Behavior of Hydroxyapatite-Coated Cementless Stems Placed With Coronal Malalignment in Primary Hip Arthroplasty. Long-Term Follow-Up Results
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Published:
Aug 19, 2021
Keywords:
Total hip arthroplasty, cementless femoral stems, coronal malalignment, hip revision
Main Article Content
Abstract
Introduction: coronal malalignment of non-cemented stems remains controversial. It’s been reported that femoral stems implanted with varus or valgus developed subsidence and lack of integration with femoral bone. The purpose of this study was to calculate prevalence of coronal malalignment in cementless, fully coated with hydroxialapatyte (HA) femoral stems focusing in their longterm clinical and radiographic outcomes.
Materials and Methods: a retrospective study was performed, assessing 220 primaries total hip replacements with non-cemented, fully coated with HA, femoral stems between 2006 and 2009. Coronal alignment was assessed with hips antero-posterior views with 10º of internal rotation of lower limbs. We registered data about subsidence, proximal femoral osteolysis and cortical hipertrophy. Functional outcomes were assessed with Harris Hip Score (HHS). Free revision rate implant survival was calculated.
Results: prevalence of femoral stems with malalignment was 32.3%. HHS showed an statistically significant increase after surgery (41.05 ± 6.5 versus 90.05 ± 2.5; p <0.01). There were 73.1% of femoral stems that achieved a bone stable fixation. We observed proximal femoral osteolysis in 3.0% of the patients and there were 3% of periprosthetic fractures. Free-revision survival rate was 100% at 10.9 years of follow-up.
Conclusion: cementless, fully coated with HA femoral stems with varus/valgus malalignment achieves good long-term clinical and radiographic outcomes.
Materials and Methods: a retrospective study was performed, assessing 220 primaries total hip replacements with non-cemented, fully coated with HA, femoral stems between 2006 and 2009. Coronal alignment was assessed with hips antero-posterior views with 10º of internal rotation of lower limbs. We registered data about subsidence, proximal femoral osteolysis and cortical hipertrophy. Functional outcomes were assessed with Harris Hip Score (HHS). Free revision rate implant survival was calculated.
Results: prevalence of femoral stems with malalignment was 32.3%. HHS showed an statistically significant increase after surgery (41.05 ± 6.5 versus 90.05 ± 2.5; p <0.01). There were 73.1% of femoral stems that achieved a bone stable fixation. We observed proximal femoral osteolysis in 3.0% of the patients and there were 3% of periprosthetic fractures. Free-revision survival rate was 100% at 10.9 years of follow-up.
Conclusion: cementless, fully coated with HA femoral stems with varus/valgus malalignment achieves good long-term clinical and radiographic outcomes.
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Simesen de Bielke, H., Pérez Alamino, L., Garabano, G., Pesciallo, C. Ángel, del Sel, H., & Lopreite, F. A. (2021). Behavior of Hydroxyapatite-Coated Cementless Stems Placed With Coronal Malalignment in Primary Hip Arthroplasty. Long-Term Follow-Up Results. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(4), 455-462. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1321
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Clinical Research
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References
1. Murphy CG, Bonnin MP, Desbiolles AH, Carrillon Y. Varus will have varus; a radiological study to assess and
predict varus stem placement in uncemented femoral stems. Hip Int 2016;26(6):554-60.
https://doi.org/10.5301/hipint.5000412
2. Vaughan PD, Sing PJ, Teare R, Kucheria R, Singer GC. Femoral stem tip orientation and surgical approach in total hip arthroplasty. Hip Int 2007;17(4):212-7. https://doi.org/10.5301/hip.2008.3618
3. Devitt A, O’Sullivan D, Quinlan W. 16- to 25-year follow-up study of cemented arthroplasty of the hip in patients
aged 50 years or younger. J Arthroplasty 1997;12(5):479-89. https://doi.org/10.1016/s0883-5403(97)90169-8
4. Jaffe W, Christopher A, Hawkins A. Normalized and proportionalized cemented femoral stem survivorship at 15
years. J Arthroplasty 1999;14(6):708-13. https://doi.org/10.1016/s0883-5403(99)90226-7
5. Khalily C, Lester DK. Results of a tapered cementless femoral stem implanted in varus. J Arthroplasty
2002;17(4):463-6. https://doi.org/10.1054/arth.2002.32171
6. Sheridan G, Hughes H, Kenny P, Toole GO, Byrne JO. The varus cemented femoral stem in total hip arthroplasty: predictors, implications and the Femoral Access Ratio. J Orthop 2021;23:8-12. https://doi.org/10.1016/j.jor.2020.12.012
7. Iwase T, Morita D, Takemoto G. The effects of patient characteristics and stem alignment on distal femoral cortical hypertrophy after cemented polished tapered stem implantation. Eur J Orthop Surg Traumatol 2020;30(4):559-67. https://doi.org/10.1007/s00590-019-02605-1
8. Mallory TH, Head WC, Lombardi AV Jr, Emerson RH Jr, Eberle RW, Mitchell MB. Clinical and radiographic
outcome of a cementless, titanium, plasma spray-coated total hip arthroplasty femoral component justification for continuance of use. J Arthroplasty 1996;11(6):653-60. https://doi.org/10.1016/s0883-5403(96)80002-7
9. Vresilovic EJ, Hozack W, Rothman RH. Radiographic assessment of cementless femoral components correlation
with intraoperative mechanical stability. J Arthroplasty 1994;9(2):137-41. https://doi.org/10.1016/0883-5403(94)90062-0
10. Vidalain J. Twenty-year results of the cementless Corail stem. Int Orthop 2011;35(2):189-94.
https://doi.org/10.1007/s00264-010-1117-2
11. Smith S, Garvin K, Jardon O, Kaplan PA. Uncemented total hip arthroplasty: prospective analysis of the tri-lock
femoral component. Clin Orthop Relat Res 1991;(269):43-50. PMID: 1864055
12. Bauer R, Kerschbaumer F, Poisel S, Oberthaler W. The transgluteal approach to the hip joint. Arch Orthop Trauma Surg 1979;95(1-2):47-9. https://doi.org/10.1007/BF00379169
13. Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone 1993;14(3):231-42. https://doi.org/10.1016/8756-3282(93)90146-2
14. Aprato A, Jayasekera N, Villar RN. Does the modified Harris Hip Score reflect patient satisfaction after hip
arthroscopy? Am J Sport Med 2012;40(11):2557-60. https://doi.org/10.1177/0363546512460650
15. Engh C, Massin P, Suthers K. Roentgenographic assessment. Clin Orthop Relat Res 1990;257:107-28.
PMID: 2199114
16. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a
radiographic analysis of loosening. Clin Orthop Relat Res 1979;(141):17-27. PMID: 2199114
17. Narayana R, Elbuluk AM, Chen KK, Eftekhary N, Zuckerman JD, Deshmukh AA. Does femoral morphology and
stem alignment influence outcomes of cementless total hip arthroplasty with proximally coated double-tapered
titanium stems? Hip Int 2020;8:1-8. https://doi.org/1120700019891702
18. Munuera L, Garcia-Cimbrelo E. The femoral component in low-friction arthroplasty after ten years. Clin Orthop Relat Res 1992;(279):163-75. PMID: 1600652
19. Gill J, Sledge JB, Orler R, Ganz R. Lateral insufficiency fractures of the femur caused by osteopenia and varus
angulation. A complication of total hip arthroplasty. J Arthroplasty 1999;14(8):982-7. https://doi.org/10.1016/s0883-5403(99)90014-1
20. Jacquot L, Bonnin MP, Machenaud A, Chouteau J, Saffarini M, Vidalain JP. Clinical and radiographic outcomes at 25-30 years of a hip stem fully coated with hydroxylapatite. J Arthroplasty 2018;33(2):482-90.
https://doi.org/10.1016/j.arth.2017.09.040
21. Ries MD, Lynch F, Jenkins P, Mick C, Richman J. Varus migration of PCA stems. Orthopedics 1996;19:581-5;
discussion 585-6. PMID: 8823815
22. Chatelet J. The cancellous environment: A privileged partner. En: Vidalain J-P, Ait Si Selm T, Beverland D, et al
(eds.). The CORAIL® Hip System. Berlin: Springer-Verlag; 2011:34-9.
23. Schneider U, Breusch SJ, Thomsen M, Wirtz DC, Lukoschek M. [Influence of implant position of a hip prosthesis on alignment exemplified by the CLS shaft]. Unfallchirurg 2002;105(1):31-5. [En alemán]
https://doi.org/10.1007/s113-002-8162-6
24. Min B, Song K, Bae K. The effect of stem alignment on results of total hip arthroplasty with a cementless taperedwedge femoral component. J Arthroplasty 2008;23(3):418-23. https://doi.org/10.1016/j.arth.2007.04.002
25. de Beer J, Mckenzie S, Hubmann M, Petruccelli D, Winemaker M. Influence of cementless femoral stems inserted in varus on functional outcome in primary total hip arthroplasty. Can J Surg 2006;49(6):407-11. PMID: 17234069
predict varus stem placement in uncemented femoral stems. Hip Int 2016;26(6):554-60.
https://doi.org/10.5301/hipint.5000412
2. Vaughan PD, Sing PJ, Teare R, Kucheria R, Singer GC. Femoral stem tip orientation and surgical approach in total hip arthroplasty. Hip Int 2007;17(4):212-7. https://doi.org/10.5301/hip.2008.3618
3. Devitt A, O’Sullivan D, Quinlan W. 16- to 25-year follow-up study of cemented arthroplasty of the hip in patients
aged 50 years or younger. J Arthroplasty 1997;12(5):479-89. https://doi.org/10.1016/s0883-5403(97)90169-8
4. Jaffe W, Christopher A, Hawkins A. Normalized and proportionalized cemented femoral stem survivorship at 15
years. J Arthroplasty 1999;14(6):708-13. https://doi.org/10.1016/s0883-5403(99)90226-7
5. Khalily C, Lester DK. Results of a tapered cementless femoral stem implanted in varus. J Arthroplasty
2002;17(4):463-6. https://doi.org/10.1054/arth.2002.32171
6. Sheridan G, Hughes H, Kenny P, Toole GO, Byrne JO. The varus cemented femoral stem in total hip arthroplasty: predictors, implications and the Femoral Access Ratio. J Orthop 2021;23:8-12. https://doi.org/10.1016/j.jor.2020.12.012
7. Iwase T, Morita D, Takemoto G. The effects of patient characteristics and stem alignment on distal femoral cortical hypertrophy after cemented polished tapered stem implantation. Eur J Orthop Surg Traumatol 2020;30(4):559-67. https://doi.org/10.1007/s00590-019-02605-1
8. Mallory TH, Head WC, Lombardi AV Jr, Emerson RH Jr, Eberle RW, Mitchell MB. Clinical and radiographic
outcome of a cementless, titanium, plasma spray-coated total hip arthroplasty femoral component justification for continuance of use. J Arthroplasty 1996;11(6):653-60. https://doi.org/10.1016/s0883-5403(96)80002-7
9. Vresilovic EJ, Hozack W, Rothman RH. Radiographic assessment of cementless femoral components correlation
with intraoperative mechanical stability. J Arthroplasty 1994;9(2):137-41. https://doi.org/10.1016/0883-5403(94)90062-0
10. Vidalain J. Twenty-year results of the cementless Corail stem. Int Orthop 2011;35(2):189-94.
https://doi.org/10.1007/s00264-010-1117-2
11. Smith S, Garvin K, Jardon O, Kaplan PA. Uncemented total hip arthroplasty: prospective analysis of the tri-lock
femoral component. Clin Orthop Relat Res 1991;(269):43-50. PMID: 1864055
12. Bauer R, Kerschbaumer F, Poisel S, Oberthaler W. The transgluteal approach to the hip joint. Arch Orthop Trauma Surg 1979;95(1-2):47-9. https://doi.org/10.1007/BF00379169
13. Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone 1993;14(3):231-42. https://doi.org/10.1016/8756-3282(93)90146-2
14. Aprato A, Jayasekera N, Villar RN. Does the modified Harris Hip Score reflect patient satisfaction after hip
arthroscopy? Am J Sport Med 2012;40(11):2557-60. https://doi.org/10.1177/0363546512460650
15. Engh C, Massin P, Suthers K. Roentgenographic assessment. Clin Orthop Relat Res 1990;257:107-28.
PMID: 2199114
16. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a
radiographic analysis of loosening. Clin Orthop Relat Res 1979;(141):17-27. PMID: 2199114
17. Narayana R, Elbuluk AM, Chen KK, Eftekhary N, Zuckerman JD, Deshmukh AA. Does femoral morphology and
stem alignment influence outcomes of cementless total hip arthroplasty with proximally coated double-tapered
titanium stems? Hip Int 2020;8:1-8. https://doi.org/1120700019891702
18. Munuera L, Garcia-Cimbrelo E. The femoral component in low-friction arthroplasty after ten years. Clin Orthop Relat Res 1992;(279):163-75. PMID: 1600652
19. Gill J, Sledge JB, Orler R, Ganz R. Lateral insufficiency fractures of the femur caused by osteopenia and varus
angulation. A complication of total hip arthroplasty. J Arthroplasty 1999;14(8):982-7. https://doi.org/10.1016/s0883-5403(99)90014-1
20. Jacquot L, Bonnin MP, Machenaud A, Chouteau J, Saffarini M, Vidalain JP. Clinical and radiographic outcomes at 25-30 years of a hip stem fully coated with hydroxylapatite. J Arthroplasty 2018;33(2):482-90.
https://doi.org/10.1016/j.arth.2017.09.040
21. Ries MD, Lynch F, Jenkins P, Mick C, Richman J. Varus migration of PCA stems. Orthopedics 1996;19:581-5;
discussion 585-6. PMID: 8823815
22. Chatelet J. The cancellous environment: A privileged partner. En: Vidalain J-P, Ait Si Selm T, Beverland D, et al
(eds.). The CORAIL® Hip System. Berlin: Springer-Verlag; 2011:34-9.
23. Schneider U, Breusch SJ, Thomsen M, Wirtz DC, Lukoschek M. [Influence of implant position of a hip prosthesis on alignment exemplified by the CLS shaft]. Unfallchirurg 2002;105(1):31-5. [En alemán]
https://doi.org/10.1007/s113-002-8162-6
24. Min B, Song K, Bae K. The effect of stem alignment on results of total hip arthroplasty with a cementless taperedwedge femoral component. J Arthroplasty 2008;23(3):418-23. https://doi.org/10.1016/j.arth.2007.04.002
25. de Beer J, Mckenzie S, Hubmann M, Petruccelli D, Winemaker M. Influence of cementless femoral stems inserted in varus on functional outcome in primary total hip arthroplasty. Can J Surg 2006;49(6):407-11. PMID: 17234069