Ultra-Short Anatomic Uncemented Femoral Stem and Ceramic-on-Ceramic Bearing in Patients With Idiopathic or Ethanol-Induced Femoral Head Osteonecrosis

Kim, Young Hoo; Park, Jang Won

doi:10.1016/j.arth.2019.08.047

Cited by 11 publications

(13 citation statements)

References 40 publications

(52 reference statements)

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“…From the above-mentioned studies, it follows that the femoral stem survivorship in patients with ONFH is in the range from 88% to 100% at 10-years follow-up, with the use of different short stems. 5,8,20 Our results are at the upper level of this range.…”

Section: Discussionmentioning

confidence: 49%

“…Kim and Park 5 published a study of the largest group of young patients with a Proxima stem implanted for idiopathic, or ethanol induced femoral head necrosis. They assessed 256 patients (335 hips) with an average age of 49.8 years.…”

Section: Discussionmentioning

confidence: 99%

“…In an effort to minimise these concerns (preservation of the femoral intramedullary canal and maintenance of femoral elasticity), short and ultra-short uncemented anatomical stems were introduced. 5 The short anatomical stems could be advantageous in younger patients with ONFH, where restoration of normal bone load transmission is crucial for long-term survival of the implant. However, clinical reports on the outcome of these stems in patients with ONFH are scarce.…”

Section: Introductionmentioning

confidence: 99%

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Total hip arthroplasty with ultra-short uncemented stem in patients with osteonecrosis of the femoral head: mid-term results

et al. 2021

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Background: Mid-term results (clinical and radiographic) of ultra-short anatomical cementless stem total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH) has not often been presented. The aim of this study is to evaluate THA using the Proxima stem in patients with ONFH in the mid-term. Methods: The study consists of 73 patients (97 THAs) with a Proxima stem implanted between 2006 and 2015. The mean age of patients was 47.4 years, with a mean follow-up 105.2 months. The clinical results include preoperative and postoperative Harris Hip Scores (HHSs). Radiological follow-up reports on stem migration, bony trabecular development and radiolucent lines. The complications and revisions were registered. Kaplan-Meier survival analysis was performed to determine the implant survival. Results: The average HHS improved significantly from 40.3 preoperatively to 98.0 at the final evaluation ( p ˂ 0.0001). Stem migration (subsidence and “varisation”) was observed in 11 hips (in 9 of them up to 6th postoperative month without any further progression, in 2 with progressive migration and radiological loosening). Bony trabecular development was detected in modified Gruen zones (1,2,4,6,7 for Proxima stem): in zone 1 (0%), 2 (67.0%), 4 (64.9%), 6 (64.9%), 7 (0%). Radiolucent lines were observed in 1 cup and 6 stems (2 were loose, 4 with fibrous stable fixation). Complications were found in 5 hips (5.1%): squeezing hip once, repeated dislocation in 1, 1 early deep infection, and 2 loose stems. 2 hips (2.1%) were revised (dislocation, infection). The implant survival was 98.9% and 97.9% clinically and radiologically, respectively. Conclusions: Observations in the mid-term show that the clinical and radiological results of the Proxima stem in patients with ONFH are promising. The stem design preserves the proximal femoral bone stock. The bony trabecular appearance confirms physiological proximal femoral load transmission.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Total hip arthroplasty with ultra-short uncemented stem in patients with osteonecrosis of the femoral head: mid-term results

et al. 2021

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“…We identified 6 studies reporting ceramic fracture, noise, and osteolysis after THAs of ONFH patients 9,[40][41][42][43][44] . In those studies, there were neither ceramic fractures nor osteolysis.…”

Section: Discussionmentioning

confidence: 99%

Third-Generation Ceramic-on-Ceramic Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head

Kim

Park

et al. 2021

Journal of Bone and Joint Surgery

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Background: Long-term follow-up results of ceramic-on-ceramic (COC) total hip arthroplasty (THA), specifically, in patients with osteonecrosis of the femoral head (ONFH) are unknown. We evaluated (1) clinical results and radiological outcomes, (2) ceramic-related complications: noise and ceramic fracture, (3) osteolysis, and (4) survivorship after alumina COC THA in ONFH patients with longer than 10-year follow-up.Methods: From May 2003 to June 2009, 325 ONFH patients (403 hips) underwent primary THAs at our department. Among them, 231 patients (293 THAs) were followed for 10 to 16 (mean, 12.9) years. There were 148 men and 83 women, their mean age at the time of THA was 47.2 years, and their mean body index was 24.0 kg/m 2 . The postoperative CT scans were done in 160 hips.Results: Grinding sensation or squeak was noted in 6.8% (20/293), ceramic head fracture occurred in 2.4% (7/293) and acetabular osteolysis developed in 0.7% (2/293). All 7 ceramic fractures occurred in 28-mm short-neck heads. There was no detectable wear or prosthetic loosening, and the 16-year survivorship was 96.0% (95% confidence interval; 93.8% to 98.2%). The mean Harris hip score was 91.7 (range, 84 to 100) points at the final follow-up. Conclusions:The 10-to 16-year results of alumina COC THAs were encouraging with an excellent survivorship. However, ceramic fracture and noise still remain matters of concern. We recommend not to use 28-mm short-neck ceramic head to avoid ceramic head fractures. Level of Evidence: IIIO steonecrosis of the femoral head (ONFH) is a devastating disease frequently leading to osteoarthritis of the hip. Nontraumatic ONFH usually affects young and middle-aged adults and frequently progresses to arthritis of the hip. In the United States, about 10,000 new patients are affected with the disease annually and the number of THAs performed for the disease has increased over the past decade 1 . In Japan, the annual incidence was more than 2,400 in 2015 2 . In South Korea, the estimated prevalence increased from 9,870 in 2002 to 18,691 in 2006 3 . In an epidemiological survey, the cumulative number of patients with the disease reached 8.12 million in China 4 . In these patients, total hip arthroplasty (THA) with use of metal-on-conventional polyethylene bearings has been associated with high failure rates mainly due to polyethylene wear and debrisrelated osteolysis 5 . To minimize the wear-related failure, durable articulations; ceramic-on-cross-linked polyethylene, metal-on-crosslinked polyethylene, metal-on-metal, and ceramic-on-ceramic (COC) bearings have been introduced [6][7][8][9][10] . Among these articulations, the COC articulation has the lowest wear rate that can translate to minimal osteolysis and longer implant survival 11 . Also Conflict of interest: Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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“…For these patients, attempts to preserve the femoral head by performing osteotomies or bone grafting procedures might delay or prevent the need for an arthroplasty, but the degree of improvement in pain and function may be suboptimal. In contrast to traditional THA implants, short-stem femoral components are sometimes used in an attempt to preserve metaphyseal bone stock [59][60][61][62][63][64]. However, the true implications of employing these implant designs in the setting of osteonecrosis has not been con rmed.…”

Section: Rationale For Pico #3mentioning

confidence: 99%

Diagnosis and Treatment of Femoral Head Osteonecrosis: A Protocol for Development of Evidence-Based Clinical Practice Guidelines

et al. 2021

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Introduction: There are many treatment options for patients who have osteonecrosis of the femoral head (ONFH) and management strategies vary widely both among and within individual countries. Although many researchers have attempted to elucidate the optimal strategies for managing this disease, the lack of large-scale randomized control trials and the lack of agreement on disease staging have curtailed the development of clear-cut guidelines. Materials and Methods: The Association Research Circulation Osseous (ARCO) group sought to address three questions for the management of patients who have ONFH: 1) What imaging studies are most sensitive and specific for the diagnostic evaluation of patients who have ONFH?; 2) What is the best treatment strategy for preventing disease progression in patients who have pre-collapse lesions?; and 3) What is the best treatment strategy for patients who have post-collapse disease? The Patient, Intervention, Comparison, and Outcome (PICO) format was used to formulate the search strategy for each research question. A systematic review will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ARCO participants have been allocated to three groups, each representing one of the PICO questions. After qualitative and quantitative analysis of the data extracted from studies pertaining to each of the three research questions, a set of evidence-based clinical practice guidelines will be proposed for the management of patients who have ONFH. Discussion: It is not always clear which treatment method is optimal for the management of ONFH. Thus, many surgeons have developed and performed various procedures based on patient-specific factors. As there is no consensus on the optimal treatment for various stages of disease, it was clear that developing evidence-based clinical practice guidelines would provide more structure and uniformity to management of these patients. Therefore, the results of this systematic review will lead to the development guidelines that may improve patient-care strategies and result in better outcomes for patients who have ONFH.

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Ultra-Short Anatomic Uncemented Femoral Stem and Ceramic-on-Ceramic Bearing in Patients With Idiopathic or Ethanol-Induced Femoral Head Osteonecrosis

Cited by 11 publications

References 40 publications

Total hip arthroplasty with ultra-short uncemented stem in patients with osteonecrosis of the femoral head: mid-term results

Total hip arthroplasty with ultra-short uncemented stem in patients with osteonecrosis of the femoral head: mid-term results

Third-Generation Ceramic-on-Ceramic Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head

Diagnosis and Treatment of Femoral Head Osteonecrosis: A Protocol for Development of Evidence-Based Clinical Practice Guidelines

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