The influence of calcar collar and surface finish in the cemented femoral component on the incidence of postoperative periprosthetic femoral fracture at a minimum of five years after primary total hip arthroplasty |
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| Institution: | 1. Department of Orthopaedic Surgery, Matsudo City General Hospital, 993-1 Sendabori, Matsudo City, Chiba 270-2296, Japan;2. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan;3. Department of Orthopaedic Surgery, Chiba University Center for Frontier Medical Engineering (CFME), Chiba University Division of Spine Surgery, 33 Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan;1. The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, China;2. Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu 610041, China;3. Engineering Research Center of Oral Translational Medicine, Ministry of Education, Chengdu 610041, China;4. National Engineering Laboratory for Oral Regenerative Medicine, Chengdu 610041, China;5. Stomatology Hospital, Zhejiang University School of Medicine, 310000, China;1. Southmead Hospital, Bristol, BS10 6NB, United Kingdom;2. Ninewells Hospital, Dundee, DD2 1SG, United Kingdom;3. Weston General Hospital, Weston-Super-Mare, BS23 4TQ, United Kingdom;4. North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 6NB, United Kingdom;5. Department of Pelvic and Acetabular Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, United Kingdom;1. Service de chirurgie orthopédique et traumatologique, CHU Dupuytren. 2, Avenue Martin Luther King, 87042 LIMOGES cedex;2. Service de pharmacie centrale, CHU Dupuytren. 2, Avenue Martin Luther King, 87042 LIMOGES cedex |
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| Abstract: | IntroductionCemented femoral component design including its mechanical behavior in total hip arthroplasty (THA) has influenced the occurrence of postoperative periprosthetic femoral fracture (PPFF). The main aim of this study was to investigate the influence of the calcar collar and surface finish in the cemented femoral component on the risk of PPFF.Materials and methodsThis retrospective review was undertaken of 1082 primary THAs in 912 patients using cemented femoral components followed for a minimum of five years (mean, 9.4 years; range, 5–24 years). The incidence of PPFF, patients’ demographics and surgical details were evaluated. Kaplan-Meier survivorship analysis was performed for four different outcomes: any PPFF, revision of the femoral component for PPFF, aseptic loosening, and for any reason.ResultsThe overall incidence of PPFFs was 1.0% (n = 11): 1.4% (n = 10) in the collarless polished (CLP) group, none in the collared polished (CP) group and 0.6% (n = 1) in the collared non-polished (CNP) group (p > 0.05). Kaplan-Meier survival analysis for the femoral component at 12 years with PPFF as the end point was 97.4% (95% confidence interval CI], 94.9 to 99.8) in the collarless group and 99.7% (95% CI, 99.1 to 100) in the collared group (p = 0.048). With revision of the femoral component for aseptic loosening as the end point, survivorship was 100.0% in the CLP and CP groups, and 98.1% (95% CI, 95.9 to 100) in the CNP group (CLP vs CP, p > 0.999; CLP vs CNP, p = 0.001; CP vs CNP, p = 0.112).ConclusionThis study demonstrated that the calcar collar in the cemented femoral component could play an important role to reduce the incidence of PPFF. The surface finish in the cemented femoral components influenced the incidence of femoral component revision for aseptic loosening over 5–12 years. Surgeons should consider not only the geometry and the mechanical function of the femoral components based on different design philosophies, but also potential complications associated with different designs that may require revision arthroplasty. |
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