Comparative Clinical-Radiological Analysis of First-Generation vs. Second-Generation Flat Cementless Femoral Stems
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Published:
Aug 19, 2021
Keywords:
second-generation flat femoral stems, femoral adaptability, femoral fixation, mediolateral
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Abstract
Introduction: The design of the femoral implant is essential for its adaptation to the different types of femoral canals. The objective of this study is to describe the adaptability of the implant and the type of fixation (fill and fit) of second-generation flat femoral stems compared to first-generation femoral stems.
Materials and Methods: We described the radiological characteristics of patients who had undergone bilateral total hip replacement between 2007 and 2020 in our institution with both a first-generation AccoladeTMZF (Stryker Orthopedics) and a second-generation Accolade II (Stryker Orthopedics) flat cementless femoral implant. Demographic variables, adaptation, and canal filling were studied. The modified Harris Hip Score and the WOMAC index were analyzed.
Results: Forty-two patients (84 cases) were included in the sample. In group 1 (Accolade TMZF) we obtained an average canal fill of 81% and in group 2 (Accolade II), we obtained an average of 84%. In group 1, the type of fixation (fit) was type 1 (60%), type 2 (16%) and type 3 (24%). In group 2, it was type 1 (88%), type 2 (7%) and type 3 (5%). The modified Harris Hip Score for group 1 was 88 and, for group 2, 87.5. The WOMAC score for group 1 was 2.5 and for group 2 it was 3.
Conclusion: The adaptability of the implant is essential for primary stability and its osseointegration/biological fixation. This adaptability is more precise with second-generation flat femoral stems.
Materials and Methods: We described the radiological characteristics of patients who had undergone bilateral total hip replacement between 2007 and 2020 in our institution with both a first-generation AccoladeTMZF (Stryker Orthopedics) and a second-generation Accolade II (Stryker Orthopedics) flat cementless femoral implant. Demographic variables, adaptation, and canal filling were studied. The modified Harris Hip Score and the WOMAC index were analyzed.
Results: Forty-two patients (84 cases) were included in the sample. In group 1 (Accolade TMZF) we obtained an average canal fill of 81% and in group 2 (Accolade II), we obtained an average of 84%. In group 1, the type of fixation (fit) was type 1 (60%), type 2 (16%) and type 3 (24%). In group 2, it was type 1 (88%), type 2 (7%) and type 3 (5%). The modified Harris Hip Score for group 1 was 88 and, for group 2, 87.5. The WOMAC score for group 1 was 2.5 and for group 2 it was 3.
Conclusion: The adaptability of the implant is essential for primary stability and its osseointegration/biological fixation. This adaptability is more precise with second-generation flat femoral stems.
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How to Cite
Perea, A. O., Spesot, P., García, M., Arce, J., García, S., & Munafó Dauccia, R. (2021). Comparative Clinical-Radiological Analysis of First-Generation vs. Second-Generation Flat Cementless Femoral Stems. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(4), 475-482. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1337
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Clinical Research
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References
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new second-generation proximally coated cementless stem compared to its predicate design. J Arthroplasty
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4. 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
5. White CA, Carsen S, Rasuli K, Feibel RJ, Kim PR, Beaulé PE. High incidence of migration with poor initial
fixation of the Accolade1 stem. Clin Orthop Relat Res 2012;470(2):410-7. https://doi.org/10.1007/s11999-011-2160-z
6. Brown TE, Larson B, Shen F, Moskal JT. Thigh pain after cementless total hip arthroplasty: evaluation and
management. J Am Acad Orthop Surg 2002;10(6):385-92. https://doi.org/10.5435/00124635-200211000-00002
7. Colacchio ND, Robbins CE, Aghazadeh MS, Talmo CT, Bono JV. Total hip intraoperative femur fracture: do
the design enhancements of a second-generation tapered-wedge stem reduce the incidence? J Arthroplasty
2017;32(10):3163e3168. https://doi.org/10.1016/j.arth.2017.05.012
8. Fleischman AN, Schubert MM, Restrepo C, Chen AF, Rothman RH. Reduced incidence of intraoperative femur
fracture with a second-generation tapered wedge stem. J Arthroplasty 2017;32(11):3457e3461.
https://doi.org/10.1016/j.arth.2017.06.018
9. Engh CA, Massin, P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 1990;(257):107-28. PMID: 2199114
10. Nam D, Salih R, Barrack R, Ryan M Nunley RN. An evaluation of proximal femur bone density in young, active
patients undergoing total hip arthroplasty at one year postoperatively. Hip Int 2019;29(1):51-7.
https://doi.org/10.1177/1120700018761152
11. Bochatey EJ, Lopreite F. Resultados a corto plazo de la artroplastia total de cadera con tallos femorales de fijación metafisaria de segunda generación. Rev Asoc Argent Ortop Traumatol 2020;85(3):214-21.
https://doi.org/10.15417/issn.1852-7434.2020.85.3.1021
12. Kvien TK, Heiberg T, Hagen KB. Minimal clinically important improvement/difference (MCII/ MCID) and patient acceptable symptom state (PASS): what do these concepts mean? Ann Rheum Dis 2007;66(Suppl 3):iii40-1. https://doi.org/10.1136/ard.2007.079798
2. Wuestemann T, Bastian A, Schmidt W, Cedermark C, Streicher R, Parvizi J, et al. A novel technique for studying
proximal femoral bone morphology for hip implant design. EFORT — European Federation of National
Associations of Orthopaedics and Traumatology (11th Congress); 2011.
3. Issa K, Pivec R, Wuestemann T, Tatevossian T, Nevelos J, Mont MM. Radiographic fit and fill analysis of a
new second-generation proximally coated cementless stem compared to its predicate design. J Arthroplasty
2014;29(1):192-8. https://doi.org/10.1016/j.arth.2013.04.029
4. 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
5. White CA, Carsen S, Rasuli K, Feibel RJ, Kim PR, Beaulé PE. High incidence of migration with poor initial
fixation of the Accolade1 stem. Clin Orthop Relat Res 2012;470(2):410-7. https://doi.org/10.1007/s11999-011-2160-z
6. Brown TE, Larson B, Shen F, Moskal JT. Thigh pain after cementless total hip arthroplasty: evaluation and
management. J Am Acad Orthop Surg 2002;10(6):385-92. https://doi.org/10.5435/00124635-200211000-00002
7. Colacchio ND, Robbins CE, Aghazadeh MS, Talmo CT, Bono JV. Total hip intraoperative femur fracture: do
the design enhancements of a second-generation tapered-wedge stem reduce the incidence? J Arthroplasty
2017;32(10):3163e3168. https://doi.org/10.1016/j.arth.2017.05.012
8. Fleischman AN, Schubert MM, Restrepo C, Chen AF, Rothman RH. Reduced incidence of intraoperative femur
fracture with a second-generation tapered wedge stem. J Arthroplasty 2017;32(11):3457e3461.
https://doi.org/10.1016/j.arth.2017.06.018
9. Engh CA, Massin, P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 1990;(257):107-28. PMID: 2199114
10. Nam D, Salih R, Barrack R, Ryan M Nunley RN. An evaluation of proximal femur bone density in young, active
patients undergoing total hip arthroplasty at one year postoperatively. Hip Int 2019;29(1):51-7.
https://doi.org/10.1177/1120700018761152
11. Bochatey EJ, Lopreite F. Resultados a corto plazo de la artroplastia total de cadera con tallos femorales de fijación metafisaria de segunda generación. Rev Asoc Argent Ortop Traumatol 2020;85(3):214-21.
https://doi.org/10.15417/issn.1852-7434.2020.85.3.1021
12. Kvien TK, Heiberg T, Hagen KB. Minimal clinically important improvement/difference (MCII/ MCID) and patient acceptable symptom state (PASS): what do these concepts mean? Ann Rheum Dis 2007;66(Suppl 3):iii40-1. https://doi.org/10.1136/ard.2007.079798