Three-dimensional morphology of the proximal femur

Husmann, Olivier; Rubin, P. J.; Leyvraz, Pierre-François; Roguin, B. De; Argenson, Jean-Noël

doi:10.1016/s0883-5403(97)90201-1

Cited by 172 publications

(167 citation statements)

References 16 publications

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“…This population has an increased life expectancy and an increased functional demand requiring, after THA, full ROM, quick and complete return to physical activity, longterm bone-implant fixation, and limited polyethylene wear and osteolysis [34,41]. In previous anatomic studies, it was shown the upper femoral anatomy may be distorted, particularly in young patients with frequent secondary forms of osteoarthritis [4,29,50]; consequently optimal fit-andfill of the metaphysis and extramedullary adaptation may be difficult to achieve in every case. A mean survival rate of 100% at 10 years was reported for a series of patients younger than 65 years without thigh pain, migration, or reoperation [56].…”

Section: Discussionmentioning

confidence: 99%

“…This is allowed by the use of a smooth custom stainless steel rasp of the same shape to compact the cancellous bone. The CT scan also allows evaluating the correction needed for the prosthetic neck's appropriate offset and anteversion [29]. The surgeon provides the engineer with the correction to be made laterally for each patient based on the contralateral side when normal or on the lever arm ratio described by Amstutz and Sakai [2] and the abductor angle [24] when abnormal or in the case of bilateral disease.…”

Section: Methodsmentioning

confidence: 99%

“…Initial stability depends either on filling the proximal femur with intimate contact between the stem and the anatomic shape of the proximal femur (an anatomic fit) or filling the femoral diaphysis [56]. In previous anatomic studies, important anatomic variations in the upper femur intramedullary shape and the femoral neck (femoral anteversion, femoral offset, and neck-shaft angle) were described for primary hip osteoarthritis (OA) [29] or developmental dysplasia of the hip (DDH) [3,4]. Proximally porous-coated stems not anatomic in shape reportedly have a revision rate resulting from aseptic loosening of 0.9% at 15 to 18 years followup [11].…”

Section: Introductionmentioning

confidence: 99%

“…However, when proximal fixation on cancellous bone is favored with an anatomic stem, optimal fit-and-fill of the metaphysis can be difficult to obtain with commercially available marketed prostheses, even with various anatomic designs and sizes [40]. Furthermore, abnormal femoral anatomy affects not only the intramedullary canal, but also the extramedullary part of the femur [29]. Considering intramedullary and extramedullary expected anatomic variations, we presumed custom cementless stems might restore and maintain hip function and result in less osteolysis and a high survival rate in patients younger than 50 years.…”

Section: Introductionmentioning

confidence: 99%

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Custom Cementless Stem Improves Hip Function in Young Patients at 15-year Followup

Flécher

Pearce

Parratte

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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THA in young patients is challenging regarding restoration and survival because patients are young, active, and tend to have disturbed anatomy. We asked whether a three-dimensional custom cementless stem could restore hip function, decrease osteolysis and wear, and enhance stem survival in young patients. We retrospectively reviewed 212 patients (233 hips) younger than 50 years (mean, 40 years) at a followup of 5 to 16 years (mean, 10 years). The Merle D'Aubigné-Postel and Harris hip scores improved at last followup. No thigh pain was recorded for any of the patients; 187 of the 212 patients (88%) had full activity recovery, 206 had full range of motion, and 151 had a score greater than 80 points for all five categories of the Hip disability and Osteoarthritis Outcome score. Five patients had femoral osteolysis not associated with pain. With revision for any reason as an end point, the survivorship was 87% (range, 77%-97%) at 15 years, and considering stem revision only, the survivorship was 93% (confidence interval, 90%-97%) at 15 years. Our data compare favorably with those from series using standard cementless stems at the same followup with a high percentage of patients achieving functional restoration and a low rate of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Custom Cementless Stem Improves Hip Function in Young Patients at 15-year Followup

Flécher

Pearce

Parratte

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…Subsequently the idea of distal over-reaming combined with proximally anatomic and hydroxyapatite-coated stem was introduced [43,47]. However, the wide varia-tion in the shape and size of the proximal femoral medullary canal makes it impossible in practice to achieve perfect cortical contact between the stem and the endosteal cortical bone [20,28,36].…”

Section: Introductionmentioning

confidence: 99%

The effects of cementless femoral stem shape and proximal surface texture on ’fit-and-fill' characteristics and on bone remodeling

Laine

Puolakka

Moilanen

et al. 2000

International Orthopaedics

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We measured the post-operative radiological "fit and fill" of two different femoral stem designs, one with a straight proximally porous-coated n=50) and the other with a proximally anatomic, hydroxyapatite-coated and distally over-reamed stem (ABG, n=26). A comparison was then made between the clinical and radiological 5-year follow-up data of these two series and also of the bone remodeling changes around the stems. The observed differences in "fit and fill" parameters in the metaphyseal region were minute. However, in the diaphyseal bone the straight stem had substantially more cortical contact. The clinical results were excellent for both groups. Subsidence (>2 mm) was more frequent with the anatomical ABG stems, although the ABG stems had better bone ingrowth in the lower metaphyseal area. The present results indicate that the anatomical design may improve the fit and fill of a femoral stem in the metaphysis. On the other hand, a looser fill of the diaphyseal bone made the stems of this type more susceptible to subsidence. The straight stem with tight diaphyseal fit showed excellent stability, but the good bone ingrowth and remodeling around the distal part of the stem indicates stress transfer through this region and increased stress shielding of the proximal metaphyseal femur.Résumé Nous avons mesuré l'adaptation et le remplissage radiographique postopératoire de deux modèles diffé-rents de tiges fémorales, une tige droite avec la porosité proximale (BI-Metric, n=50) et une tige proximalement anatomique revêtue d'hydroxyapatite avec un surfaçage distal (ABG, n=26). Nous avons comparé les renseignements cliniques et radiographiques de ces deux séries de données résultant d'un suivi de cinq ans. Le remodelage osseux autour des tiges a été pris en compte. Les diffé-rences observées dans les paramètres de l'adaptation et de remplissage dans la région métaphysaire étaient minimales. Par contre dans la région diaphysaire la tige droite faisait montre de plus de contact cortical et ceci d'une manière significative. Les résultats cliniques sur ces deux groupes furent excellents. L'enfoncement (>2 mm.) de tiges anatomiques ABG était plus fréquent. Les résul-tats présentés indiquent que le modèle anatomique pourrait améliorer l'adaptation et le remplissage de la tige fé-morale dans la région de l'os métaphysaire.

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Morphometric evaluation of proximal femur in patients with unilateral total hip prosthesis

et al. 2013

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It is important to know the morphometric characteristics of the proximal femur. This is necessary to reduce the risk of complications related to surgical procedures performed in the area due to vascular, metabolic, or traumatic causes. It is of importance for achieving the alignment of the prosthesis to be implanted as well. The aim of this study was to evaluate the morphometric characteristics of the proximal femur and to establish a database for making and performing total hip prosthesis. Anteroposterior (AP) pelvic radiographs of 162 cases, with a mean age of 65.6 years, who had undergone unilateral total hip arthroplasty were used in this study. Femoral head diameter (FHD), femoral neck width (FNW), femoral neck length (FNL), femoral neck axis length (FNAL), intertrochanteric line length (ILL), and neck-shaft angle (NSA) were measured on radiographs obtained digitally using setrapacs media. FHD was found to be 48.1 ± 3.7 mm, FNW 35.4 ± 4.2 mm, FNL 30.8 ± 6.1 mm, FNAL 98.6 ± 9.4 mm, ILL 81.1 ± 7.9 mm, and NSA 130.4 ± 5.1° on average. The comparison of the mean values for females and males revealed a statistically significant difference between the FHD, FNW, FNL, FNAL, and ILL (P = 0.000). There was no statistically significant difference in NSA between males and females (P = 0.356). A weak correlation was found between age and parameter values using correlation analysis (r < 0.24, P > 0.05). In morphometric assessment of the proximal femur, taking into consideration regional and sexual differences is of importance for prosthesis design and surgical success.

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Three-dimensional morphology of the proximal femur

Cited by 172 publications

References 16 publications

Custom Cementless Stem Improves Hip Function in Young Patients at 15-year Followup

Custom Cementless Stem Improves Hip Function in Young Patients at 15-year Followup

The effects of cementless femoral stem shape and proximal surface texture on ’fit-and-fill' characteristics and on bone remodeling

Morphometric evaluation of proximal femur in patients with unilateral total hip prosthesis

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