Does Osteoporosis Increase Early Subsidence of Cement less Double-Tapered Femoral Stem in Hip Arthroplasty?
ABSTRACT 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.
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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 · 2.37 Impact Factor
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ABSTRACT: Concerns exist regarding using short stems during total hip arthroplasties performed in elderly patients. For this study, the authors assessed sequential bone remodeling findings in metaphyseal-loading short stems using serial radiography. A total of 100 consecutive primary THAs using short stems were performed in patients with an average age of 78.3 years. The presence and patterns of radiolucent lines, radiopaque lines, calcar rounding, proximal bone resorption, spot welds, cortical hypertrophy, and intramedullary bone formation around the distal tip were assessed. The final study group comprised 92 hips, and mean follow-up was 60±3 months (range, 48-72 months). At final follow-up, condensations of spot welds were noted in 84 (91.3%) hips. Spot weld formation occurred in all zones except 1 and 4. Calcar rounding was observed in 90 (97.8%) hips. Atrophy of the calcar was noted in 19 (20.6%) hips. Analysis of the proximal zones revealed reactive radiodense lines in zones 1 and 2 (tensile area/shoulder of stem) in 22 (23.9%) hips. A prominent reactive line around the tip of the stem was recorded in 32 (34.8%) hips on radiographs at final follow-up. However, there was no increase in space between the tip of the stem and the radiopaque line. No acetabular or femoral component migrated by more than 1 mm at final follow-up. No acetabular or femoral osteolysis was identified. The radiographic findings of metaphyseal-loading short stems in elderly patients suggest that 91.3% of implants were osseointegrated. No patient required stem revision. Metaphyseal-loading short stems in elderly patients provide continued fixation with adaptive bone remodeling.Orthopedics 07/2014; 37(7):e649-e655. DOI:10.3928/01477447-20140626-57 · 0.98 Impact Factor
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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 · 2.88 Impact Factor