Subsidence of Hydroxyapatite-Coated Femoral Stem in Dorr Type C Proximal Femoral Morphology |
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| Institution: | 1. Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand;2. Department of Orthopaedics, Phramongkutklao Hospital, Bangkok, Thailand;3. Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;4. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;1. The Hip Arthroplasty Unit, Royal Gwent Hospital, Newport, Wales, United Kingdom;2. South Wales Orthopaedic Research Network, WelshBone, Trauma and Orthopaedics, Princess of Wales Hospital, Bridgend, Wales, United Kingdom;3. Grantham and District Hospital, Lincolnshire, United Kingdom;1. Kimitsu Central Hospital, 1010 Sakurai, 292-8535 Kisarazu city, Chiba, Japan;2. Graduate School of Medicine, Chiba University, 1-8-1, Inohana Chuo-ku, 260-8677 Chiba city, Chiba, Japan;3. Matudo City Hospital, 4005 Kamihongou, 271-8511 Matudo city, Chiba, Japan;4. Sanmu Medical Center, 167 Narutou, 289-1326 Sanmu city, Chiba, Japan;5. Seirei Sakura Citizen Hospital, 2-36-2 Eharadai, 285-8765 Sakura city, Chiba, Japan;6. National Hospital Organization Chiba Medical Center, 4-1-2 Tubakinomori, 260-8606 Chuo-ku, Chiba city, Chiba, Japan;7. Saiseikai Narashino Hospital, 1-1-1 Izumichou, 275-8580 Narashino City, Chiba, Japan;1. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;2. Department of Hip and Knee Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;1. Department of Orthopaedic Surgery, CHU de Québec – Centre Hospitalier de l’Université Laval (CHUL), Québec City, Québec, Canada;2. Department of Orthopaedic Surgery, Hôtel-Dieu-de-Lévis, Lévis, Québec, Canada;3. Department of Surgery, Faculté de Médecine, Université Laval, Québec City, Québec, Canada;4. Department of Orthopaedic Surgery, CHU de Québec – Hôtel-Dieu-de-Québec, Québec, Québec, Canada;1. Scunthorpe General Hospital, United Kingdom;2. Keele University, United Kingdom |
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| Abstract: | BackgroundGood bone quality and proper proximal femoral morphology are thought to be necessary for tapered design, cementless femoral stems to resist subsidence. Using tapered, cementless stem for patients with stovepipe morphology or Dorr type C is controversial. The purpose of this study is to analyze (1) subsidence of the fully hydroxyapatite (HA)-coated, tapered, cementless stem in different morphology according to Dorr classification, (2) subsidence of the stem related to radiographic canal-fill ratio.MethodsThe digitized radiographs of 311 consecutive cementless primary total hip arthroplasty with fully HA-coated, tapered stem were retrospectively reviewed. Subsidence and the canal-fill ratio at 4 locations were evaluated postoperatively after a minimum of 2 years of follow-up. The threshold of subsidence >3 mm was considered as a clinically significant migration.ResultsA multivariate regression analysis of subsidence across Dorr type, controlling for age, gender, and intraoperative calcar fracture, demonstrated 0.40 mm (P = .28) and 0.18 mm (P = .51) greater subsidence in Dorr type C and B when compared to Dorr type A. Age, gender, and calcar fracture had no influence on subsidence, whereas greater canal-fill ratio at 2 cm below lesser trochanter resulted in significantly less subsidence (P = .02). Additionally, all variables did not affect the risk of having subsidence >3 mm.ConclusionThe proximal femoral morphology has no statistically significant effect on the subsidence of fully HA-coated stem. Therefore, this stem type might be a viable option for Dorr type C. Increasing the canal-fill ratio at metadiaphyseal junction may ensure the stability of the stem. |
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| Keywords: | total hip arthroplasty proximal femoral morphology Dorr classification subsidence hydroxyapatite-coated cementless femoral stem |
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