scholarly journals Predicting Cementless Stem Fixation in Total Hip Arthroplasty Using Radiodensity Mapping

10.29007/dv5n ◽  
2020 ◽  
Author(s):  
Teja Cherukuri ◽  
Chameka Madurawe ◽  
Jim Pierrepont ◽  
Jonathan Bare ◽  
Stephen McMahon ◽  
...  
Keyword(s):  
Bone Density ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
X Rays ◽  
Implant Fixation ◽  
X Ray ◽  
Total Hip ◽  
Stem Subsidence

Femoral component loosening due to poor fixation is a common failure mode in cementless total hip arthroplasty (THA). We sought to develop a technique to predicted femoral stem fixation using pre-operative CT.Forty-nine patients requiring THA received pre-operative CTs as part of Corin OPSTM 3D dynamic planning. All patients received a taper wedged blade stem (TriFitTM TS, Corin UK) implanted through a posterior approach. Post-operatively, patients received an immediate CT and AP x-ray and a 1-year follow-up x-ray. The distance between the most superior point of the greater trochanter and the shoulder of the stem was measured and scaled using the known cup diameter on both the immediate and 1- year follow-up x-rays. The difference was recorded as stem subsidence. Subsidence greater than 4mm was deemed clinically relevant. The precise placement of the stem determined by registering the known 3D implant geometry to the post-op CT was virtually implanted back into the pre-operative OPSTM planning software. A colour map of the bone density at the stem/bone interface using the Hounsfield Units (HU) of each CT pixel was generated. Blue represents low density bone transitioning through to green and then red.Mean stem subsidence was 1.8mm (0 to 11.1mm). Five patients had clinically relevant subsidence. Significant areas of blue and green around the proximal portion of the stem was observed in high subsidence stems when compared to the stems with minimal subsidence.Using the HU of the CT scan as an indicator for bone density, we were able to predict poor implant fixation and subsequent subsidence in a taper wedge stem.

scholarly journals Ten-year comparison of two different techniques for femoral bone cavity preparation—broaching versus compaction in patients with cementless total hip arthroplasty

2021 ◽  
Vol 2 (12) ◽  
pp. 1035-1042
Author(s):  
Maciej Okowinski ◽  
Mette Holm Hjorth ◽  
Sebastian Breddam Mosegaard ◽  
Jonathan Hugo Jürgens-Lahnstein ◽  
Stig Storgaard Jakobsen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Femoral Bone ◽  
Total Hip ◽  
Stem Subsidence ◽  
Femur Fractures

Aims Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. Methods A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. Results Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. Conclusion Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042.

scholarly journals Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jingyang Sun ◽  
Bohan Zhang ◽  
Lei Geng ◽  
Qingyuan Zheng ◽  
Juncheng Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Influencing Factors ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Femoral Stem ◽  
Femoral Anteversion ◽  
Total Hip

Abstract Background Placement of femoral stem in excessive anteversion or retroversion can cause reduced range of motion, prosthetic impingement, and dislocation. The aim of this study was to assess the operative femoral anteversion in patients treated with total hip arthroplasty (THA) and analyze the need of adjusting stem anteversion. Methods We retrospectively included 101 patients (126 hips) who underwent cementless THA with a manual goniometer to determine the femoral anteversion between October 2017 and December 2018. The operative femoral anteversion we measured was recorded during THA. We further divided those hips into three subgroups based on the range of operative femoral anteversion: group 1 (<10°), group 2 (10–30°), and group 3 (>30°) and compared the differences of their demographic data. Univariate and multivariate logistic regression were used to identify the influencing factors for the need of neck-adjustable femoral stem. The clinical and radiographic outcomes were also assessed. Perioperative complications were recorded. Results After THA, the Harris hip scores improved from 52.87 ± 15.30 preoperatively to 90.04 ± 3.31 at the last follow-up (p < 0.001). No implant loosening, stem subsidence, and radiolucent lines were observed on radiographs. No severe complications occurred and no components needed revision at the latest follow-up. The mean operative femoral anteversion was 14.21° ± 11.80° (range, −9 to 60°). Patients with femoral anteversion more than 30° were about 10 years younger than others. Femoral anteversion >30° was more common in patients with developmental dysplasia of the hip (DDH). There were totally 14 hips treated with the neck-adjustable femoral stem. From the univariate analysis, we can observe that female sex, diagnosis of DDH (compared with osteonecrosis), and higher operative femoral anteversion and its value >30° (compared with <10°) are associated with higher rates of using the neck-adjustable femoral stem. However, all these factors were no longer considered as independent influencing factors when mixed with other factors. Conclusions This study highlighted the significance of operative femoral anteversion. Identification of abnormal femoral anteversion could assist in adjusting stem anteversion and reduce the risk of dislocation after THA.

Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions

2020 ◽  
Vol 102-B (11) ◽  
pp. 1491-1496
Author(s):  
Pranai K. Buddhdev ◽  
Ivor S. Vanhegan ◽  
Tahir Khan ◽  
Aresh Hashemi-Nejad
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Adolescent And Young Adult ◽  
Medium Term ◽  
Total Hip ◽  
Custom Made ◽  
The Mean ◽  
Custom Made Prostheses

Aims Despite advances in the treatment of paediatric hip disease, adolescent and young adult patients can develop early onset end-stage osteoarthritis. The aims of this study were to address the indications and medium-term outcomes for total hip arthroplasty (THA) with ceramic bearings for teenage patients. Methods Surgery was performed by a single surgeon working in the paediatric orthopaedic unit of a tertiary referral hospital. Databases were interrogated from 2003 to 2017 for all teenage patients undergoing THA with a minimum 2.3 year follow-up. Data capture included patient demographics, the underlying hip pathology, number of previous surgeries, and THA prostheses used. Institutional ethical approval was granted to contact patients for prospective clinical outcomes and obtain up-to-date radiographs. In total, 60 primary hips were implanted in 51 patients (35 female, 16 male) with nine bilateral cases. The mean age was 16.7 years (12 to 19) and mean follow-up was 9.3 years (2.3 to 16.8). Results The most common indication for teenage hip arthroplasty was avascular necrosis secondary to slipped upper femoral epiphysis (31%; n = 16). Overall, 64% of patients (n = 33) had undergone multiple previous operations. The survival at follow-up was 97%; two patients required revision for aseptic loosening (one femoral stem, one acetabular component). Both patients had fused hips noted at the time of arthroplasty. A further two patients had radiolucent lines but were asymptomatic. At latest follow-up the mean Oxford Hip Score was 44 (31 to 48) and a Visual Analogue Scale measurement of 1.5, indicating satisfactory function. Conclusion Operating on this cohort can be complicated by multiple previous surgeries and distorted anatomy, which in some cases require custom-made prostheses. We have demonstrated a good outcome with low revision rate in this complex group of patients. Cite this article: Bone Joint J 2020;102-B(11):1491–1496.

Midterm outcomes of total hip arthroplasty with a modular Birmingham head

2019 ◽  
pp. 112070001987738 ◽  
Author(s):  
Duncan W Cushnie ◽  
Brent A Lanting ◽  
Richard McCalden ◽  
Douglas DR Naudie ◽  
James L Howard
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Tissue Reaction ◽  
Harris Hip Score ◽  
Total Hip ◽  
Tissue Reactions ◽  
Clinical Records

Introduction: Birmingham Hip Resurfacing (BHR) implants may be combined with a conventional femoral stem to create a modular metal-on-metal total hip arthroplasty (BHR MoM THA). There is little outcome data regarding this construct. This study examines midterm outcomes of BHR MoM THA compared to oxidised zirconium total hip arthroplasty (THA). Methods: A retrospective institutional review identified all patients receiving BHR MoM THA between April 2005 and February 2011 and a matched control cohort of zirconium THA patients. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and SF-12 Health status scores were obtained. Revisions and complications were collected from clinical records. Radiographs were assessed for evidence of component malposition, loosening, osteolysis, or heterotopic ossification. Results: 63 modular BHR MoM THA were identified in 61 patients (36 with BHR cups, 27 with R3 cups) and 63 zirconium THA in 58 matched controls. Mean follow-up was 58 months. 14 BHR MoM THA hips (22.2%) were revised (4 infections, 1 dislocation, 9 soft tissue reactions) compared to 3 (4.8%) zirconium THA (all infections). At latest follow-up, 18.4% of surviving BHR MoM THA hips were painful compared to 0.5% of zirconium THA controls ( p < 0.001). WOMAC, HHS, and SF-12 did not differ significantly between surviving members of the 2 groups. Discussion: BHR MoM THA demonstrated a high revision rate, largely for adverse local soft tissue reaction and pain. Among those not revised, many reported some residual pain despite similar quality of life measures to those who received zirconium THA.

scholarly journals Short to Midterm Follow-Up of Periprosthetic Bone Mineral Density after Total Hip Arthroplasty with the Ribbed Anatomic Stem

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Xiang-Dong Wu ◽  
Mian Tian ◽  
Yao He ◽  
Hong Chen ◽  
Yu Chen ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Mineral Density ◽  
Periprosthetic Bone ◽  
Gruen Zone ◽  
X Ray ◽  
Periprosthetic Bone Mineral Density

Background. Femoral bone remodeling around hip prosthesis after total hip arthroplasty (THA) is definite but unpredictable in time and place. This study aimed to investigate the implant-specific remodeling and periprosthetic bone mineral density (BMD) changes after implantation of the Ribbed anatomic cementless femoral stem. Methods. After power analysis, 41 patients who had undergone primary unilateral THA with the Ribbed anatomic cementless stem were included. BMD of the seven Gruen zones was measured by dual-energy X-ray absorptiometry, and the contact, fitness, and fixation of the femoral stem and proximal femur were analyzed by X-ray. Additional clinical outcome parameters were also recorded. Results. Compared with the contralateral unoperated side, significant reductions of BMD were detected in the distal zone (Gruen zone 4: 1.665±0.198 versus 1.568±0.242 g/cm2, P=0.001) and middle distal zone (Gruen zone 5: 1.660±0.209 versus 1.608±0.215 g/cm2, P=0.026) on the prosthetic side, but no significant differences in BMD were detected in other zones (Gruen zones 1, 2, 3, 6, and 7). Subgroups analyses indicated no significant correlation between periprosthetic BMD changes and clinical factors including primary disease and body mass index. Visible areas of bone ingrowth indicated solid fixation of the femoral stem and there was no case of loosening. Clinical and functional outcome scores were excellent with mean HHS of 93.13 points and mean WOMAC score of 5.20 points, and three patients described intermittent mild thigh pain at the final follow-up. Conclusions. For the Ribbed femoral stem, the periprosthetic BMD was well maintained in the proximal femur, while periprosthetic BMD was significantly reduced in the distal and middle distal zones of the femur. Further clinical investigations are required to examine the efficacy of the Ribbed stem, particularly with regard to long-term survival. This trial is registered with ChiCTR1800017750.

scholarly journals Results of Conversion from Failed Austin-Moore Hemiarthroplasty to Cementless Total Hip Arthroplasty in Octogenarian Patients with Advanced Acetabular Erosion: A Minimum of 5 Years of Follow-Up

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Tsan-Wen Huang ◽  
Chih-Hsiang Chang ◽  
Fu-Chun Chang ◽  
Chun-Chieh Chen ◽  
Kuo-Chin Huang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Femoral Neck Fractures ◽  
Total Hip ◽  
Cementless Total Hip Arthroplasty ◽  
Mid Term Results ◽  
Acetabular Erosion ◽  
Austin Moore

Austin-Moore hemiarthroplasty (HA) had been selectively used for elderly patients with femoral neck fractures. With increasing life span and activity, the sequela of Austin-Moore HA make the implant no longer favorable. The treatment of failed Austin-Moore HA with advanced acetabular erosion is challenging; however, little has been published regarding this topic. The aim of this study was to evaluate the mid-term results of using cementless total hip arthroplasty (THA) in octogenarians. Between 2008 and 2011, 47 patients (32 women and 15 men) with an average age of 86 years (range 83-89 years) were enrolled in this retrospective study. After an average follow-up period of 6.2 years (range 5.0-7.8 years), no migration or loosening of the cup or femoral stem was found. Harris hip scores improved from 36 (range 15-42) preoperatively to 87 (range 80-90). There were no complications directly associated with the procedure except for superficial infections in two patients. Our results suggest that using cementless THA can result in favorable radiographic and clinical outcomes in octogenarian patients.

Perioperative Fracture Risk and Two-Year Survivorship of a Short Tapered Femoral Stem following Direct Anterior Approach Cementless Total Hip Arthroplasty with a Fracture Table

2020 ◽  
Vol 04 (01) ◽  
pp. 033-037
Author(s):  
Samantha Andrews ◽  
Gregory J. Harbison ◽  
Ian Hasegawa ◽  
Emily Unebasami ◽  
Cass Nakasone
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Femoral Stem ◽  
Direct Anterior Approach ◽  
Total Hip ◽  
Fracture Table ◽  
Short Femoral Stem

AbstractThe cementless, tapered wedge, short femoral stem implant is commonly used in direct anterior approach (DAA) total hip arthroplasty (THA). The lack of access and visualization, however, may increase the risk of perioperative fracture and early failure. Therefore, the current study examined perioperative complications and 2-year implant survivorship following DAA THA performed using a fracture table and short, tapered wedge femoral stem. A retrospective analysis was conducted on patients having undergone DAA THA with a cementless, tapered wedge, short femoral stem. Perioperative fractures were noted and survivorship was determined by the incidence of revision surgery within a minimum 2-year follow-up period. A total 366 consecutive patients (441 hips) were identified in the cohort. Four patients (6 hips; 1.4%) were lost to follow-up and three patients died from unrelated causes. Average follow-up time for the remaining 359 patients (435 hips) was 32.9 ± 10.2 months. There were no intraoperative factures but three perioperative fractures within two weeks. Aseptic loosening occurred in one stem at 13 months, resulting in a 99.1% survival rate with a mean survival time of 23.8 ± 0.1 months (95% confidence interval: 23.6–24.0 months). The use of a short, tapered wedge femoral stem and a fracture table for DAA THA resulted in 0.7% periprosthetic fractures and only one aseptic loosening within 2 years. These results suggest that proper femoral exposure with the use of a fracture table and a short, tapered wedge femoral stem does not appear to increase the risk of periprosthetic femoral fracture.

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