-square tests, Kaplan Meier methods, and Cox regression. Results After adjusting for age, sex, primary diagnosis, and procedural timeframe as confounders, cemented femoral stem components were 1.63 times as likely as uncemented stems to be revised for any reason (p = 0.02) and 3.76 times as likely as uncemented stems to be revised for aseptic loosening or loosening related to wear/osteolysis (p \ 0.001). When grouped by age, specifically in regard to revisions for aseptic loosening or loosening related to wear/osteolysis, uncemented stems had lower cumulative revision rates in patients aged \ 70 years (p \ 0.001) compared with cemented stems. There was a trend away from cemented fixation in our registry, which shifted from over 80% cemented stem use in 1996 to 3% in 2011.

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