Stem Loosening Research Articles

Three-year migration analysis of a new metaphyseal anchoring short femoral stem in THA using EBRA-FCA

Cementless calcar-guided femoral short stems in total hip arthroplasty (THA) have become increasingly popular over the years. Early distal migration of femoral stems measured by Einzel-Bild-Roentgen Analyse, Femoral Component Analyse (EBRA-FCA) has been reported to be a risk factor for aseptic loosening. The aim of this study was to analyse axial migration behavior and subsidence of a new short stem (launched in 2015) over a follow-up period of 3 years. According to the study protocol, 100 hip osteoarthritis patients who consecutively received an unilateral cementless calcar-guided short stem (ANA.NOVA proxy) at a single department were prospectively included in this mid-term follow-up study. Thirteen patients were lost to follow-up, resulting in 87 patients with unilateral THA who fulfilled the criteria for migration analysis with EBRA-FCA. The cohort comprised 41 males (mean age: 60 ± 16.5; mean BMI (Body Mass Index): 30 ± 13) and 46 females (mean age: 61 ± 15.5; mean BMI: 27 ± 10). Seven standardized radiographs per patient were analyzed with EBRA-FCA. An average migration of 2.0 mm (0.95–3.35) was observed within the first 3 years. The median increase during the first year was higher than in the second and third year (1.2 mm [IQR: 0.5–2.15] vs. 0.3 mm [IQR: 0.1–0.6 mm] vs. 0.25 mm [IQR: 0.1–0.5 mm]. Detected migration did not lead to stem loosening, instability, dislocation, or revision surgery in any patient. A higher risk for subsidence was observed in male and heavyweight patients, whereas the female gender was associated with a lower risk. No correlation between migration and revision could be observed. Although moderate subsidence was detectable, the performance of the short stem ANA.NOVA proxy is encouraging. Yet, its use may be re-considered in overweight and male patients due to more pronounced subsidence.

Endofemoral Shooting Technique for Removing Well-fixed Cementless Stems

BackgroundThe removal of a well-fixed cementless stem poses technical challenges. The aim of this study was to evaluate the outcomes of our endofemoral extraction technique established in 2001. MethodsBetween January 2001 and December 2016, 118 consecutive revisions following bipolar or total hip arthroplasty, which required cementless femoral stem removal, were performed at our institution. This retrospective study evaluated 106 patients (108 hips) who were followed up for a mean of 9.2 years (range, 5-20 years). The patients included 15 men and 91 women with a mean age of 65 years (range, 33-87 years). Endofemoral extracted stem removal was performed as follows. Multiple Kirschner wires were sequentially inserted into the interface between the implant and cortical bone, after which the implant was detached using a thin chisel. After the cementless stem was removed, it was replaced with a cemented stem using an autograft, as needed. Radiological loosening of the femoral stem was defined as definite or probable loosening, based on the criteria of Harris et al. Prosthesis survival was analyzed using the Kaplan-Meier method, with the endpoint set as repeat revision surgery for stem loosening or femoral fracture. ResultsRe-revision surgery was performed in 7 hips. Stem loosening was observed in 4 hips, and the mean subsidence was 0.3 mm (0-3 mm). The 10-year survival rate was 97.7% (95% confidence interval, 93.2-100). ConclusionsOur technique for removing well-fixed cementless stems yielded successful results.

Cementless primary or revision stem in revision hip arthroplasty for aseptic stem loosening with Paprosky type I/II femoral defect?

The use of primary or revision stem during revision total hip arthroplasty (THA) for aseptic stem loosening with Paprosky type I/II femoral defect remains controversial. The aim of this study was to compare the outcomes of patients who underwent revision THA with a primary or revision stem. We retrospectively reviewed 78 patients who received revision THA for aseptic stem loosening using primary (N = 28) or revision stems (N = 50). The bone defects were classified as Paprosky type I or II. The mean follow-up duration was 72.3 ± 34.7 months. The primary outcome domains included surgical complications and implant failures. The secondary outcome domains included medical complications, 30- and 90-day readmission, and Harris hip score (HHS). The use of revision stem was associated with a higher incidence than primary stem of patient complications (60.0% vs. 32.1%, p = 0.018), including intraoperative femur fracture (28.0% vs. 7.1%, p = 0.029) and greater trochanter fracture (16.0% vs. 0%, p = 0.045). The implant survival rate was comparable between groups. HHS at the final follow-up was similar. With a lower risk of surgical complications and a similar rate of mid-term implant survival, cementless primary stem appears superior to revision stem in revision THA for aseptic stem loosening with Paprosky type I/II femoral defect.

Hemiarthroplasty for nontraumatic avascular necrosis of the humeral head is associated with low complications and reoperation rates

BackgroundThe objective of this study was to retrospectively review clinical and radiographic outcomes of patients who had undergone hemiarthroplasty for nontraumatic avascular necrosis (AVN) of the humeral head and to review demographic and clinical factors that might affect patient outcomes. MethodsThe patient sample for this study was identified through our institutional Total Joint Registry Database. Between 2009 and 2019, 68 hemiarthroplasties had been performed for nontraumatic AVN. There were 44 (64.7%) female and 24 (35.3%) male patients, with a mean age of 44.3 (range 17-78) years. The average follow-up time was 6.5 years, with a minimum of 2.1 years. There were 34 patients (50%) with an identifiable underlying etiology of steroid and/or chemotherapy use, 17 (25%) were considered idiopathic, 9 (13.2%) with a hematologic or coagulopathic condition, 6 (8.8%) with radiation, and 2 (2.9%) with a history of alcohol abuse. Outcomes, including revision surgeries, reoperations, and complications, were recorded. Range of motion (ROM) data and functional outcome scores, including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and patients’ subjective level of satisfaction with the operation, were evaluated. Preoperative radiographs were reviewed, and the degree of AVN was classified. Most recent postoperative radiographs were reviewed to assess for stem loosening, humeral head subluxation, and glenoid erosion. ResultsPostoperative American Shoulder and Elbow Surgeons scores were 74.5, and Simple Shoulder Test scores were 75.3. Overall satisfaction with the operation was rated as 7.3 on a scale of 0-10. The average external rotation was 62 degrees, and the average active elevation was 163 degrees. No differences in outcomes scores or ROM were noted based on preoperative etiology, although the idiopathic group trended toward lower forward flexion compared to the steroid/chemotherapy group. Three of 68 (4.4%) patients suffered postoperative complications. The overall revision rate was 2/68 (2.9%), both involving conversion to anatomic total shoulder arthroplasty for progressive painful glenoid erosion. Radiographically, no patients had evidence of loosening. One patient (2.2%) had mild subluxation, 2 had moderate subluxation (4.4%), and 1 had severe subluxation (2.2%) of the humeral implant. Three patients had mild (6.7%), 4 had moderate (8.9%), and 3 had severe (6.7%) glenoid erosion. ConclusionHemiarthroplasty for nontraumatic AVN of the humeral head provides satisfactory functional outcomes and ROM, with low complication and revision rates. These outcomes and revision rates appear to be better than those reported in the literature for posttraumatic AVN. Hemiarthroplasty may lead to radiographic evidence of glenoid erosion, but this is well tolerated and does not appear to lead to substantially high revision rates, at least in the intermediate-term follow-up.

Total hip arthroplasty using an alkali- and heat-treated titanium Zweymüller stem with no trochanteric shoulder: results at 5-year follow-up.

A trochanteric shoulder is 1 of the characteristics of the original Zweymüller femoral stem for total hip arthroplasty (THA). There have been few clinical reports of THA using recently available versions of Zweymüller-type stems with eliminated trochanteric shoulder. 82 consecutive THAs with a Zweymüller-type stem without trochanteric shoulder were analyzed. The stem was made of alkali- and heat-treated titanium, straight, tapered, with rectangular cross-section. Survivorship was estimated with the Kaplan-Meier method. 76 of 82 hips (92.7%) were followed for more than 5 years or until revision. 35 of 82 hips (42.7%), were revised and the predominant reason for revision was aseptic loosening of the femoral stem (34 of 35 hips, 97.1%). Survival with revision for any reason as the endpoint was 71.3% (95% CI, 51.8% to 80.1%) at 5 years. The survival of the modified Zweymüller-type stem with no trochanteric shoulder was unacceptably low.

The Wear Rate and Survivorship in Total Hip Arthroplasty Using a Third-generation Ceramic Head on a Conventional Polyethylene Liner: A Minimum of 15-year Follow-up.

PurposeThe purpose of this study was to evaluate the wear and survival rates of third-generation ceramic heads on a conventional ultra-high molecular weight polyethylene liner.Materials and MethodsA total of 160 hips (147 patients with a mean age of 55.9 years) who underwent total hip arthroplasty using the third-generation ceramic head on a conventional polyethylene liner from March 1998 to August 2003 were reviewed retrospectively. Evaluation of the wear rate for 56 hips (49 patients) followed-up for at least 15 years was performed using the PolyWare program version 8 (Draftware Developers, USA). The Kaplan–Meier survivorship was also evaluated.ResultsLinear wear and volumetric wear rates were 0.11±0.47 mm/year and 32.75±24.50 mm3/year, respectively. Nine revisions were performed during the follow-up period because of cup or stem loosening. The Kaplan–Meier survival rate, using cup revision or total revision total hip arthroplasty (THA) as the endpoint of analysis, was 93.7% at 15 years and 73.6% at 20 years.ConclusionBecause all revisions were performed between 15 and 20 years in our study, surgeons should pay greater attention to patients who underwent THA with ceramic-on-polyethylene bearing from 15 years postoperatively. Contemporary alumina ceramic on highly cross-linked polyethylene could certainly be a good alternative bearing couple providing better longevity.

Aseptic Revision of Total Hip Arthroplasty With a Single Modular Femoral Stem and a Modified Extended Trochanteric Osteotomy-Treatment Assessment With the Forgotten Joint Score-12.

BackgroundAseptic loosening is among the most common reasons for revision total hip arthroplasty (RTHA). Modular revision stems implanted through an extended trochanteric osteotomy (ETO) promise good results, but patient-reported outcome measures (PROMs) are rarely conveyed. This study used the Forgotten Joint Score-12 (FJS-12) to assess patient-reported outcome in patients who had undergone RTHA for aseptic stem loosening using a modified ETO approach with a tapered, fluted modular stem.Material and methodsA single-center analysis of aseptic RTHA was performed (2007–2019). Clinical results (range of motion, walking ability, function), radiographic results (ETO healing, stem subsidence), and PROMs (FJS-12, Harris Hip Score, European Quality of Life 5D Score) were assessed. Minimum follow-up duration was 1 year. Complications including revisions were recorded.ResultsPrimary outcome parameters were assessed on 72 patients (mean age 73.3 years, mean body mass index 27.6kg/m2). Additional PROMs were collected by phone interviews from 41 patients (mean follow-up 5.7 years). In 76%, leg length was restored, and a normal gait was achieved. After 1 year, the ETO was healed in 93%; subsidence occurred in 8.3% of cases. The mean FJS-12 at the final follow-up was 85.6 ± 23.6, and the respective Harris Hip Score and European Quality of Life 5D Score averaged 87 ± 17.8 and 72.9 ± 15.9. Complication and revision rates were 33.3% and 13.9%, respectively.ConclusionAseptic RTHA as presented here resulted in excellent PROMs in the medium term. FJS-12 score averaged 85.6 with a mean follow-up of 5.7 years. Treatment using a modular implant and a modified ETO was associated with good clinical and radiographic outcomes. Complication and revision rates were 33.3% and 13.9%, respectively.

Excellent Long-Term Survival Rate of Polished, Tapered, Cemented Stems in Patients Aged 35 Years or Younger With Avascular Necrosis or Inflammatory Arthritis of the Hip.

Total hip arthroplasty (THA) for avascular necrosis (AVN) or inflammatory arthritis (IA) comes with a relatively high risk of aseptic stem loosening, especially in young patients. There are limited long-term data on the survivorship of polished, tapered, cemented stems in this population. We therefore performed a single-center retrospective study investigating the survival of this particular stem type in young patients with AVN or IA. All patients aged ≤35 years who had received a THA for AVN or IA operated on by the senior author between 1990 and 2010 at the University Hospitals Leuven were identified. In total, 85 THAs in 62 patients were included. Primary endpoint was revision of the femoral component for aseptic loosening. Secondary endpoints were revision of the acetabular component for aseptic loosening, revision for other reasons, and the presence of radiolucencies around the components. The mean follow-up for the entire cohort was 18.0±5.3 years (range 8.0-28.9). Taking revision for aseptic loosening as endpoint, the survival of cemented stems was 100% after 15 years and 95.1% after 20 years. Survival of uncemented cups (91.3%) was significantly better than survival of cemented cups (50.3%) after 20 years of follow-up for aseptic loosening. Taking revision for any reason as endpoint, the survival of THAs with uncemented and cemented cups was 90% and 43.1% at 20 years respectively. Radiolucencies developed in the cement mantles around 11 of the 81 nonrevised stems, mainly in zones 1 and 7. In this cohort of young patients with high-risk profiles for aseptic stem loosening, polished, tapered, cemented stems showed excellent long-term survival rates and they therefore remain a viable alternative to uncemented stem designs.

Comparison of the functional outcomes after treatment of periprosthetic hip fractures with femoral stem loosening: Locking plate fixation with or without femoral stem revision

IntroductionPeriprosthetic fractures have become one of the main reasons for revision of total hip arthroplasty, with the treatment strategy guided by the Vancouver and SOFCOT classification systems. The main objective of this work was to compare the functional outcomes and mortality rate in patients who suffered a periprosthetic hip fracture with femoral stem loosening and who were treated either by internal fixation with locking plate only, or in combination with revision of the existing femoral stem with a cemented stem. The secondary objective was to compare the blood loss, procedure duration, length of hospital stay, living arrangements, time to weight bearing and major complications between these two treatment strategies. The starting hypothesis was that there is no difference in the functional outcomes between these two groups. Materials and methodsThis was a single center, retrospective study of patients treated between 2013 and 2019. Thirty-six patients (54%) underwent femoral stem revision (FSR group) and 31 patients (46%) were treated by locking plate fixation only (ORIF group). In this population, 19 of the patients had been residing at a nursing home before the surgical treatment: 12 (33%) in the FSR group and 7 (23%) in the ORIF group (p=0.33). The mean preoperative Parker score was 7.03 (± 1.48) in the FSR group versus 5.19 (± 1.92) in the ORIF group. The functional outcomes at the final review were evaluated using the Parker score, HHS (Harris Hip score), WOMAC (Western Ontario and McMaster Arthritis Index) and Oxford score. Fracture healing was determined on radiographs centered over the hip joint with the entire femur visible on AP and lateral views. All patients were reviewed at a minimum of 1 year for clinical and radiological assessments. ResultsAt a mean follow-up of 28 months [12–85], the Oxford score was 40.4 (± 10.6) in the FSR group versus 37.1 (± 13.5) in the ORIF group (p=0.34), WOMAC of 45.5 (± 26.9) versus 50.5 (± 32.4) (p=0.56), and HHS of 62.7 (± 25.5) versus 60.3 (± 28.6) (p=0.79). The Parker score at the final assessment was 5.14 (± 1.96) in the FSR group versus 4.64 (± 2.17) in the ORIF group (p=0.33). In the FSR group, 10 patients were at a nursing home (34%), 6 of whom were not there initially, versus 6 in the ORIF group (43%), 5 of whom were not there initially (p=0.59). The mean operating time was 152±41.4 minutes (minimum: 85; maximum: 254) in the FSR group versus 89.2 (± 44.1) minutes (minimum: 39; maximum: 280) in the ORIF group (p<0.001). Resumption of full weight bearing occurred at 6 weeks in 21 patients (58%) in the FSR group versus 14 patients (47%) in the ORIF group (p=0.023). There were 5 major complications (14%) in the FSR group versus 7 (23%) in the ORIF group (p=0.35). Among the reviewed patients, the union rate was 86% on the latest radiographs in the FSR group versus 78% in the ORIF group. DiscussionThere was no statistically significant difference between groups in the various functional scores, confirming our study hypothesis. Internal fixation with a locking plate appears to be an acceptable solution for treating periprosthetic hip fractures in which the femoral stem has loosened. Level of evidenceIII, comparative retrospective study.

Medium- to Long-Term Outcomes after Reverse Total Shoulder Arthroplasty with a Standard Long Stem.

Background: Long-term clinical and radiographic outcome data after standard cemented long-stem reverse shoulder arthroplasty (RSA) remain underreported. The aim of this study is to report on medium- to long-term data of patients over 60 years of age. Methods: The same type of RSA (Aequalis Reverse II, Memphis, TN, USA) was implanted in 27 patients with a mean age of 73 years (range 61–84). Indications for RSA were cuff tear arthropathy (CTA) in 25 cases and osteoarthritis (OA) in two cases. Pre- and postoperative Constant Score was assessed and component loosening, polyethylene wear, scapular notching and revision rates were recorded at a mean clinical follow-up (FU) of 127.6 months (SD ± 33.7; range 83–185). Results: The mean-adjusted CS (aCS) improved from 30.0 (range 10–59) to 95.0 (range 33–141) points (p < 0.001). Glenoid loosening was found in two (9.1%) and stem loosening was found in three (13.6%) cases. Polyethylene wear was observed in four (18.2%) cases. Scapular notching appeared in 15 (68.2%) cases but was not associated with poor aCS (p = 0.423), high levels of pain (p = 0.798) or external rotation (p = 0.229). Revision surgery was necessary in three (11.1%) cases. Conclusions: RSA with a cemented standard long stem leads to improvement in forward elevation, abduction and pain after a mean FU of 10 years. However, external rotation does not improve with this prosthetic design. Moreover, scapular notching is observed in the majority of cases, and revision rates (11.1%) as well as humeral loosening rates (13.6%) remain a concern. Level of evidence: Level 4, retrospective cohort study.

Humeral stem loosening and subsidence in uncemented shoulder arthroplasties more than 10 years after surgery.

This study aimed to investigate radiographic changes in the uncemented humeral stem in shoulder arthroplasties more than 10 years after surgery. Methods: From June 2001 to April 2011, patients with hemiarthroplasty (HHR) or total shoulder arthroplasty (TSA), with uncemented humeral stem more than 10 years after surgery, were recruited. We included 39 patients (41 shoulders; 9 males, 30 females; mean age, 64.3 years) who were followed up. The average postoperative follow-up period was 12.0 years.

Revision total elbow arthroplasty using intramedullary strut allograft for aseptic loosening of the humeral stem

Total elbow arthroplasty (TEA) has become a well-accepted treatment option for many pathologies of the elbow joint. Its use in distal humerus fractures in elderly patients has become increasingly popular and has good clinical results. However, with the aging population and the increasing number of TEAs performed, so comes the potential for an increasing number of revision TEA cases. Revision TEA can be extremely challenging. In addition to the technical difficulties of safe exposure and implant removal, reimplantation of a cemented humeral component with loss of bone stock can be a challenging step in this procedure. The purpose of this article was to describe a novel technique to address aseptic loosening of the humeral stem and loss of humeral bone stock with revision of the humeral component using a long-stemmed cemented implant and intramedullary allograft fibular strut bone grafting.

A radial head prosthesis that aligns with the forearm axis of rotation: a retrospective multicenter study

BackgroundAdvancements in technique and devices and a better understanding of forearm kinematics have contributed to the improvement in outcomes following radial head arthroplasty. The results of radial head arthroplasty depend on the inherent variability of the proximal radial anatomy and on the subsequent difficulties in attaining anatomic positioning of the prosthesis. A monobloc prosthesis with an anatomical head that is aligned with the patient’s axis of forearm rotation has been recently introduced. We report the clinical and radiographic outcomes for patients across multiple centers who received this radial head implant with a minimum of 2-year follow-up. MethodsThis was a multi-institution retrospective follow-up including 6 centers and multiple surgeons. A total of 114 cases were performed prior to July 20, 2019, of which 52 (46%) responded to request for follow-up. Data collected included Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand scores, visual analog scale (VAS) for pain, major complications, and reoperations. Major complications were defined as any prosthesis-related event which may or may not have required reoperation. ResultsThe mean Mayo Elbow Performance Score was 87.0 (range, 55-100), with 46% (24/52) scoring a 100. The mean VAS for pain at rest was 0.9 (range, 0-10), and the mean VAS for pain while unscrewing a bottle cap was 1.9 (range, 0-10). The mean Disabilities of the Arm, Shoulder and Hand score was 19.6 (range, 0-88.6). We recorded a total of 4 major complications, 3 of which required reoperations, for a rate of 7.6% and 5.7%, respectively. DiscussionThe current results, collected from 6 institutions and multiple surgeons, are comparable to those of other similar series for radial head prostheses. Our series had lower rates of complications and reoperations. There were no cases of stem loosening. The alignment of the radial head to the forearm axis of rotation may restore forearm kinematics. This design may lead to radiocapitellar contact pressures that are more physiologic in load transmission.

The Clinical and Radiological Outcomes of Subtrochanteric Osteotomy in Crowe Type IV Hip Dysplasia: A Comparison of Three Different Stem Designs.

The purpose of this study was to determine whether there are differences in clinical and radiographic outcomes among three different stem designs for subtrochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH). A retrospective analysis of prospectively collected data was undertaken from a consecutive series of 37 Crowe type IV DDHs treatment of noncemented total hip arthroplasty with chevron subtrochanteric osteotomy in 30 patients. Patients are divided into three groups, including Ribbed group (using Link Ribbed stem; n = 14), Synergy group (using Synergy stem; n = 9), and Link Classic Uncemented (LCU) group (using LCU stem; n = 14), according to the design of the stem. The clinical and radiographic outcomes were evaluated. All patients were followed for 36 months. The time of bone union of the LCU stem was significantly longer than that of the Synergy stem (P = 0.02) and the Ribbed stem (P > 0.05); the time of bone union of the Ribbed stem was longer than that of the Synergy stem (P > 0.05). The length of stem in the distal femur of the Ribbed stem (P = 0.000) and the Synergy stem (P = 0.001) is significantly longer than that of the LCU stem. There were three hips with malunion, stem loosening, and varus alignment, which were observed in the LCU stem. None of these were observed in Ribbed and Synergy stems. In total hip arthroplasty with a noncemented stem combined with subtrochanteric femoral osteotomy for Crowe IV DDH, 89.2% hips (33/37) can achieve good and excellent clinical outcomes. There were three hips (1 hip in the Ribbed stem and two in the LCU stem) with fair clinical outcomes and one hip (LCU stem) with poor clinical outcomes. Although Ribbed, Synergy, and LCU stems have similar clinical outcomes, the LCU stem has a tendency to a varus position, longer union time, malunion, and stem loosening, when compared with the Ribbed and Synergy stems. We recommend against adoption of the LCU stem for Crowe IV DDH with subtrochanteric femoral osteotomy. Level III, therapeutic study.

Proximal humeral bone defect in reverse shoulder arthroplasty combined with latissimus-dorsi transfer is not related with a poor outcome

BackgroundReverse total shoulder arthroplasty (RSA) associated with modified L’Episcopo (isolated LD) or L’Episcopo (combined TM and LD) procedures had been confirmed to effectively overcome the expected external rotation deficit in patient with postero-superior massive cuff tear and teres minor deficiency. The objective of this study was to evaluate the radiological bony lesions of the lateral proximal humerus following RSA combined with tendon transfer, and to determine whether these bony lesions affect the clinical outcome. Material and methodsA retrospective review of 24 RSAs (mean age 68.71 years, range 52–83) associated with modified L’Episcopo procedure (9) and L’Episcopo procedure (15) was performed. X-rays were assessed for lateral cortex lesions and were categorized into either intact, irregular or complete lytic appearances. In addition, signs of stem loosening were assessed. Clinical outcome measures included range of motion, SSV, VAS, and Constant-Murley scores. ResultsWith a mean follow-up of 44.71 months (12–97; SD 27.42), eight (33.3%) patients demonstrated intact lateral cortex, eight (33.3%) irregular and eight (33.3%) lytic lesions. 40% of cemented stems demonstrated a deformed cortex compared to 74% of cementless stems. Radiolucent lines were detected in one cemented stem (p=0.046). GT resorption (p=0.147), condensations lines (p=0.449) and spot weld (p=0.342), appeared exclusively in non-cemented stem. Postoperatively all patients (24) demonstrated significant improvements in all clinical and functional parameters. A comparison between patient with (Group 2, 16 patients) and without bony lesions (Group 1, 8 patients) revealed no significant differences in functional scores and range of motion: Constant (p=0,61), VAS (p=0,61), SSV (p=0,66) and external rotation (p=0,34). ConclusionAt short-term follow-up, RSA combined with L’Episcopo or modified l’Episcopo procedure resulted in high incidence (67%) of lateral proximal humerus lesions. Radiolucent lines were noted in cemented stems whereas, signs of stress shielding and GT resorption appeared in non-cemented stems. Yet, no case of humeral loosening was detected and these lesions did not seem to affect the clinical outcome. The use of cemented straight standard-length humeral stems should be positively considered in RSA associated with LD\\TM tendon transfer. Level of evidenceIV; retrospective study.

Anatomic Monopolar Press-fit Radial Head Arthroplasty; High Rate of Loosening at Mid-Term Follow Up.

Radial head arthroplasty (RHA) is used for the management of unstable or unreconstructable injuries of the radial head. Our aim was to investigate clinical and radiographic outcomes in patients treated with the Acumed anatomic radial head press-fit system for trauma. Clinical and radiographic assessment of RHAs undertaken for trauma with minimum 2-year follow-up. 16 consecutive patients, mean age 53 (21-82) and 66 month ± 27 (26-122) clinical follow-up were included. There were marked radiographic changes with 11/16 showing periprosthetic lucent lines and 13/16 showing subcollar osteolysis. Radiographic changes occurred early post-surgery. Stem loosening was associated with larger cantilever quotients (0.47 vs 0.38, p = 0.004). Overall survivability was 81.2%, with 3 RHAs removed. Clinical outcomes for the retained RHAs were acceptable with mean flexion 134°, extension deficit of 10°, pronation of 82°, and supination of 73°. Mean VAS scores were 8.5 ± 14.4, QuickDASH 13.8 ± 18.9, Mayo Elbow Performance Scores were 91.5 ± 12.5 with no poor scores. Mid-term clinical functional outcomes following the Acumed anatomic RHA are acceptable in most cases. However, in view of the extensive periprosthetic lucencies and surgical removal due to loosening, patients should be cautioned when consented for implantation of the prosthesis, especially if a large collar is anticipated.

Conversion of Hemiarthroplasty to Reverse Shoulder Arthroplasty with Humeral Stem Retention.

The purpose of this study is to evaluate the mid-term clinical results of an ongoing case series on conversion reverse shoulder arthroplasty (RSA) with a modular prosthesis system. We included 17 elderly patients revised for failed hemiarthroplasty after proximal humeral fracture, of which 13 were converted using a modular reverse shoulder prosthesis. Four could not be converted due to overstuffing. For the conversion RSA, we determined the Constant score, American Shoulder and Elbow Surgeons Shoulder Score, visual analogue scale for pain and satisfaction, and range of motion preoperatively, at one year, and at the last follow-up. All measured clinical outcomes improved significantly at both follow-up time points (p < 0.05). The mean duration of surgery was 118.4 min (range: 80.0 to 140.0 min). We observed complications in three patients; these included one late infection and two aseptic stem loosenings. Modular shoulder arthroplasty is a suitable procedure for conversion RSA in elderly patients. All measured postoperative clinical outcomes improved significantly, the complication rate was acceptable, and no prosthesis-related complications occurred. Conversion RSA, although not feasible in every case, is a viable treatment option in the elderly, which can provide successful mid-term results.

Revision Total Hip Arthroplasty with Primary Stem or Full-Porous-Coated Long Stem for Aseptic Femoral Component Loosening: A Matched-Pair Study.

BackgroundRevision total hip arthroplasty (RTHA) for loosening the femoral stem is a technical challenge. Distally fixed, full-porous-coated long stems are widely accepted as the standard selection for these revisions. However, the success of primary stems in RTHA is not well known.MethodsThis study enrolled 24 patients with aseptic loosening of the femoral stem who underwent RTHA using primary stems. Another 72 patients with aseptic loosening who underwent RTHA using full-porous-coated long stems were matched in terms of operation date, proximal femoral bone stock (Paprosky classification), sex, and age. The primary and secondary outcomes of failure were the need for revision for any reason and the radiographic change in the stem respectively.ResultsIn the primary stem group, one patient had a periprosthetic fracture and received a second RTHA 2 years after the previous one. The primary outcome’s 5-and 10-year survival rates were both 95.8%. For the matched comparison group, one patient had an immediate periprosthetic fracture of the femoral shaft requiring further open reduction internal fixation surgery. Another patient had a full-porous-coated long stem breakage 6 years postoperatively, which required a second RTHA. The primary outcome’s 5-and 10-year survival rates were 98.6% and 97.2%, respectively.ConclusionPrimary stems can achieve non-inferior clinical success compared to a full-porous-coated long stem for aseptic stem loosening RTHA in patients with adequate proximal femoral bone stock.

Inflammatory tissue reactions around aseptically loose cemented hip prostheses: A retrieval study of the Spectron EF stem with Reflection All-Poly acetabular cup.

The cemented Spectron EF stem in combination with the cemented non‐crosslinked Reflection All‐Poly cup showed a high rate of mid‐term aseptic loosening. However, the failure mechanisms are not fully known. We assessed the inflammatory tissue reactions and wear particles in periprosthetic tissues, implant wear and blood metal ion levels in 28 patients with failed implants. Histological analysis showed a macrophage pre‐dominant pattern with randomly distributed lymphocytes, with various amounts of neutrophils and giant cells. The number of different cell types in the tissue samples from patients in the cup group and in the stem group was similar. Wear particles, mainly ZrO2, CoCrMo, and polyethylene particles of different sizes and shapes, were associated with macrophages/giant cells, and total particle load/mm2 was higher in cases of stem loosening. The Spectron EF stems were heavily worn, abraded, and polished. Stem abrasion correlated with metal ion concentrations in blood. The median polyethylene wear rate of the Reflection cups was 0.23 mm/year. The high proximal roughness of the Spectron EF stem resulted in excessive cement wear during loosening. The resulting inflammatory tissue responses to the degradation products both from the cup and the stem led to massive osteolysis and subsequent implant loosening.

Reverse shoulder arthroplasty for proximal humeral fracture in the elderly. Cemented or uncemented stem?

The purposes of this study were to compare functional outcomes, radiographic stem changes and complication rate in patients with proximal humeral fractures operated with cemented or uncemented RSA. Retrospective review of 68 primary RSAs in PHF, 45 cemented/23 uncemented. Functional outcomes were evaluated according to constant, ASES scales and the range of motion (ROM). Radiographic assessment was performed at a minimum of two years post-operatively. The mean follow-up cemented/uncemented was 37.8/26.5months (p = .04) and the mean age 78/80years old (p = .09). The functional outcome and range of movement were equivalent in the two groups except for the forward flexion that was significantly higher in the cemented group (p = .03). Stress shielding was seen in 30.4% of uncemented group and none in the cemented. Anatomic tuberosity healing was significantly higher with uncemented components compared with cemented components (64% vs 91%, p = .02). Cemented stems had radiolucent lines with a width of 2mm or more in three or more Gruen zones in 9% vs 0% in the uncemented group and an evident change in the stem position was present in 4% vs 0% in the non-cemented group. At mid-term follow-up, no differences in functional outcomes were detected depending on the stem fixation technique. Cemented stems, however, have a complication rate (including stem loosening) significantly higher than press-fit stems.