Clinical and Radiographic Analysis of the CEMENTFREE® Uncemented Hip Stem of National Manufacture. Short-Term Results
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Published:
Jun 25, 2022
Keywords:
Arthroplasty, cementless prosthesis, metaphyseal fixation, osseointegration.
Main Article Content
Abstract
Introduction: The stability of the femoral component and its resistance to subsidence are critical factors to achieve correct osseointegration and subsequent clinical success in cementless total hip arthroplasty. Few studies have evaluated the results of nationally manufactured stems, even in the short and medium term. Our objective is to clinically and radiologically analyze patients undergoing a total hip replacement with a nationally manufactured femoral component (Cementfree® stem).
Materials and Methods: We carried out a retrospective study on patients who had undergone a total hip replacement with the Cementfree® stem between January 2015 and August 2020 by the same surgeon and at the same institution.
Results: 46 uncemented stems were implanted in 42 patients with an age range between 60 and 81 years. The average follow-up was 3 years, with a minimum of 1 year and a maximum of 5 years. There was an evident improvement in the Harris Hip Score (an average of 47 preoperatively vs. 93 after surgery). The revision of the stem for aseptic loosening, in the Kaplan Meier analysis, demonstrated a 100% survival rate at 5 years.
Conclusion: According to the results obtained in this research, hip arthroplasty with the nationally manufactured Cementfree® stem has proven to be an option comparable to other imported stems in terms of short-term clinical and radiographic outcomes. An evaluation of the outcomes in the medium and long term is pending.
Materials and Methods: We carried out a retrospective study on patients who had undergone a total hip replacement with the Cementfree® stem between January 2015 and August 2020 by the same surgeon and at the same institution.
Results: 46 uncemented stems were implanted in 42 patients with an age range between 60 and 81 years. The average follow-up was 3 years, with a minimum of 1 year and a maximum of 5 years. There was an evident improvement in the Harris Hip Score (an average of 47 preoperatively vs. 93 after surgery). The revision of the stem for aseptic loosening, in the Kaplan Meier analysis, demonstrated a 100% survival rate at 5 years.
Conclusion: According to the results obtained in this research, hip arthroplasty with the nationally manufactured Cementfree® stem has proven to be an option comparable to other imported stems in terms of short-term clinical and radiographic outcomes. An evaluation of the outcomes in the medium and long term is pending.
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Vega, C. A., Sued , M., Moruno Cossio, F., Balderrama Uriona, G., Vergara, F., Garavano, E., Jimenez Rios , W., & Mazzeneth Contreras, A. (2022). Clinical and Radiographic Analysis of the CEMENTFREE® Uncemented Hip Stem of National Manufacture. Short-Term Results. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(3), 316-324. https://doi.org/10.15417/issn.1852-7434.2022.87.3.1489
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Clinical Research
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References
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CLS Spotorno stem. Arch Orthop Trauma Surg 2010;130(2):269-75. https://doi.org/10.1007/s00402-009-0969-7
2. Kelsey D, Goodman SB. Design of the femoral component for cementless hip replacement: the surgeon’s
perspective. Am J Orthop (Belle Mead NJ) 1997;26:407-12. PMID: 9193693
3. 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
4. Engh CA, Glassman AH. Cementless revision of failed total hip replacement: An update. Instruct Course Lect
1991;40:189-200.
5. Engh CA, Griffin WL, Marx CL. Cementless acetabular components. J Bone Joint Surg Br 1990;72:53-9.
https://doi.org/10.1302/0301-620X.72B1.2298795
6. Kärrholm J, Herberts P, Hultmark P, Malchau H, Nivbrant B, Thanner J. Radiostereometry of hip prostheses: review of methodology and clinical results. Clin Orthop Rel Res 1997;(344):94-110. PMID: 937276
7. Harris WH. Optimization of bone ingrowth for fixation of total hip replacements. En: Lin OCC, Chao EYS.
Perspectives on Biomaterials. Materials Science Monographs, 34th ed. Amsterdam: Elsevier: 1986:321-32.
8. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Joint Surg Am 1969;51:737-45. https://doi.org/10.1007/978-1-4471-5451-8_3
9. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement: the factors governing bone in growth, stress shielding and clinical results. J Bone Joint Surg Br 1987;69:45-55. https://doi.org/10.1302/0301-620X.69B1.3818732
10. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral component. Clin Orthop Relat Res 1990;(257):107-28. PMID: 2199114
11. Singh M, Magrath AR, Maini PS. Changes in trabecular pattern of upper end of the femur as an index of
osteoporosis. J Bone Joint Surg Am 1970;52(3):457-567. PMID: 5425640
12. Cameron HU, Pilliar R. The effect of movement on the bonding of porous metal to bone. J Biomed Mater Res
1973;7(4):301-11. https://doi.org/10.1002/jbm.820070404
13. Persigan VA. Molecular forces governing tight contact between cellular surfaces and substrates, J. Prosth Dent 1983;49(6):838-46. https://doi.org/10.1016/0022-3913(83)90360-8
14. Freeman MA, Plante-Bordeneuve P. Early migration and late aseptic failure of proximal femoral prostheses. J Bone Joint Surg Br 1994;76(3):432-8. https://doi.org/10.1302/0301-620X.76B3.8175848
15. McTighe T, Stulberg SD, Keppler L, Keggi J, Kennon RT, Brazil D, et al. A classification system for short stem
uncemented THA. Poster #4. International Congress for Joint Reconstruction, 2012. Disponible en:
http://www.jisrf.org/pdfs/a-classi_cation-system-short-stem.pdf
16. Rodríguez Sammartino G. Fracturas del tallo femoral en artroplastia total de cadera híbrida. Reporte de dos
casos clínicos evaluados con análisis de falla de materiales. Revista ACARO 2015;1(1). Disponible en:
https://acarorevista.org.ar/joomla-pages-iii/categories-list/40-la-revista/ediciones-anteriores/abril-2015-vol-1-num-1/99-fracturas-del-tallo-femoral-en-artroplastia-total-de-cadera-hibrida-reporte-de-dos-casos-clinicos-evaluados-conanalisis-de-falla-de-materiales
17. Köksal A, Öner A, Çimen O, Aycan OE, Akgün H, Yapici F, et al. Femoral stem fractures after primary and revision hip replacements: A single-center experience. Jt Dis Relat Surg 2020;31(3):557-63. https://doi:10.5606/ehc.2020.76162
18. Simesen de Bielke H, Pérez Alamino L, Garabano G, Pesciallo CÁ, del Sel H, Lopreite FA. Comportamiento de los tallos no cementados recubiertos con hidroxiapatita colocados con alineación coronal inadecuada en la artroplastia primaria de cadera. Resultados del seguimiento a largo plazo. Rev Asoc Argent Ortop Traumatol 2021;86(4):455-62. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1321
19. Perea AO, Spesot P, García M, Arce J, García S, Munafó Ducia R. Análisis clínico-radiológico comparativo de
tallos femorales no cementados planos de primera vs. segunda generación. Rev Asoc Argent Ortop Traumatol
2021;86(4):475-82. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1337
20. Bochatey EJ, Lopreite FA. 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
21. Colacchio N, Robbins C, Aghazadeh M, Talmo C, Bono J. Total hip intraoperative femur fracture: does a tapered wedge design with a size specific medial curvature reduce the incidence of intraoperative femur fracture? J Arthroplasty 2017;32(10):31638. https://doi.org/10.1016/j.arth.2017.05.012
22. Steens W, Skripitz R, Schneeberger AG, Petzing I, Simon U, Goetze C. [Cementless femoral neck prosthesis CUT--clinical and radiological results after 5 years]. Z Orthop Unfall 2010;148(4):413–9. https://doi.org/10.1055/s-0030-1250150 [En alemán]
23. Santori FS, Santori N. Mid-term results of a custom-made short proximal loading femoral component. J Bone Joint Surg Br 2010;92(9):1231-7. https://doi.org/10.1302/0301-620X.92B9.24605
24. Kim YH, Kim JS, Joo JH, Park JW. A prospective short-term outcome study of a short metaphyseal fitting total hip arthroplasty. J Arthroplasty 2012;27(1):88. https://doi.org/10.1016/j.arth.2011.02.008
25. Cornell CN, Ranawat CS. Survivorship analysis of total hip replacements. J Bone Joint Surg Am 1986;68(9):1430-7. PMID: 3782214
CLS Spotorno stem. Arch Orthop Trauma Surg 2010;130(2):269-75. https://doi.org/10.1007/s00402-009-0969-7
2. Kelsey D, Goodman SB. Design of the femoral component for cementless hip replacement: the surgeon’s
perspective. Am J Orthop (Belle Mead NJ) 1997;26:407-12. PMID: 9193693
3. 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
4. Engh CA, Glassman AH. Cementless revision of failed total hip replacement: An update. Instruct Course Lect
1991;40:189-200.
5. Engh CA, Griffin WL, Marx CL. Cementless acetabular components. J Bone Joint Surg Br 1990;72:53-9.
https://doi.org/10.1302/0301-620X.72B1.2298795
6. Kärrholm J, Herberts P, Hultmark P, Malchau H, Nivbrant B, Thanner J. Radiostereometry of hip prostheses: review of methodology and clinical results. Clin Orthop Rel Res 1997;(344):94-110. PMID: 937276
7. Harris WH. Optimization of bone ingrowth for fixation of total hip replacements. En: Lin OCC, Chao EYS.
Perspectives on Biomaterials. Materials Science Monographs, 34th ed. Amsterdam: Elsevier: 1986:321-32.
8. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Joint Surg Am 1969;51:737-45. https://doi.org/10.1007/978-1-4471-5451-8_3
9. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement: the factors governing bone in growth, stress shielding and clinical results. J Bone Joint Surg Br 1987;69:45-55. https://doi.org/10.1302/0301-620X.69B1.3818732
10. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral component. Clin Orthop Relat Res 1990;(257):107-28. PMID: 2199114
11. Singh M, Magrath AR, Maini PS. Changes in trabecular pattern of upper end of the femur as an index of
osteoporosis. J Bone Joint Surg Am 1970;52(3):457-567. PMID: 5425640
12. Cameron HU, Pilliar R. The effect of movement on the bonding of porous metal to bone. J Biomed Mater Res
1973;7(4):301-11. https://doi.org/10.1002/jbm.820070404
13. Persigan VA. Molecular forces governing tight contact between cellular surfaces and substrates, J. Prosth Dent 1983;49(6):838-46. https://doi.org/10.1016/0022-3913(83)90360-8
14. Freeman MA, Plante-Bordeneuve P. Early migration and late aseptic failure of proximal femoral prostheses. J Bone Joint Surg Br 1994;76(3):432-8. https://doi.org/10.1302/0301-620X.76B3.8175848
15. McTighe T, Stulberg SD, Keppler L, Keggi J, Kennon RT, Brazil D, et al. A classification system for short stem
uncemented THA. Poster #4. International Congress for Joint Reconstruction, 2012. Disponible en:
http://www.jisrf.org/pdfs/a-classi_cation-system-short-stem.pdf
16. Rodríguez Sammartino G. Fracturas del tallo femoral en artroplastia total de cadera híbrida. Reporte de dos
casos clínicos evaluados con análisis de falla de materiales. Revista ACARO 2015;1(1). Disponible en:
https://acarorevista.org.ar/joomla-pages-iii/categories-list/40-la-revista/ediciones-anteriores/abril-2015-vol-1-num-1/99-fracturas-del-tallo-femoral-en-artroplastia-total-de-cadera-hibrida-reporte-de-dos-casos-clinicos-evaluados-conanalisis-de-falla-de-materiales
17. Köksal A, Öner A, Çimen O, Aycan OE, Akgün H, Yapici F, et al. Femoral stem fractures after primary and revision hip replacements: A single-center experience. Jt Dis Relat Surg 2020;31(3):557-63. https://doi:10.5606/ehc.2020.76162
18. Simesen de Bielke H, Pérez Alamino L, Garabano G, Pesciallo CÁ, del Sel H, Lopreite FA. Comportamiento de los tallos no cementados recubiertos con hidroxiapatita colocados con alineación coronal inadecuada en la artroplastia primaria de cadera. Resultados del seguimiento a largo plazo. Rev Asoc Argent Ortop Traumatol 2021;86(4):455-62. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1321
19. Perea AO, Spesot P, García M, Arce J, García S, Munafó Ducia R. Análisis clínico-radiológico comparativo de
tallos femorales no cementados planos de primera vs. segunda generación. Rev Asoc Argent Ortop Traumatol
2021;86(4):475-82. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1337
20. Bochatey EJ, Lopreite FA. 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
21. Colacchio N, Robbins C, Aghazadeh M, Talmo C, Bono J. Total hip intraoperative femur fracture: does a tapered wedge design with a size specific medial curvature reduce the incidence of intraoperative femur fracture? J Arthroplasty 2017;32(10):31638. https://doi.org/10.1016/j.arth.2017.05.012
22. Steens W, Skripitz R, Schneeberger AG, Petzing I, Simon U, Goetze C. [Cementless femoral neck prosthesis CUT--clinical and radiological results after 5 years]. Z Orthop Unfall 2010;148(4):413–9. https://doi.org/10.1055/s-0030-1250150 [En alemán]
23. Santori FS, Santori N. Mid-term results of a custom-made short proximal loading femoral component. J Bone Joint Surg Br 2010;92(9):1231-7. https://doi.org/10.1302/0301-620X.92B9.24605
24. Kim YH, Kim JS, Joo JH, Park JW. A prospective short-term outcome study of a short metaphyseal fitting total hip arthroplasty. J Arthroplasty 2012;27(1):88. https://doi.org/10.1016/j.arth.2011.02.008
25. Cornell CN, Ranawat CS. Survivorship analysis of total hip replacements. J Bone Joint Surg Am 1986;68(9):1430-7. PMID: 3782214