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Arun Kannan MD John R. Owen MS Jennifer S. Wayne PhD William A. Jiranek MD 《Clinical orthopaedics and related research》2014,472(7):2231-2236
Background
Experimental studies have suggested that initial micromotion of cementless components may lead to failure of osteointegration. Roentgen stereophotogrammetric analyses have shown durable implant fixation can be achieved long-term even when initial instability exists, as evidenced by subsidence. However improved implant stability as a result of subsidence, before osteointegration, has not been shown biomechanically.Questions/purposes
We asked whether insertionally loose cementless tapered femoral stems show (1) less rotational stability (more toggle); (2) more subsidence; and (3) reduced ability to resist torsion (lower initial construct stiffness), lower torque at failure, and greater rotation to failure in comparison to well-fixed cementless tapered femoral stems.Methods
Ten matched pairs of cadaveric femurs were implanted with well-fixed and loose cementless tapered stems. The loose stem construct was obtained by appropriately broaching the femur but afterwards inserting a stem one size smaller than that broached. Femoral stem rotational stability of implanted femurs was tested by measuring the angular rotation (ie, toggle) required to produce a torque of 2 N-m at 0 N, 250 N, and 500 N vertical load in 25° adduction simulating single-legged stance. Subsidence was measured as vertical movement during the toggle tests. Then at 500 N initial vertical load, femoral stems were externally rotated to failure. The construct stiffness between 5 and 40 N-m was determined to assess ability to resist torsion. The torque and rotation to failure were recorded to compare failure characteristics. Groups were compared using mixed model ANOVA followed by Tukey–Kramer post hoc pairwise comparison for toggle and subsidence tests and by Student’s paired t-tests for stiffness, torque at failure, and rotation to failure tests.Results
Loose tapered cementless stems were less stable (ie, more toggle) than well-fixed at 0 N of load (p < 0.0001), but no difference was detectable in toggle between loose and well-fixed stems at 250 N (p = 0.7019) and 500 N (p = 0.9970). Loose tapered cementless stems showed significant subsidence at 250 N (p < 0.0001) and 500 N (p < 0.0001), which was not found in the well-fixed stems at 250 N (p = 0.8813) and 500 N (p = 0.1621). Torsional stiffness was lower for loose stems as compared with well-fixed stems (p = 0.0033). No difference in torque at failure (p = 0.7568) or rotation to failure (p = 0.2629) was detected between loose and well-fixed stems.Conclusions
In this study, we observed that insertionally loose cementless stems have the ability to subside and become rotationally stable with loading. They did not exhibit a lower torque or rotation to failure in comparison to well-fixed stems when under simulated single-legged stance.Clinical Relevance
Secondary rotational stabilization may prevent insertionally loose tapered stems from producing a stress pattern that predisposes to early postoperative periprosthetic fracture around loose cemented stems. 相似文献3.
Ingwon Yeo Kee-Hyung Rhyu Sang-Min Kim Yoon-Soo Park Seung-Jae Lim 《International orthopaedics》2016,40(11):2365-2371
Purpose
Unified classification system (UCS) type B1 periprosthetic femoral fractures are associated with many complications, and management decisions continue to be controversial. The purpose of this study was to evaluate outcomes of UCS type B1 periprosthetic femoral fractures treated by locking compression plating with strut allograft augmentation.Materials and methods
We retrospectively reviewed 17 consecutive UCS type B1 periprosthetic femoral fractures treated by open reduction and internal fixation using a lateral locking compression plate supplemented with an anterior cortical strut allograft. There was one man and 16 women with an average age of 74 years (range, 57–92 years). All had a cementless hip arthroplasty, and eight of the arthroplasties were revisions.Results
The mean duration of follow-up was 28 months (range, 12–74 months). All 17 fractures healed successfully at a mean of 20 weeks (range, 12–30 weeks). The mean post-operative Harris hip score was 86 points (range, 77–95 points). No mechanical complications such as failure of plate or screws and malalignment were noted. According to the graft-remodeling classification of Emerson et al., a partial bridging was observed in nine and a complete bridging in eight. Two patients required a removal of the plate due to irritation of the iliotibial band. No femoral stem loosening or deep infection was observed.Conclusion
Our findings indicate that open reduction and internal fixation of UCS type B1 periprosthetic femoral fractures using a lateral locking compression plate supplemented with anterior cortical strut allograft provides adequate mechanical stability of fracture fixation and enhances the fracture healing.4.
Matthew J. Grosso Jonathan R. Danoff Taylor S. Murtaugh David P. Trofa Andrew N. Sawires William B. Macaulay 《The Journal of arthroplasty》2017,32(1):150-154
Background
Hemiarthroplasty (HA) has been a mainstay treatment for displaced femoral neck fractures for many years. The purpose of this study was to report the conversion rate of HA to total hip arthroplasty (THA) for displaced femoral neck fractures and compare outcomes between implant constructs (bipolar vs unipolar), fixation options (cemented vs cementless stems), and age groups (<75 years vs ≥75 years).Methods
We retrospectively reviewed the results of a consecutive cohort of 686 patients who underwent HA for the treatment of femoral neck fractures at our institution between 1999 and 2013 with a minimum of 2-year follow-up.Results
The overall component revision rate, including conversion to THA, revision HA, revision with open reduction internal fixation, and Girdlestone procedure, was 5.6% (39/686). Seventeen patients (2.5%) were converted from HA to THA at an average of 1.9 years after index procedure. A significantly lower conversion rate of 1.4% (7/499 patients) was found in the older patient cohort (≥75 years old) compared to 5.3% (11/187) in the younger cohort. The most common causes for conversion surgery to THA were acetabular wear (5 patients), aseptic loosening (4 patients), and periprosthetic fracture (3 patients). There was a significantly lower rate of periprosthetic fracture (0.4% vs 2.5%, P value .025) in the cemented implant group compared to the cementless group. We observed a higher rate of dislocations in the bipolar vs unipolar group (3.8% vs 1%, P value .02) and no other significant differences between these groups.Conclusion
We observed a low reoperation rate for this cohort of patients, relatively higher conversion rates for the younger population, fewer periprosthetic fractures with the use of cemented stems, and no advantage of bipolar over unipolar prostheses. 相似文献5.
Andrew C. Waligora John R. Owen Jennifer S. Wayne Shane R. Hess Gregory J. Golladay William A. Jiranek 《The Journal of arthroplasty》2017,32(6):2023-2027
Background
Despite literature to support the use of various cerclage techniques to address intraoperative femoral fractures in total hip arthroplasty, there are limited data to support prophylactic cerclage wiring of the femur during cementless implant placement. This study aims to evaluate the effect of prophylactic calcar cerclage wires on the biomechanical parameters required to produce periprosthetic femoral fractures and on the morphology of these fracture patterns in stable cementless femoral implants.Methods
Ten pairs of matched fresh frozen cadaveric femurs were implanted with anatomic tapered cementless implants with or without the addition of 2 monofilament calcar wires. Specimens were axially loaded and externally rotated to failure. Initial torsional stiffness, rotation and energy to failure, and torque at failure were measured. Statistical significance was set at P < .05. Fracture patterns were classified according to a well-known classification system.Results
Wired specimens required significantly more rotation (P = .039) and energy to failure (P = .048). No significant difference was detected in initial torsional stiffness (P = .63) or torque at failure (P = .10). All unwired samples developed a Vancouver B2 fracture pattern. Seven of the 8 wired specimens also developed a Vancouver B2 fracture pattern, while the eighth wired specimen developed a Vancouver B1 fracture pattern.Conclusion
Prophylactic cerclage wire placement increases the rotation and energy to failure in well-fixed press-fit femoral implants. The increase in torsional energy needed for failure may reduce the risk of early periprosthetic fracture. Further studies are needed to evaluate cost vs benefit and long-term outcomes of prophylactic wiring. Based on the results of our study, consideration of prophylactic wiring should be addressed on a case-to-case basis. 相似文献6.
Andrew N. Fleischman Max M. Schubert Camilo Restrepo Antonia F. Chen Richard H. Rothman 《The Journal of arthroplasty》2017,32(11):3457-3461
Background
Intraoperative fractures during total hip arthroplasty (THA) are more common when using cementless stems. The purpose of this study was to investigate the impact of a new shorter second-generation cementless, tapered wedge stem with improved proximal femoral fit in reducing the incidence of intraoperative fracture.Methods
A retrospective study was conducted on primary THA cases performed at a single institution using a first-generation or second-generation cementless stem from 2006-2016. All intraoperative femur fractures were identified, as well as early 30-day postoperative periprosthetic femur fractures, which could represent nondisplaced intraoperative fractures that were initially missed. Risk for intraoperative femur fracture was analyzed using logistic regression, accounting for demographic covariates and surgeon.Results
Of 6473 primary THA performed with a cementless, tapered wedge stem during the study period, 3126 used a first-generation stem and 3347 used a second-generation stem. The incidence of intraoperative fracture was 1.79% for first-generation stems and 0.24% for second-generation stems, representing a 7.5-fold reduction of risk for fracture. After accounting for covariates, the odds of intraoperative fracture were 0.33 using the second-generation stem relative to the first-generation stem (P = .01). However, there was no significant difference in the odds of early 30-day postoperative fractures using the second-generation stem (odds ratio 0.93, P = .56).Conclusion
A new second-generation cementless stem resulted in a 7.5-fold decrease in the incidence of intraoperative femur fracture compared with the preceding stem. 相似文献7.
Kerem Canbora Ozkan Kose Atilla Polat Faruk Aykanat Mucahit Gorgec 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2013,23(5):545-552
Objective
The purpose of this study was to evaluate the clinical results of femoral revision using an uncemented extensively porous-coated long femoral stems with or without onlay strut allografts in the treatment of Vancouver type B2 and B3 periprosthetic femoral fractures.Materials and methods
We retrospectively reviewed 17 cases of periprosthetic femoral fracture (eight B2 and nine B3) treated with the uncemented extensively porous-coated long femoral stem. Clinical outcomes were assessed with Harris Hip Score and Barthel ADL index. Radiological evaluations were conducted using Beals and Towers’ criteria. Any complication during the follow-up period was recorded.Results
The average follow-up period was 41.7 ± 31.08 (range, 15–132) months. The average Harris Hip Score was 68.2 ± 18.4 (range, 32–100), and the average Barthel ADL index was 80.1 ± 19.75 (range, 30–100) points at the final follow-up. All fractures were united, and a good graft consolidation was achieved in 5 of 9 cases. There was femoral stem subsidence in 4 cases less than 10 mm without an evidence of loosening both radiologically and clinically. The radiological results using Beals and Towers’ criteria were excellent in eight hips, good in five and poor in four.Conclusions
An uncemented extensively porous-coated long femoral stem together with or without onlay strut allografts provides a good fracture stability that promotes fracture healing and offers a successful solution for the management of Vancouver type B2 and B3 femoral periprosthetic fractures. 相似文献8.
Masanobu Ohishi Yasuharu Nakashima Takuaki Yamamoto Goro Motomura Jun-ichi Fukushi Satoshi Hamai Yusuke Kohno Yukihide Iwamoto 《International orthopaedics》2016,40(8):1601-1606
Purpose
Femur deformities can make stem fixation difficult in total hip arthroplasty (THA). We report the clinical results of cementless THA using a press-fit stem in patients who had previously undergone femoral osteotomy for hip dysplasia.Methods
The subjects included 66 hips in 64 patients, with the mean follow-up period of 7.3 years. THA was performed at a mean period of 17.1 years after intertrochanteric femoral osteotomy. Valgus osteotomy was performed in 42 hips, and varus osteotomy in 24. Clinical results were evaluated by using the Merle d’Aubigne-Postel score. Implant survival was determined with revision as the end point, and any related complications were investigated.Results
The Merle d’Aubigne-Postel score improved from 9.4 to 16.1 at the final follow-up, without any implant loosening. However, periprosthetic femoral fractures were observed in four hips (6.0 %), one intra-operatively and three within three weeks after THA. Among these cases, three hips previously had varus osteotomy (12.5 %) and one hip had valgus osteotomy (2.3 %). Two hips were revised with full porous stems and circumferential wiring. The five and ten year cumulative survivorship rates were 97 % (range, 88.8–99.3 %) and 97 % (88.8–99.3 %), respectively.Conclusions
Although the use of a press-fit cementless stem yielded acceptable results in most of the patients, perioperative femoral fracture was a major complication especially in the patients previously treated with intertrochanteric varus osteotomy. Careful planning and implant selection could be emphasized for these cases.9.
Cortical Strut Allograft Support of Modular Femoral Junctions During Revision Total Hip Arthroplasty
Chin Tat Lim Derek F. Amanatullah James I. Huddleston Katherine L. Hwang William J. Maloney Stuart B. Goodman 《The Journal of arthroplasty》2017,32(5):1586-1592
Background
There is risk of junction failure when using modular femoral stems for revision total hip arthroplasty (THA), especially with loss of bone stock in the proximal femur. Using a cortical strut allograft may provide additional support of a modular femoral construct in revision THA.Methods
We reviewed prospectively gathered clinical and radiographic data for 28 revision THAs performed from 2004 to 2014 using cementless modular femoral components with cortical strut allograft applied to supplement proximal femoral bone loss: 5 (18%) were fluted taper designs and 23 (82%) were porous cylindrical designs All the patients had a Paprosky grade IIIA or greater femoral defect. The mean follow-up was 5.4 ± 3.9 years.Results
The Harris Hip Scores improved from 26 ± 10 points preoperatively to 71 ± 10 points at final follow-up (P < .001). The Western Ontario McMaster Universities Osteoarthritis Index scores improved from 45 ± 12 points preoperatively to 76 ± 12 points at final follow-up (P < .001). Eighty-nine percent (25 hips) of all revision or conversion THAs were in place at final follow-up. Three (11%) patients underwent reoperations, 2 for infection and 1 for periprosthetic fracture. There was no statistical significant change in femoral component alignment (P = .161) at final follow-up. Mean subsidence was 1.8 ± 1.3 mm at final follow-up. Femoral diameter increased from initial postoperative imaging to final follow-up imaging by a mean of 9.1 ± 5.1 mm (P < .001) and cortical width increased by a mean of 4.5 ± 2.2 mm (P < .001). Twenty-seven hips (96%) achieved union between the cortical strut allograft and the host femur.Conclusion
The use of a modular femoral stem in a compromised femur with a supplementary cortical strut allgraft is safe and provides satisfactory clinical and radiological outcomes. 相似文献10.
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Purpose
We wished to compare the outcome of two types of cemented and uncemented modern stem design implants after hemiarthroplasty, with both an Orthopaedic Data Evaluation Panel rating of 10A.Methods
This retrospective study compares data obtained from two centres, with a total study population of 655 (n?=?393 cemented, n?=?262 uncemented). Patients were matched at baseline for gender, age, surgery side, American Society of Anesthesiologists score, body mass index and pre-operative haemoglobin level. Outcome measurements were prosthesis-related complications, pre- and post-operative, with reoperation rate and mortality and other complications after 1 year, surgery time, blood loss and immobility at discharge.Results
There were no significant differences in mortality after 1 year, total other complications, immobility at the time of discharge and total prosthesis-related complications between both groups. Significantly more periprosthetic fractures and post-operative infections were seen in the uncemented group with significantly more reoperations compared to the cemented group. Significant differences were seen in cardiovascular complications, blood loss and surgery time in favour of the uncemented group.Conclusions
In consequence of the significant higher prosthesis-related complications (e.g. infections, periprosthetic fractures and reoperations) in the uncemented group in this study, we recommend cemented hemiarthroplasty in patients with a femoral neck fracture.Level of evidence
Level III, Case Controlled Study.12.
Introduction
The SOFCOT symposium (2005) on periprosthetic fractures of the femur (PFFs) highlighted a high rate of dislocation (15.6% at 6 months) after change of prosthesis. So far, no study has ever proved the benefit of dual-mobility articulation during PFFs revisions. We conducted a comparative study on two prospective cohorts in order to (1) assess the influence of systematic acetabular revision in favor of a double mobility on dislocation rate (2) and in order to evaluate the rate of morbidity associated with this extra surgical procedure.Hypothesis
A systematic replacement of the cup in favor of a dual-mobility articulation enables to reduce the dislocation rate in PFFs revisions without increasing morbidity.Methodology
We compared two prospective multicenter cohorts over a year (2005 and 2015) using the same methodology. Any fracture around hip prosthesis which occurred 3 months at least after surgery was included. Data collection was clinical and radiological on preoperative, intraoperative and 6 months after surgery. The 2015 “bipolar” group (n = 24) included patients who had a bipolar revision (both femoral and dual-mobility articulation). The 2005 “unipolar” group (n = 25) included patients who had only a femoral implant revision. Patients were comparable by age (p = 0.36), sex (p = 0.91), ASA score (p = 0.36), history of prosthetic revision (p = 1.00), Katz score (p = 0.50) and the type of fracture according to the Vancouver classification (p = 0.55).Results
There was a 4% rate of dislocation in the “bipolar group” while there was 21% rate of dislocation in the “unipolar group” (8% of recurrent dislocation) (p = 0.19). The rate of all-cause complications 6 months after surgery was not significantly different (p = 0.07): 12.5% in the 2015 “bipolar” cohort (one dislocation, one non-symptomatic cup migration and one pseudarthrosis of the major trochanter) versus 35% in the “unipolar” cohort (5 dislocations, 1 major trochanter fracture and 1 femur pseudarthrosis, 1 secondary displacement associated with a superficial infection). The surgical revision after 6 months was not significantly different (1/23 or 4% vs. 4/25 or 16%, p = 0.35).Conclusion
We confirm the low rate of dislocations after fitting a dual-mobility cup in case of revision of the femoral side in case of periprosthetic femoral fracture, as well as the need for additional cases to be carried out upon further studies to significantly confirm the interest of preventing instability after femoral revision.13.
Background
The femoral neck fracture is one of the most common fractures in the elderly. A variety of methods and approaches are used to treat it. Total hip arthroplasty is a preferred approach in independent, mobile, elderly patients, given its more favorable long-term outcome.Our hypothesis is that the direct anterior approach in geriatric trauma patients has a lower dislocation-rate with the advantage of early recovery due to a muscle sparing approach and therefore early possible full weight-bearing.Methods
Patients were retrospectively sought who suffered a femoral neck fracture from 2008 to 2013. All patients were treated through a direct anterior approach and using the same brand of implants. Medical history, standardized physical exam, conventional pelvic plain and axial hip x-rays, Harris Hip Score, Merle D'Aubigné and Postel and SF-36 were assessed.Results
Eighty-six patients were included in the study with a mean age of seventy-five years. The mortality rate was 16.7 %. Complications were encountered in nineteen patients (22.0 %) who needed operative revision and one postoperative complication (1.2 %) which could be handled conservatively. There were five intraoperative complications (5.8 %), two dislocations (2.3 %), one aseptic loosening in a non-cemented stem (1.2 %), six periprosthetic fractures in non-cemented stems (6.9 %), one displacement of a non-cemented cup (1.2 %), two early infections (2.3 %) and three hematomas (3.5 %) recorded.Conclusions
Although the direct anterior approach is associated with a rather long learning curve we have found it to preserve the soft-tissues with no injury to abductors. It therefore shows an early advantage in elderly patients in terms of early recovery and therefore early possible full weight-bearing. Fracture treatment with dual mobility cups might lead to lower dislocation rates, but are associated with higher costs. Due to higher complication rates in non-cemented versus cemented shafts, we have changed our practice towards favoring cemented femoral stems in patients with suspected or manifest osteoporosis.14.
Long Wang Zixun Dai Ting Wen Mingqing Li Yihe Hu 《Archives of orthopaedic and trauma surgery》2013,133(2):275-281
Purpose
Modular femoral prostheses can provide independent distal fixation and intraoperative flexibility and are being used increasingly, especially in patients with proximal femoral bone defects. This retrospective clinical study evaluated whether modular prostheses were effective and reliable implants for femoral revision.Method
This case series consisted of 58 patients who underwent hip revision with a tapered modular femoral prosthesis at our institution between 2004 and 2008. Mean patient age at surgery was 64 years (range 18–86 years). Femoral bone defects before revision surgery were evaluated using the Paprosky classification. All patients were followed for a minimum of 3 years (mean 4.3 years, range 3–7 years) with clinical and radiographic evaluation. Re-revisions and complications were also recorded.Results
Two stems required re-revision, one each for recurrent deep infection and periprosthetic fracture. At last follow-up, the Harris Hip Score and Visual Analog Pain Scores had improved significantly, the median radiographic stem migration was 1.6 mm, leg length discrepancy was corrected in 64 % of the patients and osseointegration occurred in 90 %. Complications included intraoperative fracture in 10 (17 %) patients and hip dislocation in 2 (3 %).Conclusion
Modular femoral components can improve hip function, provide distal fixation, equalize leg length, and result in fewer complications when used to revise failed femoral components. 相似文献15.
Gerasimos Petridis Martin Nolde Jürgen Beck Michael Scherer Thomas Perneger 《European orthopaedics and traumatology》2014,5(3):221-231
Introduction
This prospective 12 months of dual-energy X-ray absorptiometry (DEXA) study evaluated differences in periprosthetic bone mineral density in 40 patients undergoing cementless total hip arthroplasty (THA) by a minimally invasive anterior approach (AMIS), using Medacta AMIStem or Quadra stems. Both stems are straight rectangular. AMIStem shows reduced lateral flare and length in comparison to Quadra.Objectives
The main goal of the study is to verify if bone mineral density is equivalent following THA with the AMIStem and Quadra femoral components.Methods
Forty patients were randomly allocated to the Quadra and AMIStem groups. Three patients were lost to follow-up because they moved to another town, and revision surgery was performed on one patient due to periprosthetic fracture after a car accident. Patients were examined clinically and underwent DEXA preoperatively and at 1 week, 6 weeks, 6 months, and 1 year after THA. Patients enrolled had no preexisting lower limb arthroplasty and no osteoporosis.Results
Harris hip score increased significantly for Quadra stem 5.3?±?14.1 and AMIStem 41.0?±?13.4. The high-activity hip score increased significantly for Quadra stem 3.8 ±2.2 and AMIStem 4.1?±?2.4. Considering 0.15 mg/cm2 as an acceptable difference, bone mineral density for AMIStem and Quadra groups was statistically equivalent. A limited remodeling process with slight bone loss in the proximal calcar region R7, as expected after implantation of uncemented components, was observed for both stems.Conclusions
The study demonstrates that the two stems are statistically equivalent in all zones at all time points investigated. 相似文献16.
Jörg Schilcher Ingemar Ivarsson Rico Perlbach Lars Palm 《The Journal of arthroplasty》2017,32(4):1220-1226
Background
Cementless femoral stems in total hip arthroplasty provide dependable clinical and radiographic results in the treatment of osteoarthritis. Stem length might affect the preservation of proximal bone stock and stability. We hypothesized that a shorter stem decreases proximal bone loss without affecting implant stability.Methods
We randomly assigned 60 patients aged between 50 and 70 years to either a standard cementless femoral stem or a 35-mm shorter version. Patients were followed with dual-energy X-ray absorptiometry, radiostereometric analysis, Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, and clinical follow-up at 3, 6, 12, and 24 months. The trial is registered on ClinicalTrials.gov/.Results
After 24 months, short stems had on average 3.8% (95% confidence interval, 1.2%-8.9%) more bone loss in zone 1 compared to standard stems (P = .14). In zone 7, the bone loss was on average 6.5% (95% confidence interval, 6.6%-19.7%) higher compared to standard stems (P = .33). After 24 months, standard stems had migrated 0.93 mm (range, 0.25-4.66 mm) and short stems 0.93 mm (range, 0.17-2.96 mm; Student t-test after log transformation, P = .3). Patient-reported outcome measures were similar in both groups. One patient in the standard stem group was diagnosed with infection, one with a posterior dislocation, and one with a deep venous thrombosis. No stems were revised.Conclusion
There were no statistically significant differences in periprosthetic bone loss or fixation between the stems at 24 months. 相似文献17.
Tanner W. Grant Luke R. Lovro David J. Licini Lucian C. Warth Mary Ziemba-Davis Robert M. Meneghini 《The Journal of arthroplasty》2017,32(3):891-897
Background
Femoral component stability and resistance to subsidence is critical for osseointegration and clinical success in cementless total hip arthroplasty. The purpose of this study was to radiographically evaluate the anatomic fit and subsidence of 2 different proximally tapered, porous-coated modern cementless femoral component designs.Methods
A retrospective cohort study of 126 consecutive cementless total hip arthroplasties was performed. Traditional fit-and-fill stems were implanted in the first 61 hips with the remaining 65 receiving morphometric tapered wedge stems. Preoperative bone morphology was radiographically assessed by the canal flare index. Canal fill in the coronal plane, subsidence, and the sagittal alignment of stems was measured digitally on immediate and 1-month postoperative radiographs.Results
Demographics and canal flare indices were similar between groups. The percentage of femoral canal fill was greater in the tapered wedge compared to the fit-and-fill stem (P = .001). There was significantly less subsidence in the tapered wedge design (0.3 mm) compared to the fit-and-fill design (1.1 mm) (P = .001). Subsidence significantly increased as body mass index (BMI) increased in the fit-and-fill stems, a finding not observed in the tapered wedge design (P = .013).Conclusion
An anatomically designed morphometric tapered wedge femoral stem demonstrated greater axial stability and decreased subsidence with increasing BMI than a traditional fit-and-fill stem. The resistance to subsidence, irrespective of BMI, is likely due to the inherent axial stability of a tapered wedge design and may be the optimal stem design for obese patients. 相似文献18.
Christian Hank Michael Schneider Cheryl S. Achary Leslie Smith Steffen J. Breusch 《Archives of orthopaedic and trauma surgery》2010,130(1):17-22
Purpose
To analyse the influence of femoral stem design in the lateral plane (anatomic vs. straight) on the cement mantle quality.Method
In this consecutive multi-surgeon radiographic study we determined, Dorr grading, cement mantle quality (Barrack) and mantle thickness using Gruen zones 1–14 in 280 primary cemented total hip replacements, divided into two groups (140 anatomic Biomet Olympia, 140 straight Exeter Universal Series).Results
Twenty-three per cent of the straight Exeter Universal stems had a cement mantle of <2 mm thickness in Gruen zone 8 and 25% in Gruen zone 9, compared to 0.7% of the anatomical Olympia stems in Gruen zone 8 and 1.4% in Gruen zone 9. The difference between the two groups was statistically significant (P < 0.001). In all other zones no significant differences were found.Conclusion
This radiological study confirms that femoral stems with an anatomical curve in the lateral plane carry a lower risk of thin cement mantles (especially in Gruen zones 8 and 9) than straight stems. Cement mantle analysis in one radiographic plane only is insufficient. 相似文献19.
Gaurav Sharma Ravijot Singh Kiran Kumar GN Vaibhav Jain Ankit Gupta Shivanand Gamanagatti Kamran Farooque Vijay Sharma 《International orthopaedics》2016,40(5):1009-1017
Purpose
To determine whether radiographic measurements derived from standard computed tomography (CT) evaluation can be used to predict likelihood of a peri-operative lateral femoral wall fracture in AO/OTA 31-A2 pertrochanteric fractures treated with a dynamic hip screw (DHS).Methods
Fifty-one patients with AO/OTA 31-A2 classified pertrochanteric fractures were evaluated using a pre-operative CT scan of the pelvis with both hips. Dimensions of the lateral wall were calculated for each patient using four parameters: (1) height of the lateral wall above the vastus ridge; (2) circumference of the lateral wall 2 cm below the vastus ridge at an angle of 135°; this circumference was further divided into an anterior, lateral and posterior component; (3) cortical thickness at the centre of the lateral component of the lateral wall; and (4) cortical index. All patients were treated with a 135° DHS. Postoperative radiographs were assessed for lateral femoral wall fracture.Results
Patients with a lateral wall fracture (17/51) had a smaller circumference (4.47 cm vs 5.44 cm p value?<0.001) as well as a lower height of the lateral femoral wall (1.37 cm vs 2.21 p value?<?0.001). Analysis of the three components of the circumference revealed a significant difference for the anterior component only and not for the lateral and posterior components. There was no statistical difference in the cortical thickness or cortical index in the two groups. The cutoff values for height of the lateral wall and anterior component were calculated using ROC curves and found to be 1.68 cm (AUC 0.918) and 2.10 cm (AUC 0.851) respectively.Conclusion
AO/OTA 31-A2 pertrochanteric fractures with a lateral wall height of > 1.68 cm and an anterior component of > 2.10 cm in circumference are not likely to sustain a lateral wall fracture when treated with a DHS.20.
Sureshan Sivananthan Chin-Tat Lim Rapeepat Narkbunnam Alex Sox-Harris James I. Huddleston Stuart B. Goodman 《The Journal of arthroplasty》2017,32(4):1245-1249