Migration characteristics of the Corail hydroxyapatite-coated femoral stem\u2014a retrospective clinical evaluation and migration measurement with EBRA

Dietmar Dammerer,Dietmar Krappinger,Philipp Blum,David Putzer,Martin Thaler,Christof Pabinger,Michael C. Liebensteiner

doi:10.1007/s00402-021-03926-9

Dietmar Dammerer, Dietmar Krappinger + Show 5 more

Open Access

https://doi.org/10.1007/s00402-021-03926-9

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Abstract

PurposeUncemented stem migration analysis by EBRA-FCA (Einzel-Bild-Roentgen Analyse, Femoral Component Analysis) has been seen to be a good predictive indicator for early implant failure. In this study, we investigated the migration behavior of a cementless press-fit stem after two years follow-up. Stem type and postoperative gap between collar and femur were evaluated as a risk factor.MethodsApplying a retrospective study design, we reviewed all consecutive patients who between 2013 and 2017 received a cementless press-fit Corail stem (DePuy Orthopaedics Inc., Warsaw, IN, USA) at our Department. We reviewed medical histories and performed radiological measurements using EBRA-FCA software.ResultsA total of 109 stems in 105 patients (female: 60; male: 45) fulfilled our inclusion criteria. Mean age at surgery was 67.8 (range, 21.6–90.5) years. EBRA migration analysis showed a mean subsidence of 1.8 mm (range, 0.0–12.1) at final follow-up. At 18 months mean subsidence of collared stems was significantly lower than in the collarless group [1.3 mm (range, 0.0–7.6) vs. 3.2 mm (range, 0.5–10.7), p = 0.0104]. Collared stems resting on the femoral cut presented a tendency to less subsidence than did collared stems showing a postoperative gap between collar and femur (1.3 vs. 2.0 mm) without finding statistical significance (p > 0.05).ConclusionsLow subsidence and the migration pattern of the cementless press-fit stem may predict a good long-term result. Collared stems investigated in our study provide good stability and are able to prevent significant subsidence.Trial registration number and date of registration: Number: 20181024-1875; Date: 2018-10-24

Highlights

Cemented as well as cementless femoral components in total hip arthroplasty (THA) yielded excellent long-term survival rates over 95% after ten years [1]
The investigated stem was combined with a cementless press-fit Pinnacle cup (DePuy Orthopaedics Inc., Warsaw, IN, USA)
The most important finding of our study is a mean subsidence of 1.8 mm after a followup of 24 months

Summary

Introduction

Cemented as well as cementless femoral components in total hip arthroplasty (THA) yielded excellent long-term survival rates over 95% after ten years [1]. The most common cause of failure in THA is aseptic loosening [2]. Published studies reported distal migration of the stem, called subsidence, which has shown to be a good predictive factor for early aseptic loosening [3,4,5,6]. According to Krismer et al distal migration of the stem of more than 1.5 mm (mm) detected with EBRA-FCA within the first two years is a well-established risk factor for early implant failure [7]. Comparability is limited due to the inclusion of cemented and cementless stems by Krismer et al [7]. Streit et al rated a limit of 2.7 mm axial migration as critical for the cementless CLS stem (Zimmer Inc, Warsaw, IN, USA) within the first two years after surgery [6]

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