Total hip arthroplasty for dysplastic coxarthrosis using a cementless Wagner Cone stem

Abstract

Background Total hip arthroplasty (THA) is currently the best surgical option for hip osteoarthritis secondary to developmental hip dysplasia (DDH); it may be extremely challenging, because of the hypoplasic proximal metaphysis, pathological anteversion, and excessive cervico-diaphyseal angle of the neck at the femoral side. The purpose of this retrospective study was to evaluate the long-term survival and clinical and radiological results of Conus uncemented stems, implanted in patients affected by hip osteoarthritis with Crowe not-type IV secondary to DDH. Material and methods We identified 100 consecutive THAs performed for DDH in 63 women and 24 men, with an average age of 53 years in a single center. Thirteen patients underwent bilateral hip replacement. The patients’ mean body mass index was 29.8 kg/m2 (range 27.1–35.6 kg/m2). The main indications for surgery were severe hip pain and considerable functional impairment: the preoperative Harris Hip Score was 29.5 on average (range 22–61). Radiologically, 8 hips were classified as Crowe I, 43 hips as Crowe II, and 49 hips as Crowe III. In all cases, we implanted the Wagner femoral cone prosthesis using the direct lateral approach; in the attempt to reestablish native hip biomechanics, 66 stems were 135° and 34 were 125°. Results The mean follow-up of the study was 11.7 years (range 2.2–21.8 years). Harris Hip Score increased to a mean value of 71.5 points (range 52–93 points). Radiographic evaluation demonstrated osteointegration of the implant with stable bone growth observed at the stem–endosteum interface; signs of bone readaptation and thinning of the femoral calcar were present in nine hips. None of the patients underwent revision for septic or aseptic loosening of the stem; none sustained a periprosthetic fracture. Conclusions This study confirms the theoretical advantages that suggest the choice of the Wagner cone when technical difficulties during prosthetic surgery are expected owing to abnormal proximal femoral anatomy. Level of evidence Level IV, retrospective case study

Outcomes of Ceramic Composite in Total Hip Replacement Bearings: A Single-Center Series

“…A new low-frictional torque arthroplasty theory can be established owing to their sliding characteristics and better wettability than PE: with ceramic components (inlay and head), due to a lower coefficient of friction, it is possible to enlarge the femoral head diameter without increasing the frictional torque and to grant a wider range of movement that will last because ceramic-ceramic bearings avoid wear. When a PE liner develops wear, the center of rotation migrates centrally and/or cranially, and the deeper the head, the more restricted the range of motion becomes; in fact, late dislocation can be the first clinical sign of wear, with a cumulative risk of firsttime dislocation that is 2-fold and 3-fold at 10 and 20 years, respectively, when compared to the 1-year follow-up [14,[30][31][32][33][34][35][36][37][38][39][40][41][42][43]. Breakage of ceramic components is a ceramic-specific issue; we have not seen any fractures in our series.…”

“…Because internal fixation has a significantly greater failure probability, resulting in more pain for these patients, primary arthroplasty stands out as the best option for displaced Garden 3 and 4 femoral neck fractures (FFN). When a THA is performed, the surgeon must consider implant dislocation as a possible complication, which is said to be more common after a hip fracture, with the posterior surgical approach, in elderly patients with soft-tissue laxity due to sarcopenia and thus poor muscular strength, and the attempt to regain the full range of motion before the injury [41,42]. Even with heads bigger than 28 and 22.2 mm, the ceramic-on-ceramic connection delivers little friction and wear.…”

“…The periprosthetic retroacetabular bone should not be regarded as a source of stress shielding: the titanium shell is thought to function as a shock absorber between the high stiffness of the alumina and the likely porotic bone, addressing the problem of socket fixation described when a cup of bulky alumina was cemented into the acetabulum [36]. In Bystrom S et al [42], the femoral head size was shown to be a significant risk factor for prosthesis luxation in a retrospective study of 42,987 primary operations: 22 mm heads performed as well as or better than 28 mm heads, while 28 mm heads led to revision four times more often than 32 mm heads. According to the Norwegian Arthroplasty Register, femoral head size is a risk factor for total hip luxation, with 28 mm heads leading to revision substantially more frequently than 32 mm heads, and 26 mm heads leading to revision significantly more frequently than 30 mm heads.…”

Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review

“…The calcar-to-canal ratio was calculated by dividing the canal width, measured at 10 cm below the lesser trochanter, by the calcar width, measured at the middle level of the lesser trochanter. Femurs with a ratio of 0-0.5 were considered type A, 0.5-0.75 as type B, and 0.75-1 as type C[ 23 , 24 ].…”

Surgical Tactics for Optimizing Total Hip Arthroplasty Technology

“…Применяемые в последние годы для тотального эндопротезирования имплантаты, качество которых постоянно повышается в соответствии с европейскими и международными стандартами, изготавливаются ведущими фирмами из высококачественных современных материалов и имеют некоторые отличительные свойства, касающиеся особенностей конструкции, ее дизайна и технологии применения [16][17][18][19]. Несмотря на усовершенствование протезных систем, остается актуальным вопрос оптимального их выбора для каждого конкретного случая с учетом индивидуальных анатомических особенностей, степени тяжести патологии, наличия сопутствующих нарушений локального или системного характера [20][21][22][23], степени травматичности хирургического доступа, который в свою очередь может сопровождаться большой кровопотерей и нередкими серьезными осложнениями, что требует длительной реабилитации и особого послеоперационного ведения пациентов [24].…”