Influence of patient-related characteristics on early migration in calcar-guided short-stem total hip arthroplasty: a 2-year migration analysis using EBRA-FCA

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Abstract

Background

Short stems have gained popularity in recent years. Because of encouraging clinical results, indications have been expended from young to elderly and obese patients. However, long-term results are lacking. The purpose of this study was to evaluate the influence of gender, age, body weight, body mass index (BMI), and offset version on short-stem migration in correlation to the clinical outcome.

Methods

The implant migration of 202 metaphyseal-anchoring, calcar-guided short stems in 151 patients was assessed by “Einzel-Bild-Roentgen-Analyse” femoral component analysis (EBRA-FCA, femoral component analysis) in a 2-year follow-up. Full weight bearing was allowed directly after surgery. Patients were divided into groups regarding gender, age, body weight, BMI, and offset version. The Harris hip score (HHS) and satisfaction on visual analogue scale (VAS) were analyzed.

Results

After 2 years, mean axial subsidence of all 202 implants was 1.43 mm (standard deviation, SD 1.45 mm). A continuous reduction of initially pronounced subsidence over time could be observed. None of the stems had to be revised. Statistically significant increased rates of subsidence were seen in male (1.68 mm; SD 1.56 mm; p = 0.005) and heavy patients (1.54 mm; SD 1.48 mm; p = 0.022). No differences in implant migration were found regarding age, BMI, and different offset versions. HHS improved markedly from 45.8 (SD 15.9) to 98.1 (SD 4.7) while satisfaction on VAS improved from 1.8 (SD 2.2) to 9.7 (SD 0.9) after 2 years.

Conclusions

The results suggest a migration pattern with initially pronounced subsidence followed by subsequent stabilization. Male and obese patients show a slightly increased initial subsidence without any signs of sustained micromovement. No correlation was found concerning clinical results and pronounced initial subsidence above the threshold of 1.5 mm. No aseptic loosening or other signs of implant failure were seen within the observation period of 2 years.

Trial registration

German Clinical Trials Register, DRKS00009834.

Related collections

Most cited references 37

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Short bone-conserving stems in cementless hip arthroplasty.

Harpal S Khanuja, Samik Banerjee, Deepak Jain … (2014)

➤ Short bone-conserving femoral stems in total hip arthroplasty were designed to preserve proximal bone stock.➤ Given the distinct fixation principles and location of loading among these bone-conserving stems, a classification system is essential to compare clinical outcomes.➤ Due to the low quality of currently available evidence, only a weak recommendation can be provided for clinical usage of certain stem designs, while some other designs cannot be recommended at this time.➤ A high prevalence of stem malalignment, incorrect sizing, subsidence, and intraoperative fractures has been reported in a subset of these short stem designs.➤ Stronger evidence, including prospective multicenter randomized trials comparing standard stems with these newer designs, is necessary before widespread use can be recommended.

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In vivo skeletal responses to porous-surfaced implants subjected to small induced motions.

Suzanne Burke, M Jasty, C Bragdon … (1997)

Cylindrical porous-coated implants were placed in the distal femoral metaphyses of twenty dogs and were subjected to zero, twenty, forty, or 150 micrometers of oscillatory motion for eight hours each day for six weeks with use of a specially designed loading apparatus. The in vivo skeletal responses to the different magnitudes of relative motion were evaluated. Histological analysis demonstrated growth of bone into the porous coatings of all of the implants, including those that had been subjected to 150 micrometers of motion. However, the ingrown bone was in continuity with the surrounding bone only in the groups of implants that had not been subjected to motion or that had been subjected to twenty micrometers of motion; in contrast, the implants that had been subjected to forty micrometers of motion were surrounded in part by trabecular bone but also in part by fibrocartilage and fibrous tissue, and those that had been subjected to 150 micrometers of motion were surrounded by dense fibrous tissue. Trabecular microfractures were identified around three of the five implants that had been subjected to forty micrometers of motion and around four of the five that had been subjected to 150 micrometers of motion, suggesting that the ingrown bone had failed at the interface because of the large movements. The architecture of the surrounding trabecular bone also was altered by the micromotion of the implant. The implants that had stable ingrowth of bone were surrounded by a zone of trabecular atrophy, whereas those that had unstable ingrowth of bone were surrounded by a zone of trabecular hypertrophy. The trabeculae surrounding the fibrocartilage or fibrous tissue that had formed around the implants that had been subjected to forty or 150 micrometers of motion had been organized into a shell of dense bone tangential to the implant (that is, a neocortex outside the non-osseous tissue).

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Revision rate after short-stem total hip arthroplasty

Jakob van Oldenrijk, Jeroen Molleman, Michel Klaver … (2014)

Background and purpose The aim of short-stem total hip arthroplasty is to preserve proximal bone stock for future revisions, to improve biomechanical reconstruction, and to make minimally invasive approaches easier. It is therefore being increasingly considered to be a sound alternative to conventional total hip arthroplasty, especially for young and active patients. However, it is still unknown whether survival rates of short-stem hips match current standards. We made a systematic summary of reported overall survival after short-stem total hip arthroplasty. Materials and methods We conducted a systematic review of English, French, German, and Dutch literature. 2 assessors independently identified clinical studies on short-stem hip arthroplasty. After recalculating reported revision rates, we determined whether each implant had a projected revision rate of 10% or less at 10 years of follow-up or a revision rate per 100 observed component years of 1 or less. Stems were classified as “collum”, “partial collum”, or “trochanter-sparing”. Results and Interpretation We found 49 studies, or 51 cohorts, involving 19 different stems. There was a large increase in recent publications. The majority of studies included had a follow-up of less than 5 years. We found a large number of observational studies on “partial collum” and “trochanter-sparing” stems, demonstrating adequate survival rates at medium-term follow-up. Clinical evidence from “collum stem” studies was limited to a small number of studies with a medium-term follow-up period. These studies did not show a satisfactory overall survival rate.

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Author and article information

Contributors

Karl Philipp Kutzner: +49-(611)-1773636 , kkutzner@joho.de

Mark Predrag Kovacevic: mark.kovacevic@gmx.de

Tobias Freitag: Tobias.Freitag@rku.de

Andreas Fuchs: dea.fuchs@me.com

Heiko Reichel: Heiko.Reichel@rku.de

Ralf Bieger: Ralf.Bieger@rku.de

Journal

Journal ID (nlm-ta): J Orthop Surg Res

Journal ID (iso-abbrev): J Orthop Surg Res

Title: Journal of Orthopaedic Surgery and Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-799X

Publication date (Electronic): 7 March 2016

Publication date PMC-release: 7 March 2016

Publication date Collection: 2016

Volume: 11

Electronic Location Identifier: 29

Affiliations

[ ]Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189 Wiesbaden, Germany

[ ]Clinic of Traumatology, Hand- and Orthopaedic Surgery, HELIOS Dr. Horst Schmidt Clinic Wiesbaden, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany

[ ]Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany

Article

Publisher ID: 363

DOI: 10.1186/s13018-016-0363-4

PMC ID: 4782512

PubMed ID: 26951069

SO-VID: 42013d20-c733-4077-8897-4ca6269da22b

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 15 January 2016

Date accepted : 3 March 2016

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: total hip arthroplasty,migration,subsidence,short stem,optimys,ebra,weight,bmi

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ScienceOpen disciplines: Surgery

Keywords: total hip arthroplasty, migration, subsidence, short stem, optimys, ebra, weight, bmi

Influence of patient-related characteristics on early migration in calcar-guided short-stem total hip arthroplasty: a 2-year migration analysis using EBRA-FCA

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Most cited references 37

Short bone-conserving stems in cementless hip arthroplasty.

In vivo skeletal responses to porous-surfaced implants subjected to small induced motions.

Revision rate after short-stem total hip arthroplasty

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