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Archives of Orthopaedic and Trauma Surgery

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Open Access 29-09-2023 | Hip-TEP | Hip Arthroplasty

Demographic characteristics influencing the stem subsidence in total hip arthroplasty: an imaging study

Authors: Filippo Migliorini, Nicola Maffulli, Marco Pilone, Erlis Velaj, Ulf Krister Hofmann, Andreas Bell

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2024

Abstract

Introduction

The present study evaluated whether patient demographic characteristics influence the subsidence of the stem in total hip arthroplasty (THA). The following characteristics were evaluated: age, height, weight, and sex. The association between the time elapsed from the THA implantation and the amount of stem subsidence was also investigated.

Methods

The records of patients who underwent THA in the period between 2016 and 2023 were accessed. All patients underwent two-staged bilateral THA using cementless DePuy collarless Corail (DePuy Synthes, Raynham, MA, USA) stems. The following parameters were measured and compared to assess stem subsidence: distance from the proximal femur at the stem bone interface and the medial apex of the regular triangle built within the trochanter minor (point A); distance from the medial apex of the regular triangle built within the trochanter minor and the distal portion of the femoral stem (point B).

Results

Overall, 294 patients were included. 62% (182 of 294 patients) were women. 45% (134 of 296 THAs) were on the right side. The mean age was 64.9 ± 10.4 years. The mean BMI was 28.3 ± 5.1 kg/m². The mean length of the follow-up was 14.4 ± 11.0 months. The mean subsidence in point A was 2.1 mm (P < 0.0001), and that in point B was 3.1 mm (P < 0.0001). There was evidence of a weak positive association between patient weight (P < 0.0001), age (P = 0.03), follow-up (P = 0.002) and the amount of stem subsidence. Patient height did not demonstrate any association with the amount of stem subsidence (P = 0.07). There was no difference in stem subsidence between women and men (P = 0.9).

Conclusion

Stem subsidence in THA using cementless DePuy collarless Corail implants is approximately 2.6 mm after 14.4 months. Greater patient weight, age, and longer time elapsed from THA implantation were associated with greater stem subsidence. Patient height and sex did not demonstrate any influence on the amount of stem subsidence. These results must be considered in light of the limitations of the present study.

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Metcalfe D, Perry DC, Claireaux HA, Simel DL, Zogg CK, Costa ML (2019) Does this patient have hip osteoarthritis?: The rational clinical examination systematic review. JAMA 322(23):2323–2333. https://doi.org/10.1001/jama.2019.19413CrossRefPubMedPubMedCentral

Trudelle-Jackson E, Emerson R, Smith S (2002) Outcomes of total hip arthroplasty: a study of patients one year postsurgery. J Orthop Sports Phys Ther 32(6):260–267. https://doi.org/10.2519/jospt.2002.32.6.260CrossRefPubMed

Kärrholm J, Borssén B, Löwenhielm G, Snorrason F (1994) Does early micromotion of femoral stem prostheses matter? 4-7-year stereoradiographic follow-up of 84 cemented prostheses. J Bone Joint Surg Br 76(6):912–917CrossRefPubMed

Selvaratnam V, Shetty V, Sahni V (2015) Subsidence in collarless corail hip replacement. Open Orthop J 9:194–197. https://doi.org/10.2174/1874325001509010194CrossRefPubMedPubMedCentral

Al-Najjim M, Khattak U, Sim J, Chambers I (2016) Differences in subsidence rate between alternative designs of a commonly used uncemented femoral stem. J Orthop 13(4):322–326. https://doi.org/10.1016/j.jor.2016.06.026CrossRefPubMedPubMedCentral

Campbell D, Mercer G, Nilsson KG, Wells V, Field JR, Callary SA (2011) Early migration characteristics of a hydroxyapatite-coated femoral stem: an RSA study. Int Orthop 35(4):483–488. https://doi.org/10.1007/s00264-009-0913-zCrossRefPubMed

von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008CrossRef

Petersson IF, Boegard T, Saxne T, Silman AJ, Svensson B (1997) Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35–54 years with chronic knee pain. Ann Rheum Dis 56(8):493–496CrossRefPubMedPubMedCentral

Bertin KC, Rottinger H (2004) Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Clin Orthop Relat Res 429:248–255CrossRef

10.

Reimeringer M, Nuno N (2016) The influence of contact ratio and its location on the primary stability of cementless total hip arthroplasty: a finite element analysis. J Biomech 49(7):1064–1070. https://doi.org/10.1016/j.jbiomech.2016.02.031CrossRefPubMed

11.

Viceconti M, Pancanti A, Varini E, Traina F, Cristofolini L (2006) On the biomechanical stability of cementless straight conical hip stems. Proc Inst Mech Eng H 220(3):473–480. https://doi.org/10.1243/09544119H06904CrossRefPubMed

12.

Leiss F, Gotz JS, Meyer M, Maderbacher G, Reinhard J, Parik L, Grifka J, Greimel F (2022) Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing. Arch Orthop Trauma Surg 142(4):673–680. https://doi.org/10.1007/s00402-021-03913-0CrossRefPubMed

13.

Mavrogenis AF, Dimitriou R, Parvizi J, Babis GC (2009) Biology of implant osseointegration. J Musculoskelet Neuronal Interact 9(2):61–71PubMed

14.

Parithimarkalaignan S, Padmanabhan TV (2013) Osseointegration: an update. J Indian Prosthodont Soc 13(1):2–6. https://doi.org/10.1007/s13191-013-0252-zCrossRefPubMedPubMedCentral

15.

Eriksson RA, Albrektsson T (1984) The effect of heat on bone regeneration: an experimental study in the rabbit using the bone growth chamber. J Oral Maxillofac Surg 42(11):705–711. https://doi.org/10.1016/0278-2391(84)90417-8CrossRefPubMed

16.

Lerch M, von der Haar-Tran A, Windhagen H, Behrens BA, Wefstaedt P, Stukenborg-Colsman CM (2012) Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study. Int Orthop 36(3):533–538. https://doi.org/10.1007/s00264-011-1361-0CrossRefPubMed

17.

Streit MR, Haeussler D, Bruckner T, Proctor T, Innmann MM, Merle C, Gotterbarm T, Weiss S (2016) Early migration predicts aseptic loosening of cementless femoral stems: a long-term study. Clin Orthop Relat Res 474(7):1697–1706. https://doi.org/10.1007/s11999-016-4857-5CrossRefPubMedPubMedCentral

18.

Stihsen C, Radl R, Keshmiri A, Rehak P, Windhager R (2012) Subsidence of a cementless femoral component influenced by body weight and body mass index. Int Orthop 36(5):941–947. https://doi.org/10.1007/s00264-011-1360-1CrossRefPubMed

19.

Freitag T, Fuchs M, Woelfle-Roos JV, Reichel H, Bieger R (2019) Mid-term migration analysis of a femoral short-stem prosthesis: a five-year EBRA-FCA-study. Hip Int 29(2):128–133. https://doi.org/10.1177/1120700018772277CrossRefPubMed

20.

Vidalain JP (2011) Twenty-year results of the cementless Corail stem. Int Orthop 35(2):189–194. https://doi.org/10.1007/s00264-010-1117-2CrossRefPubMed

21.

Gema A, Irianto KA, Setiawati R (2021) Femoral stem subsidence and its associated factors after cementless bipolar hemiarthroplasty in geriatric Patients. Malays Orthop J 15(1):63–71. https://doi.org/10.5704/MOJ.2103.010CrossRefPubMedPubMedCentral

22.

Rattanaprichavej P, Laoruengthana A, Chotanaphuti T, Khuangsirikul S, Phreethanutt C, Pongpirul K (2019) Subsidence of hydroxyapatite-coated femoral stem in Dorr type c proximal femoral morphology. J Arthroplasty 34(9):2011–2015. https://doi.org/10.1016/j.arth.2019.05.017CrossRefPubMed

23.

Lupsa BC, Insogna K (2015) Bone health and osteoporosis. Endocrinol Metab Clin North Am 44(3):517–530. https://doi.org/10.1016/j.ecl.2015.05.002CrossRefPubMed

24.

Dyreborg K, Sorensen MS, Flivik G, Solgaard S, Petersen MM (2021) Preoperative BMD does not influence femoral stem subsidence of uncemented THA when the femoral T-score is > -2.5. Acta Orthop 92 (5):538–543. https://doi.org/10.1080/17453674.2021.1920163

25.

Johanson PE, Antonsson M, Shareghi B, Karrholm J (2016) Early subsidence predicts failure of a cemented femoral stem with minor design changes. Clin Orthop Relat Res 474(10):2221–2229. https://doi.org/10.1007/s11999-016-4884-2CrossRefPubMedPubMedCentral

26.

Russell LA (2013) Osteoporosis and orthopedic surgery: effect of bone health on total joint arthroplasty outcome. Curr Rheumatol Rep 15(11):371. https://doi.org/10.1007/s11926-013-0371-xCrossRefPubMed

27.

Troelsen A, Malchau E, Sillesen N, Malchau H (2013) A review of current fixation use and registry outcomes in total hip arthroplasty: the uncemented paradox. Clin Orthop Relat Res 471(7):2052–2059. https://doi.org/10.1007/s11999-013-2941-7CrossRefPubMedPubMedCentral

28.

Paulino EC, de Souza LJ, Molan NA, Machado MC, Jancar S (2007) Neutrophils from acute pancreatitis patients cause more severe in vitro endothelial damage compared with neutrophils from healthy donors and are differently regulated by endothelins. Pancreas 35(1):37–41. https://doi.org/10.1097/MPA.0b013e31805c177bCrossRefPubMed

29.

Makela KT, Matilainen M, Pulkkinen P, Fenstad AM, Havelin L, Engesaeter L, Furnes O, Pedersen AB, Overgaard S, Karrholm J, Malchau H, Garellick G, Ranstam J, Eskelinen A (2014) Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations. BMJ 348:f7592. https://doi.org/10.1136/bmj.f7592

30.

Moritz N, Alm JJ, Lankinen P, Makinen TJ, Mattila K, Aro HT (2011) Quality of intertrochanteric cancellous bone as predictor of femoral stem RSA migration in cementless total hip arthroplasty. J Biomech 44(2):221–227. https://doi.org/10.1016/j.jbiomech.2010.10.012CrossRefPubMed

31.

Zak S, Greenbaum S, Singh V, Schwarzkopf R, Davidovitch RI (2020) The effect of age and activity level on stem subsidence in total hip arthroplasty. J Hip Surg 4(04):173–179. https://doi.org/10.1055/s-0040-1721120CrossRef

32.

Schaer MO, Finsterwald M, Holweg I, Dimitriou D, Antoniadis A, Helmy N (2019) Migration analysis of a metaphyseal-anchored short femoral stem in cementless THA and factors affecting the stem subsidence. BMC Musculoskelet Disord 20(1):604. https://doi.org/10.1186/s12891-019-2980-7CrossRefPubMedPubMedCentral

33.

Nieuwenhuijse MJ, Valstar ER, Kaptein BL, Nelissen RG (2012) The Exeter femoral stem continues to migrate during its first decade after implantation: 10–12 years of follow-up with radiostereometric analysis (RSA). Acta Orthop 83(2):129–134. https://doi.org/10.3109/17453674.2012.672093CrossRefPubMedPubMedCentral

34.

Critchley O, Callary S, Mercer G, Campbell D, Wilson C (2020) Long-term migration characteristics of the Corail hydroxyapatite-coated femoral stem: a 14-year radiostereometric analysis follow-up study. Arch Orthop Trauma Surg 140(1):121–127. https://doi.org/10.1007/s00402-019-03291-8CrossRefPubMed

35.

Reinbacher P, Smolle MA, Friesenbichler J, Draschl A, Leithner A, Maurer-Ertl W (2022) Three-year migration analysis of a new metaphyseal anchoring short femoral stem in THA using EBRA-FCA. Sci Rep 12(1):17173. https://doi.org/10.1038/s41598-022-22160-wCrossRefPubMedPubMedCentral

36.

Aro E, Alm JJ, Moritz N, Mattila K, Aro HT (2018) Good stability of a cementless, anatomically designed femoral stem in aging women: a 9-year RSA study of 32 patients. Acta Orthop 89(5):490–495. https://doi.org/10.1080/17453674.2018.1490985CrossRefPubMedPubMedCentral

37.

Ries C, Boese CK, Dietrich F, Miehlke W, Heisel C (2019) Femoral stem subsidence in cementless total hip arthroplasty: a retrospective single-centre study. Int Orthop 43(2):307–314. https://doi.org/10.1007/s00264-018-4020-xCrossRefPubMed

38.

Krismer M, Biedermann R, Stockl B, Fischer M, Bauer R, Haid C (1999) The prediction of failure of the stem in THR by measurement of early migration using EBRA-FCA. Einzel-Bild-Roentgen-Analyse-femoral component analysis. J Bone Joint Surg Br 81(2):273–280. https://doi.org/10.1302/0301-620x.81b2.8840CrossRefPubMed

39.

Hasler J, Flury A, Dimitriou D, Holweg I, Helmy N, Finsterwald M (2021) Mid-term subsidence and periprosthetic radiolucency of the AMIStem: a 5-year EBRA-FCA analysis. J Orthop Surg Res 16(1):19. https://doi.org/10.1186/s13018-020-02104-8CrossRefPubMedPubMedCentral

40.

van der Voort P, Pijls BG, Nieuwenhuijse MJ, Jasper J, Fiocco M, Plevier JW, Middeldorp S, Valstar ER, Nelissen RG (2015) Early subsidence of shape-closed hip arthroplasty stems is associated with late revision. A systematic review and meta-analysis of 24 RSA studies and 56 survival studies. Acta Orthop 86(5):575–585. https://doi.org/10.3109/17453674.2015.1043832CrossRefPubMedPubMedCentral

41.

Callaghan JJ, Fulghum CS, Glisson RR, Stranne SK (1992) The effect of femoral stem geometry on interface motion in uncemented porous-coated total hip prostheses. Comparison of straight-stem and curved-stem designs. J Bone Joint Surg Am 74(6):839–848CrossRefPubMed

42.

Teeter MG, McCalden RW, Yuan X, MacDonald SJ, Naudie DD (2018) Predictive accuracy of RSA migration thresholds for cemented total hip arthroplasty stem designs. Hip Int 28(4):363–368. https://doi.org/10.1177/1120700018762179CrossRefPubMed

43.

Nazari-Farsani S, Vuopio M, Loyttyniemi E, Aro HT (2021) Contributing factors to the initial femoral stem migration in cementless total hip arthroplasty of postmenopausal women. J Biomech 117:110262. https://doi.org/10.1016/j.jbiomech.2021.110262CrossRefPubMed

44.

Ebert JR, Nivbrant NO, Petrov V, Yates P, Wood DJ (2022) A 2-year prospective clinical and bone density evaluation, with a subset undergoing radiostereometric analysis, using the absolut cemented stem. ANZ J Surg 92(4):830–836. https://doi.org/10.1111/ans.17519CrossRefPubMedPubMedCentral

Title: Demographic characteristics influencing the stem subsidence in total hip arthroplasty: an imaging study
Authors: Filippo Migliorini
Nicola Maffulli
Marco Pilone
Erlis Velaj
Ulf Krister Hofmann
Andreas Bell
Publication date: 29-09-2023
Publisher: Springer Berlin Heidelberg
Keywords: Hip-TEP
Hip-TEP
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2024
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-05054-y

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Springer Medicine

Demographic characteristics influencing the stem subsidence in total hip arthroplasty: an imaging study

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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