Cementless Stem Research Articles

Resultados clínicos y radiológicos del vástago SL-Plus con un seguimiento mínimo de 10 años: un estudio retrospectivo

Purpose: The SL-Plus cementless stem was introduced in 1993 as an evolution of the Alloclassic stem with some modifications. The aim of this study was to analyse if these modifications have any influence in clinical and radiological outcomes at minimum 10-year follow-up.Methods: Sixty-eight consecutive implants (64 patients) were retrospective evaluated. The mean duration of clinical and radiographic follow-up was 12.2 years. There were 41 female and 23 male patients with a median age of 73.5 years. All complications and reinterventions were collected. Functional outcomes were assessed using the modified Harris Hip Score (mHHS). Radiographs were evaluated immediately after the operation, after a minimum 2-year follow-up and by the end of follow-up (time A, B and C, respectively).Results: Two stems were revised, one due to periprosthetic fracture and one due to aseptic loosening with a cumulative probability of not having a stem revision for any reason of 97.2% at 12.2 years. Mean mHHS was 76.7 points at the latest follow-up. Significant differences were found in distal migration (time A: 5.9mm±6.7, B: 6.9mm±7.1 and C: 8.2mm±6.3; p=0.000) and varus angulation (time A: 0.0° ±2, B: 0.0° ±2 and C: 1.0° ±3; p<0.001), although these stems showed radiographic signs of osseointegration. Thirty-three hips (48.5%) showed any radiolucent line around the stem, most of them located the proximal femur (Gruen 1 and 7). Multivariate regression analysis showed lower mHHS scores in older patients (p=0.004) and female (p=0.00).Conclusions: The modifications of the SL-Plus stem influence the long-term outcome of the implant regarding radiological results, particularly in progressive varus angulation and distal migration. However, our study has not been able to demonstrate any clinical repercussions: functional scores and survival free of all cause revision were favorable and comparable to previous reports.Level of evidence: Therapeutic Level IV (Case Series)

Weak hammering sounds are associated with postoperative subsidence in cementless total hip arthroplasty.

The aim of this study was to investigate the relationship between the hammering sound level and the presence of postoperative subsidence. The last five hammering sounds during the final-size broaching procedure and during the real stem insertion were recorded and analysed in 95 patients who were operated on by one of seven surgeons using two implants (Trident cup, Accolade II, Stryker; G7 cup, Taperloc Complete Microplasty Stem, Zimmer Biomet). The maximum peak was semi-automatically identified and analysed to determine the maximum C-weighted sound pressure level (LCpeak) of each of the five hammering sounds and the equivalent continuous A-weighted sound pressure (LAeq) of the entire five-sound hammering procedure. Among the 95 hips, 25 (26.3%) had ≥ 3mm of postoperative subsidence. Therefore, 125 of 475 hammering sounds (LCpeak) and 25 of 95 hammering procedures (LAeq) in both the broaching procedure and stem insertion procedure were associated with postoperative subsidence. The hammering sound level in both the broaching and stem insertion procedures were significantly weaker in patients with postoperative subsidence than in those without subsidence. Among the seven surgeons, there was intra-surgeon and inter-surgeon heterogeneity with large variance regarding the sound levels. With univariate and multivariate analyses, the hammering sound level was independently associated with postoperative subsidence in the two models. A weak hammering sound level was associated with postoperative subsidence in THA with a cementless stem. An objective evaluation of the hammering procedure might be useful to decrease the incidence of postoperative subsidence.

Cemented vs Cementless Stems for Reverse Shoulder Arthroplasty for Proximal Humerus Fractures: A Registry Analysis with Patient-Reported Outcomes from a Level 1 Trauma Centre

BackgroundReverse total shoulder arthroplasty (rTSA) is being increasingly used in the treatment of comminuted or unreconstructible proximal humerus fractures. It is currently unclear if cementless rTSA have equivocal revision rates, mortality and functional outcomes compared to cemented or cementless rTSA. MethodsTwo data sources were used for this study. All rTSA performed for proximal humerus fractures between 1 January 2010 and 1 January 2020 recorded on the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were used to determine revision rate and mortality between cemented and cementless rTSA. Patient-reported outcome measurements (PROM) including the American Shoulder and Elbow Surgeons (ASES) score, Oxford Shoulder Score (OSS) and Single Assessment Numerical Value (SANE) were obtained via telephone from Royal Perth Hospital (RPH) patients between 01 January 2010 and 10 February 2021. ResultsThe study included 83 patients who underwent rTSA for proximal humerus fractures at Royal Perth Hospital. There were 4,335 rTSA procedures identified at other hospitals nationally. Of these, 54% of rTSA used cementless humeral stems. There was no significant difference in revision rate or mortality between cemented and cementless humeral stems adjusted for age and gender. For the RPH cohort, PROM scores included ASES score of 65.9 (CI: 60.6 - 71.2), OSS of 34.6 (CI: 31.9 - 37.2) and SANE value of 68.8 (CI: 61.8 - 75.8). ConclusionRevision rates and mortality are similar between cemented and cementless humeral stems used for rTSA for proximal humerus fractures. For appropriate patients, cementless humeral stems may be an acceptable first line treatment for proximal humerus fractures.

What features of stem increase the risk of intraoperative femoral fracture during cementless primary hip arthroplasty?

Cementless fixation has become increasingly popular in hip arthroplasty due to its shorter operation time, easier technique, biologic fixation, and avoidance of bone cement implantation syndrome compared to cemented fixation. However, intraoperative periprosthetic femoral fracture (IOPFx) is a disconcerting complication during cementless hip arthroplasty. Our purpose was to identify the features of cementless stem that increase the risk of IOPFx during primary hip arthroplasty. We retrospectively reviewed all 4806 hip arthroplasties that was performed in a single institution from May 2003 to December 2020. Age at the index arthroplasty, sex, body mass index, physical status, ambulatory function, side of the operation, operational history, cause of the index arthroplasty, type of arthroplasty, surgical approach, surgeon, implant information, and events during the operation were investigated. The shoulder geometry and length of stem were also reviewed. The event of interest was narrowed down to IOPFx among various records of intraoperative events. We found IOPFx of 2.6% among all the hips operated with cementless stem. In the multivariable analysis, female (OR = 1.52), childhood hip disease (OR = 2.30), stove-pipe femur (OR = 2.43), combined approach (OR = 2.60), and standard length of stem (OR = 1.59) were found to be significant risk factors of IOPFx. In conclusion, a stem with a standard length is significantly associated with risk of IOPFx compared to a shortened stem. These findings highlight the importance of careful consideration in terms of the risk of IOPFx when standard length cementless stem is chosen.

Early Postoperative Functional Recovery in Older Patients With Periprosthetic Femoral Fractures: Comparison Between Cemented and Cementless Stem Revisions

BackgroundEarly postoperative functional recovery is important in older patients with lower-extremity fractures to prevent disuse, and periprosthetic femoral fractures (PFFs) are no exception. This study aimed to compare the postoperative functional recovery in the early phase after revision for PFF with loose stems between cemented and cementless stems. MethodsEighteen patients with Unified Classification System type B2 PFF were included in this retrospective cohort study with a follow-up period of about 2 years. All patients underwent stem revision and were divided into 2 groups: the cemented stem group (n = 9) and the cementless stem group (n = 9). In postrevision, functional independence measure score, independent walk rate, activities of daily living recovery rate to the original level at 2 weeks postoperatively, the Beals and Tower classification for radiological status, and survival rate for readmission as endpoints were compared between the 2 groups. ResultsPatients in the cemented group recovered functional mobility earlier than in the cementless group, with higher postoperative functional independence measure functional subscale values (73 vs 50 points, P = .02), higher independent walk rate (89 vs 11%, P < .01), and more postoperative activities of daily living recovery (100% vs 44%, P = .03) at 2 weeks postoperatively. The Beals and Tower classification and survival rates were similar in both groups. ConclusionsRevision using a cemented stem for PFF in older patients was a useful surgical procedure in terms of early postoperative functional recovery. Cemented stem revision was comparable with cementless in bone union and safety at 2 years postoperatively.

Do All Postoperative Vancouver B2 Fractures Require Revision Arthroplasty With Cementless Stems?

BackgroundManagement of periprosthetic fractures has been guided by the Vancouver classification, which recommends revision for fractures around a loose femoral implant (B2). New studies have challenged this approach, demonstrating acceptable outcomes with internal fixation. This study evaluates our experience with Vancouver B2 fractures, comparing internal fixation to femoral revision. We hypothesized that in select cases with cementless stems, internal fixation would provide acceptable results with reduced morbidity. MethodsA retrospective review was performed of periprosthetic hip fractures treated at our institution between 1 January 2012 and 4 November 2022. We excluded patients who did not have prior radiographs and evidence of stem subsidence, suggestive of a Vancouver B2 fracture. Thirteen patients were included in the analysis. ResultsFour patients (31%) underwent revision of the femoral component, 4 patients (31%) underwent plating, and 5 patients (38%) underwent internal fixation with cerclage cabling. The average operative duration was 158 minutes, 203 minutes, and 62 minutes for the revision, plating, and cabling cohorts, respectively (P = .009). Blood loss was 463 cc, 510 cc, and 90 cc for the revision, plating, and cabling cohorts, respectively (P = .036). Three patients in both the revision and plating cohorts each received a transfusion (75%), whereas no patients in the cabling cohort required a transfusion (P = .033). All patients demonstrated fracture healing on the postoperative radiographs. No patients required additional surgery during the follow-up period. ConclusionsWe have demonstrated that Vancouver B2 periprosthetic fractures with intact lateral cortices may be treated with internal fixation with cerclage cabling with excellent results.

Association between the canal filling ratio and bone resorption in trabecular metal stems in reverse total shoulder arthroplasty: a radiographic analysis using tomosynthesis

BackgroundSeveral factors affect the incidence of osteopenia with cortical narrowing (CNO) in reverse shoulder arthroplasty. This study aimed to compare the incidence of CNO with different fixation methods (cemented or cementless) using a single implant (trabecular metal humeral stem) evaluated using tomosynthesis and to analyze the factors affecting the incidence of CNO for cementless stem fixation. MethodsA total of 109 patients (cementless: 75 cases; cemented: 34 cases) who underwent reverse total shoulder arthroplasty were included in this study. The patients were divided into two groups (cementless or cemented), and the incidence of CNO was compared. In addition, patients in the cementless group were divided into two groups (canal filling ratio of ≥0.7 or <0.7), the incidence of CNO was compared, and the Cramer's coefficient of association between CNO and canal filling ratio>0.7 (and 0.8) was calculated. ResultsNo significant difference was observed in the incidence of CNO between the cementless and cemented groups (7/75 vs. 3/35, P-value=1.0). The association between CNO and the canal filling ratio using Cramer's coefficient of association showed that there were few correlations (coefficient: 0.14, P-value=0.59). ConclusionCementless reverse total shoulder arthroplasty with a trabecular metal stem has a similar low incidence of CNO as cemented fixation, and the incidence of CNO with a trabecular metal stem was lower than that reported in previous studies. A canal filling ratio>0.7 was not associated with the incidence of CNO.

Comparative Analysis of Cemented and Cementless Straight-Stem Prostheses in Hip Replacement Surgery for Elderly Patients: A Mid-Term Follow-up Study

This retrospective cohort study assesses the effectiveness of straight-stem cementless versus cemented prostheses in hip replacement surgeries for elderly patients with femoral neck fractures. We analyzed 80 patients aged 70 and over who underwent surgery between 2018 and 2021. Clinical outcomes were evaluated using the Harris Hip Score, WOMAC Score, and Visual Analogue Scale, alongside radiological assessments through Brooker’s classification. Preoperative Dorr classification and five postoperative criteria (subsidence, cortical hypertrophy, pedestal sign, radiolucent lines, and stress shielding) were used to assess implant efficacy. The results demonstrated satisfactory mid-term outcomes for both groups, with slightly higher clinical scores observed in the cementless stem group. The Harris Hip Score (HHS) averaged 74.4 ± 6.7 in the cemented group and 79.2 ± 10.4 in the cementless group, with a statistically significant difference (p = 0.0146). The WOMAC Score showed an average of 30.1 ± 4.6 in the cemented group compared to 27.1 ± 6.9 in the cementless group, also indicating a statistically significant improvement (p = 0.0231). However, radiographic findings call for a re-evaluation of long-term stability. Our statistical analysis, which included power calculation and multivariate analysis to adjust for confounding variables, offers a comprehensive assessment of implant effectiveness. The findings contribute to the ongoing debate on the choice between cemented and cementless prostheses, indicating that both are viable options catering to different patient needs. Further research overcoming this study’s limitations is crucial for a deeper understanding of optimal treatment strategies in hip replacement surgery for the elderly.

Effects of Cerclage Cabling on Preventing Periprosthetic Femoral Fractures When Using Cementless Stems for Unstable Femoral Neck Fractures

BackgroundPeriprosthetic femoral fractures (PFFs) are serious complications in hip arthroplasty for femoral neck fractures. The rates of intraoperative (iPFFs) and postoperative PFFs (pPFFs) are higher in cementless stem cases than in cemented cases. This study aimed to investigate the effects of cerclage cabling on PFF prevention in cementless arthroplasty for femoral neck fractures. MethodsThis retrospective study included 329 consecutive patients who underwent hip arthroplasty using a cementless stem for femoral neck fractures. A total of 159 and 170 patients were in the non-cabling and cabling groups, respectively. Patient characteristics were comparable in both groups. The PFF occurrence (iPFF and pPFF) rates, reoperation rates, operative time, and blood loss volume were compared between the groups. ResultsThe iPFF rate was significantly higher in the noncabling group (6.3%) than in the cabling group (0%, P < .001). The rate of pPFF was significantly higher in the non-cabling group (5.1%) than in the cabling group (0.6%; P = .016). All patients in the non-cabling group required reoperation (5.1%), whereas the patient in the cabling group was an ambulatory case and required no reoperation (0%, P = .003). No significant difference in either operative time or blood loss volume was observed between the non-cabling (50 minutes, 133 mL) and cabling (52 minutes, P = .244; 149 mL, P = .212, respectively) groups. ConclusionsWhen a cementless stem is used to treat unstable femoral neck fractures, cerclage cabling effectively prevents iPPF and pPPF without increasing surgical time or blood loss volume.

Cemented vs cementless stems for revision arthroplasties due to Vancouver B2 periprosthetic hip fracture.

According to Vancouver classification, B2 type fractures are most often treated with removal of the loose stem and implantation of a long stem that bypasses the fracture site. However, there is a controversy about the stem fixation that should be used: cemented or cementless. Hence, this study aims to compare cemented and cementless stems in prosthetic revision due to Vancouver B2 (VB2) periprosthetic hip fracture. A retrospective study was done including all the patients treated with stem exchange due to VB2 periprosthetic hip fracture in a tertiary hospital between 2015 and 2022. Patients were divided into two groups according to the stem fixation used: cemented or cementless. Functional outcomes, hospital stay, surgical time, complication rate, and mortality were compared between the two groups of patients. Of the 30 included patients, 13 (43.4%) were treated with cementless stems and 17 (56.7%) with cemented stems. There were no statistically significant differences in age, gender, anesthesia risk scale (ASA) or functional capacity prior to the intervention. Patients treated with cementless stems had a higher complication and reintervention rate than those treated with cemented stems: 62 and 45% versus 34 and 6% (p = 0.035; p = 0.010), respectively. Furthermore, in the group of cementless stems a higher proportion of non-union was found (53.8% vs. 17.6%; p = 0.037). Also, the hospital stay (33 vs. 24days; p = 0.037) and the time to full weight-bearing (21days vs. 9days; p < 0.001) were longer in the cementless stem group. Cemented fixation in stem revision due to Vancouver B2 periprosthetic hip fracture could be an optimal option with faster recovery which could decrease the rate of complications and reintervention, without compromising the fracture healing and patient mortality. Thus, this option can be considered when an anatomical reduction can be obtained, especially in elderly patients with multiple comorbidities in which a less aggressive surgical option should be considered.

Durability of Primary Total Hip Arthroplasty With Cementless Stems Without a Collar in Elderly Patients Age 75 Years and Over

BackgroundCementless femoral fixation in total hip arthroplasty (THA) has increased in prevalence worldwide. However, cementless fixation in elderly patients is controversial due to the risks of periprosthetic fracture and aseptic loosening. This study evaluated outcomes in patients undergoing primary THA utilizing a cementless stem without a collar, comparing those less than 75 years to those older than 75 years. MethodsBetween 2011 and 2021, there were 2,605 cementless THAs performed by 4 surgeons utilizing a highly porous metal fixation surface without a collar and consistent clinical protocols. There were 469 patients who had an age ≥ 75 years. Revision rates, intraoperative fractures, and 90-day mortality were compared between cohorts. In the ≥ 75 year age group, there were more women, more American Society of Anesthesiologists physical status classification III or IV, a lower body mass index, and more kidney disease, osteoporosis, and thyroid disease (P ≤ .002). ResultsAll-cause revision rates trended lower for the ≥75 year age group compared to < 75 year (1.9 versus 3.5%, P = .082) at 20-months of follow-up. Moreover, there was no difference in all-cause femoral component revisions comparing ≥ 75 to < 75 year age groups (1.5 versus 2.2%, P = .375), with only 3 of 10 femoral revisions due to aseptic loosening being in the ≥ 75 year age group. Intraoperative fracture (0.2 versus 0.5%, P = .701) and 90-day mortality (0.2 versus 0.1%, P = .460) did not differ between ≥ 75 and < 75 year age groups. ConclusionsOlder patients had comparable revision rates compared to younger patients using cementless femoral fixation without a collar. Furthermore, there was no difference in 90-day mortality or intraoperative fracture rates. Study findings provide evidence for the safety and durability of cementless THA using collarless femoral stems in elderly patients ≥ 75 years of age. Level of EvidenceIII.

Mid-term results of total hip arthroplasty with anatomical ultra-short cementless stem in patients with developmental dysplasia of the hip Crowe type II

The aim of this study was to present the mid-term results of ultra-short cementless stem total hip arthroplasty (THA) in patients with Crowe type II developmental dysplasia of the hip. The study consists of 68 patients (75 THAs) with a Proxima stem implanted between 2006 and 2015. The clinical results include Harris Hip Scores. Radiological follow-up reports on stem migration, bony trabecular development and radiolucent lines. Kaplan–Meier survival analysis was performed. The mean age of patients was 48.4 years, with a mean follow-up 114 months. The average Harris Hip Score improved significantly from 45.1 preoperatively to 97.6 at the final evaluation (p < 0.001). Stem migration was observed in five hips (in all of them up to the 6th postoperative month, without any further progression of migration or radiological loosening). Bony trabecular development was detected in modified Gruen zones (1, 2, 4, 6, 7 for Proxima stem): in zone 1 (0%), 2 (49.3.0%), 4 (38.7%), 6 (82.7%), 7 (0%). Radiolucent lines were observed around one cup (DeLee and Charnley zone I) and three stems (none was loose, all three with fibrous stable fixation). Complications were found in three hips (4.0%): intraoperative periprosthetic femoral fracture (threated with cerclage wire) in two hips and squeezing hip in one patient (with perioperative ceramic inlay breakage and exchange). No hip was revised. The implant survival was 100.0% both clinically and radiologically. Observations in the mean follow-up of 114 months show that the results (clinical and radiological) of the Proxima stem in patients with Crowe type II DDH are promising.

Cementless Primary Stems in Revision Hip Arthroplasty: A Narrative Review.

Cementless primary stems in revision hip arthroplasties may be conservative options to preserve bone stock and provide adequate reconstruction of the hip biomechanics. However, there is still little evidence about indications, limitations, and outcomes. This narrative review showed that conventional standard stems were adopted in different revision settings, up to Paprosky IIIA grade bone defects. In cases of acceptable metaphyseal bone stock, when a scratch fit of at least 4 cm can be achieved, a conventional cementless stem may be an adequate solution. Mid-term clinical and radiographic outcomes and survival rates were similar to long revision stems, whereas complications, surgical time, and costs were lower among conventional stems. However, unsuitable contexts for conventional stems included canal diameters larger than 18 mm and failed revision stems with cortical weakening. Even short stems can be considered in revisions, in order to preserve bone stock and stay proximal to femoral remodeling zones and bone/cement plugs. Short stems were successfully adopted up to Paprosky IIIA bone defects, achieving mid-term survival rates not inferior to long revision stems. Ageing, osteoporosis, and intraoperative femoral fractures were the main negative prognostic factors. In very select cases, a downsizing technique (from longer to shorter stems) may be adopted to simplify the procedure and reduce complications.

Long-term survival and complication rate of cementless prosthetic stems in primary total hip arthroplasty categorized by types according to Mont classification: a regional registry-based study on 53,626 implants.

The purpose of this retrospective registry-based study is to assess survival and causes of failure of cementless stem implants used in total hip arthroplasty (THAs), to ascertain if there are differences when these are categorized according to the six types described by Mont. Data collected from the regional registry regarding all primary THAs performed from 2000 to 2019 were analyzed. Femoral prosthetic stems were divided into the six types of Mont classification. For each stem type, number of implants, survival and causes of failure were evaluated and compared. The most frequently implanted stem type was the 3c type (53.4%). Type 1 had the lowest stem failure rate (1.6%), and type 6 showed the highest (3.9%). Periprosthetic fracture was the most frequent complication in type 6, accounting for 34.5% of failures. Aseptic loosening was the main complication in type 2 stems, accounting for 36.4% of failures. Pairwise comparisons showed significant higher survival of type 1 compared to type 3c (p = 0.000026) and type 6 (p = 0.000076), and between type 3a compared to type 3c (p = 0.03) and type 6 (p = 0.026). Significant variations in implant survival rates were found among the six Mont-types of cementless stems. These findings emphasize the paramount importance of stem design and fixation area in determining long-term survival, providing a guidance for orthopedic surgeons in the selection of the most appropriate stem for primary THA, contributing to our understanding of cementless stem performance, presenting invaluable insights to further improve patient outcomes in THA surgery.

Chronological Changes in Sagittal Femoral Bowing after Primary Cementless Total Hip Arthroplasty: A Comparative 3D CT Study.

Little is known about dynamic changes of femoral anatomy after total hip arthroplasty (THA), in particular about sagittal femoral bowing (SFB). A 3D CT study was designed to evaluate the chronological changes of SFB after cementless femoral stem implantation for primary THA. Ten patients who underwent unilateral primary THA with a cementless femoral stem, with 2 consecutive CT scans (extending from the fourth lumbar vertebra to the tibial plateaus), performed before THA and at least 3 years after THA, were enrolled. The 3D models of femurs were created using image segmentation software. Using the two CT scans, SFB values of the proximal and middle thirds were calculated on the replaced and untreated sides by two different observers. Eight anatomical stems and two conical stems were involved. The post-operative CT was performed at an average follow-up of 6.5 years after THA (range: 3-12.5). The measurements performed by the two observers did not differ in the proximal and middle regions. A significant difference between the pre-operative and post-operative SFB compared to the untreated side was found in the proximal femur segment (p = 0.004). Use of a cementless stem in THA induced chronological changes in SFB of the proximal femur, after a minimum timespan of 3 years.

COMPARATIVE STUDY OF REVISION HIP ARTHROPLASTY AFTER SHORT STEM VERSUS AFTER CONVENTIONAL STEM

AbstractObjectiveShort-stem total hip arthroplasty (THA) aims to preserve the proximal bone stock for future revisions, so that the first revision should resemble a primary intervention rather than a revision. This study aimed to compare the clinical and radiological outcomes in revision THA after failed short stem versus after failed conventional stem THA.MethodsThis study included forty-five patients with revision THA divided into three groups (15 each); group A: revision after short stem, group B: revision after conventional cementless stem and group C revision after conventional cemented stem. The studied groups were compared regarding 31 variables including demographic data, details of the primary and revision procedures, postoperative radiological subsidence, hospital stay, time for full weight bearing (FWB), preoperative and postoperative clinical scores.ResultsEarly stem subsidence (40%) was the main indication of revision in group A compared to peri-prosthetic femoral fractures (PFFs) (73.3%) and aseptic loosening (53.3%) in group B and C respectively (P=0.021). The mean time to revision was significantly shorter in group A (15 months) compared to 95.33 and 189.40 months in group B and C respectively. (P=0.005). Sixty % (9 patients) in group A were revised in the first year. The mean operative time, blood loss, postoperative blood transfusion and hospital stay were significantly lower in group A compared to group B and C (P&lt;0.001, &lt;0.001, 0.002 and 0.001 respectively). Revisions in group A were performed using either short stems (13.3%) or conventional stems (86.7%) whilst 80% of patients needed long stems and 20% of patients needed conventional stems in group B and C (P&lt;0.001). The mean postoperative Harris Hip Score (HHS) at the latest follow up was 87.07, 87.53 and 85.47 in group A, B and C respectively. All PFFS had excellent results according to Beal's and Tower's criteria; all fractures healed and the implants were stable.ConclusionThe most common cause of failure of short stems is early stem subsidence. Short stem THA has specific indications and patient selection is very crucial. Preoperative templating for short stems and a detailed analysis of the individual patient anatomy in anteroposterior and lateral views are mandatory to predict the correct implant size more accurately. The use of intraoperative imaging can verify the sizing, implant position, and sufficient contact with the lateral cortex. Revision of short stem THA resembled the primary THA. If a standard implant can be used in a surgical revision instead of a longer revision stem, this can be considered as an advantage for the hip arthroplasty treatment concept. However, this only applies if the longevity of the first treatment with a short stem is comparable with that of a standard stem.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Cemented versus Cementless Stem Fixation in Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

The number of revision knee arthroplasties (rTKA) is growing significantly as is the use of intramedullary stems for optimized stability. The choice of the most appropriate stem fixation method is still controversial. The purpose of this meta-analysis is to compare cemented versus cementless stem fixation in rTKA. Publications with patients undergoing rTKA with a follow-up > 24 months were systemically reviewed. Extracted parameters included total revision and failure rates for any reason, incidence of aseptic loosening, periprosthetic infection, and radiolucent lines, as well as the clinical outcome. A statistical regression analysis was then performed on all extracted clinical and radiological outcome data. A total of 35 publications met the inclusion criteria and were included and analyzed. Overall, 14/35 publications compared cementless versus cemented stem fixation, whereas 21/35 publications investigated only one stem fixation method. There were no significant differences in revision (p = 0.2613) or failure rates (p = 0.3559) and no differences in the incidence of aseptic loosening (p = 0.3999) or periprosthetic infection (p = 0.1010). The incidence of radiolucent lines was significantly higher in patients with cemented stems (26.2% versus 18.6%, p < 0.0001). However, no differences in clinical outcomes were observed. No superiority of a specific stem fixation method in rTKA was found. Rates of revision or failure for any reason as well as incidence of aseptic loosening and periprosthetic infection in cemented versus cementless stem fixation showed no significant difference. A higher incidence of radiolucent lines was observed in cemented stem fixation; however, no effect was observed on the clinical outcome.

Femoral revision in total hip arthroplasty using a cementless modular stem: clinical and radiological results with a 8-year follow-up.

Modular femoral components allow for patient-specific restoration of hip joint geometry and the reconstruction of extensive bone defects in revision total hip arthroplasty (THA); however, potential problems of modular implants such as taper corrosion and the risk of implant fracture continue to be of concern. The aim of the present study was to evaluate the clinical and radiological results of a cementless modular revision stem following revision surgery due to aseptic loosening and periprosthetic fracture and to assess patient-reported outcome measures (PROMs) in these patients at mid-term follow-up. In this study, a consecutive cohort of 75 patients who underwent primary revision THA at our institution using a modular cementless stem design (MRP-TITAN stem) was retrospectively evaluated at a mean follow-up of 7.7 years. Kaplan-Meier survivorship analyses were performed with revision of the femoral component for any reason as the end point. The Harris-Hip Score, the UCLA Activity Score, the Forgotten Joint Score and the SF-12 Score were used for clinical assessment. We used the Wilcoxon signed rank test to compare pre- and postoperative clinical scores. Overall stem survival with the endpoint stem re-revision for any reason was 85.4% at a mean follow-up of 7.7 years (range 2.4-14 years). Stem survival was 89.5% in the aseptic loosening group and 78.3% in the periprosthetic fracture group with no statistically significant difference between both groups (p = 0.107). One patient had to be revised due to taper fracture. PROMs improved significantly up to the latest follow-up, and radiographic evaluation showed full osseointegration of all stems in this cohort. Revision THA using a modular cementless titanium revision stem demonstrated adequate clinical and radiological results at mid- to long-term follow-up in this cohort. Cementless revision stems are a useful treatment option to restore the anatomy, especially in deformed hips and in complex revision hip arthroplasty. However, there are some significant disadvantages related to an increased risk of mechanical failure such as corrosion/fretting damage and implant fracture. Future high-quality prospective studies with longer follow-up are necessary to confirm the supposed advantages.

Acute postoperative infections after dual head arthroplasty in geriatric patients

Acute periprosthetic joint infections (PJI) after dual head arthroplasty represent amajor challenge with a1-year mortality rate up to 50% in the mostly multimorbid geriatric patient collective. Due to the limited possibilities of preoperative patient optimization, infection rates of up to 9% have been reported, which is significantly higher than in elective arthroplasty. Atherapeutic gold standard has not yet been established due to the heterogeneous study situation and the lack of prospective randomized studies. The most promising therapeutic option currently appears to be asingle-stage stem replacement in combination with implantation of acup component (conversion to total hip arthroplasty, infection eradication in up to 100%). An approach of débridement, antibiotics, implant retention (DAIR) alone shows significantly poorer success rates (16-82%). Surgical treatment should always be followed by antibiotic treatment with atotal duration of 12weeks. In addition to the established perioperative antibiotic prophylaxis, the use of antibiotic-loaded bone cement seems to be superior to cementless stem fixation in preventing PJI in dual head arthroplasty.

The Use of a High Offset Fully Coated Collarless Cementless Stem Does Not Result in Early Failures in Total Hip Arthroplasty.

The Corail femoral stem has excellent long-term survivorship in total hip arthroplasty (THA). However, there remains a paucity of information on the specific performance of the high offset collarless stem in relation to subsidence, loosening, offset, and failure rates. Retrospective data were collected on all consecutive high offset collarless Corail stems implanted at a single centre in the UK. Data included patient demographics, femoral Dorr classification, radiographic analysis for radiolucent lines, and stem subsidence. The postoperative femoral offset was measured against the native offset of the contralateral hip. Any early failures, re-operations, or requirements for revision surgery were recorded. We identified 162 stems for inclusion in the study. Ninety-five patients were male. The mean age was 60.5 (40 to 78) years, and the mean BMI was 29.8 (21 to 50) kg/m2. The mean length of follow-up was 84.5 (12-130) months. Subsidence was recorded on 113 (69.7%) stems. The mean amount of total stem subsidence in the whole cohort was 1.62mm (0 to 3.9mm). There was no correlation between the amount of subsidence and the preoperative Dorr classification, age, sex, BMI, or indication for surgery. Radiolucent lines were exclusively seen in stems paired with a large-diameter 36-mm femoral head. The high offset stem accurately reproduced native femoral offset; the mean difference in offset was -1.21mm (-24mm to +21mm). There were no early failures, re-operations, or revision surgeries. The use of a high offset stem can accurately reproduce native femoral offset when chosen for THA. The high offset collarless Corail stem does not result in early failures in THA, and we support its use.