Total hip arthroplasty with an uncemented hydroxyapatite-coated tapered titanium stem: results at a minimum of 10years’ follow-up in 104 hips

Bodén, Henrik; Salemyr, Mats; Sköldenberg, Olof; Ahl, Torbjörn; Adolphson, Per

doi:10.1007/s00776-005-0986-5

Cited by 29 publications

(23 citation statements)

References 151 publications

(186 reference statements)

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“…Excellent clinical results have been reported with a variety of uncemented stems (Bourne et al 2001, Aldinger et al 2003, Bodén et al 2006, Sanz-Reig et al 2011). We observed equally excellent clinical results with the ultra-short stem in patients with adequate bone stock.…”

Section: Discussionmentioning

confidence: 93%

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Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Salemyr¹,

Muren²,

Ahl³

et al. 2015

Acta Orthopaedica

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Background and purpose — We hypothesized that an ultra-short stem would load the proximal femur in a more physiological way and could therefore reduce the adaptive periprosthetic bone loss known as stress shielding.Patients and methods — 51 patients with primary hip osteoarthritis were randomized to total hip arthroplasty (THA) with either an ultra-short stem or a conventional tapered stem. The primary endpoint was change in periprosthetic bone mineral density (BMD), measured with dual-energy x-ray absorptiometry (DXA), in Gruen zones 1 and 7, two years after surgery. Secondary endpoints were change in periprosthetic BMD in the entire periprosthetic region, i.e. Gruen zones 1 through 7, stem migration measured with radiostereometric analysis (RSA), and function measured with self-administered functional scores.Results — The periprosthetic decrease in BMD was statistically significantly lower with the ultra-short stem. In Gruen zone 1, the mean difference was 18% (95% CI: −27% to −10%). In zone 7, the difference was 5% (CI: −12% to −3%) and for Gruen zones 1–7 the difference was also 5% (CI: −9% to −2%). During the first 6 weeks postoperatively, the ultra-short stems migrated 0.77 mm more on average than the conventional stems. 3 months after surgery, no further migration was seen. The functional scores improved during the study and were similar in the 2 groups.Interpretation — Up to 2 years after total hip arthroplasty, compared to the conventional tapered stem the ultra-short uncemented anatomical stem induced lower periprosthetic bone loss and had equally excellent stem fixation and clinical outcome.

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Section: Discussionmentioning

confidence: 93%

“…The conventional stem, evaluated as control, has been used extensively in our practice—with more than 2,000 implanted stems since 1990 and with excellent clinical and radiographic results (Bodén et al 2006). …”

Section: Methodsmentioning

confidence: 99%

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Salemyr¹,

Muren²,

Ahl³

et al. 2015

Acta Orthopaedica

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“…It has plasma-sprayed hydroxyapatite (HA) on the entire surface (thickness 65–95 µm, crystallinity 50–70%, purity > 95%) to enable fast ingrowth into osteoporotic bone. The geometry of the stem, except for the collar, is identical to that of the Bi-Metric stem (Meding et al 2004, Boden et al 2006). …”

Section: Methodsmentioning

confidence: 99%

“…Excellent long-term results have been reported for patients with primary osteoarthritis (OA) of the hip (Boden et al 2006a). The concept of inserting an uncemented femoral component is attractive to many surgeons, as the cementing procedure can induce cardiac arrhythmia and/or cardiorespiratory collapse (Parvizi et al 1999).…”

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confidence: 99%

Good stability but high periprosthetic bone mineral loss and late-occurring periprosthetic fractures with use of uncemented tapered femoral stems in patients with a femoral neck fracture

et al. 2014

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Background and purposeWe previously evaluated a new uncemented femoral stem designed for elderly patients with a femoral neck fracture and found stable implant fixation and good clinical results up to 2 years postoperatively, despite substantial periprosthetic bone mineral loss. We now present the medium-term follow-up results from this study.Patients and methodsIn this observational prospective cohort study, we included 50 patients (mean age 81 (70–92) years) with a femoral neck fracture. All patients underwent surgery with a cemented cup and an uncemented stem specifically designed for fracture treatment. Outcome variables were migration of the stem measured with radiostereometry (RSA) and periprosthetic change in bone mineral density (BMD), measured with dual-energy X-ray absorptiometry (DXA). Hip function and health-related quality of life were assessed using the Harris hip score (HHS) and the EuroQol-5D (EQ-5D). DXA and RSA data were collected at regular intervals up to 4 years, and data concerning reoperations and hip-related complications were collected during a mean follow-up time of 5 (0.2–7.5) years.ResultsAt 5 years, 19 patients had either passed away or were unavailable for further participation and 31 could be followed up. Of the original 50 patients, 6 patients had suffered a periprosthetic fracture, all of them sustained after the 2-year follow-up. In 19 patients, we obtained complete RSA and DXA data and no component had migrated after the 2-year follow-up. We also found a continuous total periprosthetic bone loss amounting to a median of –19% (–39 to 2). No changes in HHS or EQ-5D were observed during the follow-up period.InterpretationIn this medium-term follow-up, the stem remained firmly fixed in bone despite considerable periprosthetic bone mineral loss. However, this bone loss might explain the high number of late-occurring periprosthetic fractures. Based on these results, we would not recommend uncemented femoral stems for the treatment of femoral neck fractures in the elderly.

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“…in the coated region of the stem (Figure 3). In primary arthroplasty, using the same prosthesis, the incidence of spot welds is higher (Bodén et al 2006). The reason for this may be that the endocortex in the proximal femur is smooth with less trabecular bone in a revision situation.…”

Section: Discussionmentioning

confidence: 94%

Good results with an uncemented proximally HA-coated stem in hip revision surgery: 62 hips followed for 2–13 years

et al. 2008

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Background and purpose Proximal bone loss due to stress-shielding is a matter of concern after uncemented femoral hip revision. We have used short, proximally hydroxyapatite-coated prostheses in revision since 1989, and we now report the results.Methods 60 patients (62 hips) were revised because of aseptic loosening. Bone defects prior to revision were mostly of type II according to the Gustilo-Pasternak and Endo-Klinik classifications. Follow-up time was 73 (24-161) months. 9 patients had died before follow-up; 8 of these still had the stem in place. Clinical assessment was performed with the Harris hip score. Radiographs were evaluated for bone defects at revision, postoperative stem fixation, and periprosthetic bone remodeling.Results Mean Harris hip score was 75 (30-100) points. There was no stem loosening or progressive subsidence. 8 patients had mild to moderate thigh pain. Osteolysis, present at revision, had diminished, partially or completely, in four-fifths of the hips at follow-up. 4 hips had required re-revision due to fracture or dislocation. The 6-year prosthesis survival rate was 95% (95% CI: 0.83-0.98).Interpretation Uncemented revision with a short, proximally hydroxyapatite-coated prosthesis is a reliable procedure with encouraging results in the medium term if bone defects at revision are moderate.

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Total hip arthroplasty with an uncemented hydroxyapatite-coated tapered titanium stem: results at a minimum of 10years’ follow-up in 104 hips

Cited by 29 publications

References 151 publications

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Good stability but high periprosthetic bone mineral loss and late-occurring periprosthetic fractures with use of uncemented tapered femoral stems in patients with a femoral neck fracture

Good results with an uncemented proximally HA-coated stem in hip revision surgery: 62 hips followed for 2–13 years

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