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Archives of Orthopaedic and Trauma Surgery

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14-08-2021 | Hip-TEP | Hip Arthroplasty

Cementless total hip arthroplasty with anatomic-shaped implants. Does the minimal invasive anterolateral technique influence the stem position or subsidence in contrast to the standard lateral approach?

Authors: Nils Wirries, Marcus Örgel, Michael Schwarze, Stefan Budde, Henning Windhagen, Michael Skutek

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2022

Abstract

Introduction

Using cementless stems in total hip arthroplasty (THA) has revealed variable results. The risk for early aseptic loosening has been associated to certain surgical approaches and implant designs. This study determines misalignment of collared/collarless stems and the rate of subsidence using the anterolateral approach (ALA) compared to implantations via the direct lateral approach (DLA).

Materials and methods

One hundred consecutive patients underwent primary unilateral THA using the minimal invasive ALA in the lateral decubitus position and were compared to another cohort of 100 patients, treated trough the DLA. Clinical results were noted preoperatively and after 1 year using the WOMAC score. The radiographic evaluation included the stem alignment and subsidence.

Results

Overall, all patients improved in WOMAC from 48.9 points (± 11.4; 21.0–82.0) to 3.1 (± 3.2; 0.0–22.0) (p < 0.001). For DLA and ALA, the stem was placed on average 2.5° in varus to the femoral axis. The mean alignment was about 0.5° more valgus for collarless stems. The mean subsidence in the DLA group was about 0.3 mm higher compared to the ALA group. With collarless implants, the subsidence was about 1.0 mm higher compared to collared implants (p < 0.05), especially in patients with Dorr type B femurs.

Conclusions

Changing from the DLA to the minimal invasive ALA did not significantly affect the implant position. Misalignment and a potential risk for early aseptic loosening could not be seen. The use of a collared cementless stem seems safe and is likely to prevent a relevant subsidence, even more so in Dorr type B femurs.

Level of evidence

III.

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Title: Cementless total hip arthroplasty with anatomic-shaped implants. Does the minimal invasive anterolateral technique influence the stem position or subsidence in contrast to the standard lateral approach?
Authors: Nils Wirries
Marcus Örgel
Michael Schwarze
Stefan Budde
Henning Windhagen
Michael Skutek
Publication date: 14-08-2021
Publisher: Springer Berlin Heidelberg
Keywords: Hip-TEP
Hip-TEP
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 9/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-04122-5

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Cementless total hip arthroplasty with anatomic-shaped implants. Does the minimal invasive anterolateral technique influence the stem position or subsidence in contrast to the standard lateral approach?

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

Keynote Webinar | Spotlight on Diet and Diabetes

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

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