Mid-Term Outcomes of Cemented Stem and Subtrochanteric Shortening Derotational Osteotomy in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia

Background Performing total hip arthroplasty (THA) in patients with Crowe IV developmental dysplasia of the hip (DDH) is technically challenging. Subtrochanteric shortening osteotomy is typically required for placing the acetabular component within the anatomic hip center. However, the outcomes of subtrochanteric osteotomy using cemented components are not widely reported. This study aimed to evaluate the outcomes of cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy in patients with Crowe IV DDH.Methods We retrospectively evaluated data of patients with Crowe IV DDH who underwent cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy between 2010 and 2018. Patients who underwent surgery at the hip joint were excluded. Data regarding pre- and postoperative clinical and radiological parameters were collected and reviewed.Results Among 14 patients included (14 hips), the mean age was 60.4 (range, 47–73) years. The mean Harris hip score improved from 40.7 to 87.7. The mean limb length discrepancy reduced from 52 mm to 12.7 mm. No neurologic deficits were noted. The mean osteotomy union time was 10.6 months. Delayed union and postoperative dislocation were observed in one and two patients, respectively. Cement leakage into the osteotomy gap was observed in one patient. No revisions were required. No signs of loosening or migration were observed. Conclusions Cemented stem THA combined with subtrochanteric femoral shortening and transverse derotational osteotomy is safe and effective for the treatment of patients with Crowe IV DDH. The cemented femoral component showed promising mid-term follow up results. However, cement leakage affects bone healing. Osteotomy and cementing should be performed meticulously.Trial Registration: Retrospectively registered

The Olympia anatomic polished cemented stem is associated with a high survivorship, excellent hip-specific functional outcome, and high satisfaction levels: follow-up of 239 consecutive patients beyond 15 years

Introduction The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term survivorship, radiographic outcome, and patient-reported outcome measures (PROMs) of the Olympia stem. Patients and methods Between May 2003 and December 2005, 239 patients (264 THAs) underwent a THA with an Olympia stem in our institution. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS), EuroQol-5 dimensions (EQ-5D) score, and patient satisfaction at mean 10 years following THA. Patient records and radiographs were then reviewed at a mean of 16.5 years (SD 0.7, 15.3–17.8) following THA to identify occurrence of complications or revision surgery for any cause following surgery. Radiographs were assessed for lucent lines and lysis according to Gruen’s zones Results Mean patient age at surgery was 68.0 years (SD 10.9, 31–93 years). There were 156 women (65%, 176 THAs). Osteoarthritis was the indication for THA in 204 patients (85%). All cause stem survivorship at 10 years was 99.2% (95% confidence interval [CI], 97.9%–100%) and at 15 years was 97.5% (94.6%–100%). The 15-year stem survival for aseptic loosening was 100%. Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (96.3%–100%) at 10 years and 95.9% (92.4%–99.4%) at 15 years. There were 9 THAs with non-progressive lucent lines in a single Gruen zone and 3 had lines in two zones, and no patient demonstrated signs for lysis. At a mean of 10-year (SD 0.8, 8.7–11.3) follow-up, mean OHS was 39 (SD 10.3, range 7–48) and 94% of patients reported being very satisfied or satisfied with their THA. Conclusions The Olympia stem demonstrated excellent 10-year PROMs and very high rates of stem survivorship at final follow-up beyond 15 years.

Atypical periprosthetic femoral fractures after arthroplasty for fracture are at high risk of complications

It is difficult to investigate clinical features in a single-center study because atypical periprosthetic femoral fracture (APFF) is rare. This study aims to perform a nationwide survey of APFF to investigate the characteristics of this fracture and compare the clinical outcome with that of typical periprosthetic femoral fracture (typical PFF). A nationwide survey was performed asking for cooperation from 183 councilors of the Japanese Society for Fracture Repair. The subjects were patients with APFF injured between 2008 and 2017. The control group was comprised of patients with typical PFF of our facility injured in the same period. A total of 43 patients met the APFF definition. The control group was comprised of 75 patients with typical PFF. The rate of bisphosphonate use was significantly higher in the APFFs group than in the typical PFF group (62.8% and 32%, p < 0.02). The rate of cemented stem was significantly higher in the APFFs group than in the typical PFF group (30.2% and 6.7%, p < 0.001). In the patients with arthroplasty for hip fracture, multivariable logistic regression analyses showed that APFF was an independent risk factor of complications following the initial management (Odds ratio 11.1, 95% confidence interval 1.05–117.2, p = 0.045). However, no significant association between PFF and APFF was observed in the patients with arthroplasty for other hip diseases. The risk of complications was higher in the APFF group than in the typical PFF group in the patients with arthroplasty for fracture. When AFPP after arthroplasty for the fracture is suspected, it may be necessary to add not only internal fixation with a normal plate but also some additional treatment.

Cemented femoral stem fixation through the anterior approach has fewer early complications than cementless fixation

Aims To achieve the functional benefits of the direct anterior (DA) approach and the fixation benefits of cemented replacement, this study combined the two techniques posing the following questions: does the limited access of the DA approach adversely affect the cement technique?; and does such a cementing technique reduce the incidence of cementless complications? Methods A consecutive series of 341 patients (360 hips) receiving the DA approach between 2016 and 2018 were reviewed. There were 203 cementless stems and 157 cemented stems. Mean age was 75 years (70 to 86) in the cementless group and 76 years (52 to 94) in the cemented group, with 239 (70%) females in the whole series. Femoral complications were compared between the two groups. Mean follow-up was 1.5 years (0.1 to 4.4) for patients in the cementless group and 1.3 years (0.0 to 3.9) for patients in the cemented group. Results The cementless group had a higher rate of femoral complications (8 vs 0; p = 0.011). There were two loose stems and six fractures, all requiring revision. Fractures occurred a mean 14.5 days (2 to 31) postoperatively and loosening at 189 days and 422 days postoperatively. Femoral cementing can be done using the DA approach safely and reduces the number of complications compared with a contemporary cementless series. Conclusion A higher rate of early fractures and loosening occurred with cementless stems. This was not observed in our cemented stem cohort and cementing was safely accomplished through the DA approach. The modern femoral cementing process with the DA approach does not add to surgical complexity or time, has fewer early complications, and is a safer option for older patients compared to cementless femoral arthroplasties. Cite this article: Bone Joint J 2021;103-B(7 Supple B):33–37.

Quantitative measurements of adaptive bone remodeling around the cemented Zimmer® segmental stem after tumor resection arthroplasty using dual-energy x-ray absorptiometry

Background Limb salvage surgery (LSS) is the preferred method for treatment of patients with sarcomas and to a greater extent also to patients with metastatic bone disease. The aim of the present study was to evaluate the adaptive remodeling of the periprosthetic cortical bone after insertion of a tumor prosthesis with cemented stem. Methods A prospective study of 21 patients (F/M = 12/9), mean age 55 years (range 15–81) with metastatic bone disease (n = 9), sarcomas (n = 8) or aggressive benign tumors (n = 4) who underwent bone resection due to a tumor, and reconstruction with a tumor-prosthesis (Zimmer® Segmental 130 mm straight fluted cemented stem with trabecular metal (TM) collars) in the proximal femur (n = 10), distal femur (n = 9) or proximal tibia (n = 2). Measurements of bone mineral density (BMD) (g/cm2) were done postoperatively and after 3, 6, and 12 months using dual-energy X-ray absorptiometry. BMD was measured in 4 regions of interest around the cemented stem and in one region of interest 1 cm proximal from the ankle joint of the affected limb and measurement of the contralateral ankle was used as reference. Repeated measures ANOVA and students paired t-test was used to evaluate BMD changes over time. Results At 1-year follow-up, BMD decreased compared to baseline in all four regions of interest with a statistically significant bone loss of 8–15%. The bone loss was most pronounced (14–15%) in the 2 regions of interest closest to the trabecular metal (TM) collar and lowest (8%) adjacent to the tip of the stem. Conclusion After 1 year the decrease in bone mineral density of the ankle on the affected limb was 9% and the contralateral ankle was close to baseline, thus suggesting that the periprosthetic bone mineral density changes during follow-up, mainly are caused by stress shielding and immobilization. Trial registration The study was approved by the Scientific Ethical Committee of the Capital Region of Denmark (J. No. H-2-2014-105) and the Danish Data Protection Agency (J. No.:2012–58-00004).

Anterolateral Bone Window for Revision Broken Cemented Stem of Unipolar Hemiarthroplasty

Background. Fractured stem of the hip prosthesis is well documented in the literature. Although it is rare, it is considered as a challenging problem. Many techniques have been described to solve this problem. Purpose of the Study. Evaluation of the effect of anterolateral bone window for extraction of the cemented femoral stem of hemiarthroplasty in revision total hip replacement. Methods. The study included eight revision hip arthroplasties in eight patients, with a broken stem of cemented (Thompson) hemiarthroplasty, which has been revised by the anterolateral proximal femoral window. All cases received cemented cups and cement-in-cement stems, except one case who received cementless long stem. Clinical follow-up of cases by Harries hip score (HHS) and X-ray. Results. Functional improvement of HHS of all cases, with no signs of loosening, after a mean follow-up period of 1.5 years. Conclusion. Extraction of broken stem is a challenging procedure. Many techniques have been described for revision of cases with a fractured stem of hip prosthesis, but we think that the anterolateral femoral bone window is a reproducible technique due to the characteristics of simplicity, short-time procedure, less invasive, not requiring extra instruments, and can be successful for most patients.