Among 320 hip arthroplasties performed between January 2007 and March 2008, patients younger than 50 years old and patients older than 70 with a T-score at the proximal femur less than -2.5 made up the control and study group, respectively. There were 40 patients in each group. We measured stem subsidence, both digital and manual methods. Measurements were made from radiographs taken serially from 2 weeks to 1 year after surgery. The amount of mean subsidence for each group was not different, and all stems showed stable fixation in the final radiographs. Our study suggests that even in osteoporotic proximal femurs, press-fit fixation of double-tapered stems for hip arthroplasty can be safe and effective without excessive early subsidence.
[Show abstract][Hide abstract] ABSTRACT: Severe osteoporosis is becoming a common problem faced by surgeons performing primary hip arthroplasty. As the population ages, osteoporosis is increasing, especially as the population aged more than 80 years increases. Patients may need a total hip replacement to treat osteoarthritis or an acute femoral neck fracture. Recent data have shown an advantage to hip replacement in this population. Although uncemented and cemented designs of femoral prostheses have been used successfully, there is a high rate of periprosthetic fracture associated with the use of uncemented stems in patients with osteoporosis. Successful replacement requires knowledge of the particular stem type used in the weakened proximal femur. Total hip replacement for fracture also has a higher rate of dislocation. Additional study is required to determine if a particular uncemented stem design is better than others in this scenario or whether more use of cemented stems would help to limit periprosthetic fracture.
[Show abstract][Hide abstract] ABSTRACT: Use of cementless hip replacements is increasing in many countries, but the best method for fixation for octogenarian patients remains unknown.
We studied how fixation method (cemented, cementless, hybrid) affects the survival of primary hip replacements and mortality in patients 80 years or older. Specifically, we asked if fixation method affects (1) the risk of revision; (2) the reasons for revision; and (3) the mortality after contemporary primary hip replacement in octogenarian patients.
A total of 4777 primary total hip replacements were performed in 4509 octogenarian patients with primary osteoarthritis in Finland between 1998 and 2009 and were registered in the Finnish Arthroplasty Register. Comorbidity data were collected from a nationwide quality register. Survival of hip replacements, using any revision as the end point, and mortality were analyzed using competing risks survival analysis and Cox regression analysis. The average followup was 4 years (range, 1-13 years).
Cementless hip replacements were associated with a higher rate of early (within 1 year) revision compared with cemented hip replacements (hazard ratio, 2.9; 95% CI, 1.7-5.1), particularly in women. The difference was not explained by comorbidity or provider-related factors. Periprosthetic fracture was the leading mode of failure of cementless hip replacements. After 1 year, there were no differences in the survival rates although 10-year survival was slightly lower for cementless than cemented and hybrid hip replacements (93.9% [95% CI, 91.1%-96.7%] versus 97.4% [95% CI, 96.9%-98.0%] and 98.1% [95% CI, 96.9%-99.4%], respectively). Fixation method was not associated with mortality.
Cementless fixation was associated with an increased risk of revision and did not provide any benefit in terms of lower mortality in octogenarian patients.
Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 04/2014; 472(9). DOI:10.1007/s11999-014-3641-7 · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report midterm functional, radiographic and survivorship data for the cemented, triple taper C-stem AMT femoral component from a consecutive cohort of 415 hip arthroplasties in 386 patients at a non-developer centre. Follow-up ranges were from 60 to 99months, with a mean of 76months. 32 hips were lost to follow-up. The median OHS was 40, median SF-12 mental component score (MCS) was 50, and median SF-12 physical component score (PCS) was 39. At 99months follow up, stem survivorship is 96.9% (95% confidence interval (CI) 82.5-99.5), and construct survivorship is 96.0% (95% CI 84.2-99.0). Adverse events such as calcar fracture, greater trochanter fracture and dislocation were rare at <1%. There have been no revisions for aseptic loosening.
The Journal of Arthroplasty 05/2014; DOI:10.1016/j.arth.2014.04.034 · 2.67 Impact Factor
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