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Clinical Orthopaedics and Related Research®

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01-02-2012 | Symposium: Papers Presented at the Annual Meetings of The Hip Society

High Incidence of Migration with Poor Initial Fixation of the Accolade^® Stem

Authors: Craig A. White, MD, Sasha Carsen, MD, Kevin Rasuli, BSc, Robert J. Feibel, MD, FRCSC, Paul R. Kim, MD, FRCSC, Paul E. Beaulé, MD, FRCSC

Published in: Clinical Orthopaedics and Related Research® | Issue 2/2012

Abstract

Background

Numerous cementless femoral stem design variations are in clinical use. Because initial implant instability and micromotion are associated with aseptic loosening of the femoral component, migration analysis provides an early assessment of implant survivorship.

Questions/purposes

We determined the (1) migration pattern of the Accolade^® cementless femoral stem; (2) clinical factors predisposing to stem migration; (3) self-reported patient outcomes; and (4) our current rate of aseptic stem loosening.

Methods

We retrospectively analyzed 81 femoral stems for aseptic migration using Ein-Bild-Roentgen-Analyse-femoral component analysis. Postoperatively, patients completed the WOMAC and SF-12 questionnaires. We assessed radiographic factors potentially associated with subsidence: indices of bone shape and quality, canal fill of the implant, and radiographic signs of loosening. Minimum followup was 24 months (mean, 29 months; range, 24–48 months).

Results

The average subsidence at 24 months was 1.3 mm (range, 0–1.5 mm). In the first 2 years, 36% of stems subsided more than 1.5 mm. Large stem size was associated with subsidence. Radiolucent lines (> 1.5 mm in three zones) were present in 10% of stems and associated with lower questionnaire scores. The 5-year survivorship for aseptic loosening of the 367 stems was 97% with revision as end point and 95% for radiographic failure.

Conclusions

The high incidence of migration and stems with radiographic failure raises concerns about patient clinical function and long-term survivorship of this stem design. This migration pattern may be due to poor initial stability with a subsequent lack of osseointegration. Our results differ from radiographic findings and clinical durability of other similar cementless stem designs.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Aldinger PR, Jung AW, Breusch SJ, Ewerbeck V, Parsch D. Survival of the cementless Spotorno stem in the second decade. Clin Orthop Relat Res. 2009;467:2297–2304.PubMedCrossRef

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMed

Biedermann R, Krismer M, Stöckl B, Mayrhofer P, Ornstein E, Franzén H. Accuracy of EBRA-FCA in the measurement of migration of femoral components of total hip replacement: Einzel-Bild-Röntgen-Analyse-femoral component analysis. J Bone Joint Surg Br. 1999;81:266–272.PubMedCrossRef

Biedermann R, Stöckl B, Krismer M, Mayrhofer P, Ornstein E, Franzén H. Evaluation of accuracy and precision of bone markers for the measurement of migration of hip prostheses: a comparison of conventional measurements. J Bone Joint Surg Br. 2001;83:767–771.PubMedCrossRef

Buma P, Van Loon PJ, Versleyen H, Weinans H, Slooff TJ, de Groot K, Huiskes R. Histological and biomechanical analysis of bone and interface reactions around hydroxyapatite-coated intramedullary implants of different stiffness: a pilot study on the goat. Biomaterials. 1997;18:1251–1260.PubMedCrossRef

Buratti CA, D’Arrigo C, Guido G, Lenzi F, Logroscino GD, Magliocchetti G, Mannocci C, Patella S, Patella V, Salvi V, Speranza A, Speciale D, Spinarelli A, Topa D. Assessment of the initial stability of the Symax femoral stem with EBRA-FCA: a multicentric study of 85 cases. Hip Int. 2009;19:24–29.PubMed

Callaghan JJ, Albright JC, Goetz DD, Olejniczak JP, Johnston RC. Charnley total hip arthroplasty with cement: minimum twenty-five-year followup. J Bone Joint Surg Am. 2000;82:487–497.PubMed

Chafetz N, Baumrind S, Murray WR, Genant HK. Femoral prosthesis subsidence in asymptomatic patients: a stereophotogrammetric assessment. Invest Radiol. 1984;19:235–241.PubMed

De Witte PB, Brand R, Vermeer HG, van der Heide HJ, Barnaart AF. Mid-term results of total hip arthroplasty with the cementless Spotorno (CLS) system. J Bone Joint Surg Am. 2011;93:1249–1255.PubMedCrossRef

10.

Donnelly WJ, Kobayashi A, Freeman MA, Chin TW, Yeo H, West M, Scott G. Radiological and survival comparison of four methods of fixation of a proximal femoral stem. J Bone Joint Surg Br. 1997;79:351–360.PubMedCrossRef

11.

Dorr LD, Faugere MC, Mackel AM, Gruen TA. Structural and cellular assessment of bone quality of proximal femur. Bone. 1993;14:231–242.PubMedCrossRef

12.

Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement: the factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987;69:45–55.PubMed

13.

Freeman MA, Plante-Bordeneuve P. Early migration and late aseptic failure of proximal femoral prostheses. J Bone Joint Surg Br. 1994;76:432–438.PubMed

14.

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.PubMed

15.

Hamadouche M, Witvoet J, Porcher R, Meunier A, Sedel L, Nizard R. Hydroxyapatite-coated versus grit-blasted femoral stems: a prospective, randomised study using EBRA-FCA. J Bone Joint Surg Br. 2001;83:979–987.PubMedCrossRef

16.

Hardoon SL, Lewsey JD, Gregg PJ, Reeves BC, van der Meulen JH. Continuous monitoring of the performance of hip prostheses. J Bone Joint Surg Br. 2006;88:716–720.PubMedCrossRef

17.

Healy WL, Tilzey JF, Iorio R, Specht LM, Sharma S. Prospective, randomized comparison of cobalt-chrome and titanium Trilock femoral stems. J Arthroplasty. 2009;24:831–836.PubMedCrossRef

18.

Huiskes R, Weinans H, Rietbergen BV. The relationship between stress shielding and bone resorption around total hip stems and the effects of flexible materials. Clinical Orthop Relat Res. 1992;274:124–134.

19.

Ince A, Lermann J, Göbel S, Wollmerstedt N, Hendrick C. No increased stem subsidence after arthroplasty in young patients with femoral head osteonecrosis: 41 patients followed for 1–9 years. Acta Orthop. 2006;77:866–870.PubMedCrossRef

20.

Jacobs CA, Christensen CP. Progressive subsidence of a tapered, proximally coated femoral stem in total hip arthroplasty. Int Orthop. 2009;33:917–922.PubMedCrossRef

21.

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

22.

Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am. 2011;93:500–509.PubMedCrossRef

23.

Kim YH, Kim VE. Uncemented porous-coated anatomic total hip replacement: results at six years in a consecutive series. J Bone Joint Surg Br. 1993;75:6–13.PubMed

24.

Klestil T, Bidermann R, Krüger A, Gfoller P, Schmoelz W, Rangger P, Krismer M, Blauth M. Cementless hemiarthroplasty in femoral neck fractures: evaluation of clinical results and measurement of migration by EBRA-FCA. Arch Orthop Trauma Surg. 2006;126:380–386.PubMedCrossRef

25.

Kobayashi A, Donnelly WJ, Scott G, Freeman MA. Early radiological observations may predict the long-term survival of femoral hip prostheses. J Bone Joint Surg Br. 1997;79:583–589.PubMedCrossRef

26.

Kobayashi S, Saito N, Horiuchi H, Iorio R, Takaoka K. Poor bone quality or hip structure as risk factors affecting survival of total-hip arthroplasty. Lancet. 2000;355:1499–1504.PubMedCrossRef

27.

Krismer M, Bauer R, Tschupik JP, Mayrhofer P. EBRA: a method to measure migration of acetabular components: technical note. J Biomechanics. 1995;28:1225–1236.CrossRef

28.

Krismer M, Biedermann R, Stöckl B, Fischer M, Bauer R, Haid C. 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. 1999;81:273–280.PubMedCrossRef

29.

Kroell A, Beaulé P, Krismer M, Behensky H, Stoeckl B, Biedermann R. Aseptic stem loosening in primary THA: migration analysis of cemented and cementless fixation. Int Orthop. 2009;33:1501–1505.PubMedCrossRef

30.

Lettich T, Tierney MG, Parvizi J, Sharkey PF, Rothman RH. Primary total hip arthroplasty with an uncemented femoral component: two- to seven-year results. J Arthroplasty. 2007;22:43–46.PubMedCrossRef

31.

Loudon JR, Charnley J. Subsidence of the femoral prosthesis in total hip replacement in relation to the design of the stem. J Bone Joint Surg Br. 1980;62:450–453.PubMed

32.

Mazoochian F, Schrimpf FM, Kircher J, Mayer W, Hauptmann S, Fottner A, Muller PE, Pellengahr C, Jansson V. Proximal loading of the femur leads to low subsidence rates: first clinical results of the CR-stem. Arch Orthop Trauma Surg. 2007;127:397–401.PubMedCrossRef

33.

McLaughlin JR, Lee KR. Total hip arthroplasty with an uncemented tapered femoral component. J Bone Joint Surg Am. 2008;90:1290–1296.PubMedCrossRef

34.

Middleton RG, Howie DW, Costi K, Sharpe P. Effects of design changes on cemented tapered femoral stem fixation. Clin Orthop Relat Res. 1998;355:47–56.PubMedCrossRef

35.

Mjoberg B. Fixation and loosening of hip prostheses: a review. Acta Orthop Scand. 1991;62:500–508.PubMedCrossRef

36.

Mjoberg B, Selvik G, Hansson LI. Mechanical loosening of total hip prostheses: a radiographic and roentgen stereophotogrammetric study. J Bone Joint Surg Br. 1986;68:770–774.PubMed

37.

Noble PC, Alexander JW, Lindahl LW, Yew DT, Granberry WM, Tullos HS. The anatomic basis of femoral component design. Clin Orthop Relat Res. 1988;235:148–165.PubMed

38.

Radl R, Hungerford M, Materna W, Rehak P, Windhager R. Higher failure rate and stem migration of an uncemented femoral component in patients with femoral head osteonecrosis than in patients with osteoarthritis. Acta Orthop. 2005;76:49–55.PubMedCrossRef

39.

Schütz U, Decking J, Decking R, Puhl W. Assessment of femoral component migration in total hip arthroplasty: digital measurements compared to RSA. Acta Orthop Belg. 2005;71:65–75.PubMed

40.

Simpson DJ, Kendrick BJL, Hughes M, Glyn-Jones S, Gill HS, Rushforth GF, Murray DW. The migration patterns of two versions of the Furlong cementless femoral stem: a randomised, controlled trial using radiostereometric analysis. J Bone Joint Surg Br. 2010;92:1356–1362.PubMedCrossRef

41.

Swanson TV, Peterson DJ, Seethala R, Bliss RL, Spellmon CA. Influence of prosthetic design on squeaking after ceramic-ceramic total hip arthroplasty. J Arthroplasty. 2010;25:36–42.PubMedCrossRef

42.

Teloken MA, Bissett G, Hozack WJ, Sharkey PF, Rothman RH. Ten to fifteen-year follow-up after total hip arthroplasty with a tapered cobalt-chromium femoral component (Tri-Lock) inserted without cement. J Bone Joint Surg Am. 2002;84:2140–2144.PubMed

43.

Walker PS, Mai SF, Cobb AG, Bentley G, Hua J. Prediction of clinical outcome of THR from migration measurements on standard radiographs: a study of cemented Charnley and Stanmore femoral stems. J Bone Joint Surg Br. 1995;77:705–714.PubMed

44.

Wang K, Gustavson L, Dumbleton J. The characterization of Ti-12Mo-6Zr-2Fe—a new biocompatible titanium alloy developed for surgical implants. In: Eylon D, Boyer RR, Koss DA, eds. Beta Titanium Alloys in the 1990’s: Proceedings of a Symposium on Beta Titanium Alloys Sponsored by the Titanium Committee of TMS. Warrendale, PA: Minerals, Metals and Materials Society; 1993:49–58.

45.

Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233.PubMedCrossRef

Title: High Incidence of Migration with Poor Initial Fixation of the Accolade® Stem
Authors: Craig A. White, MD
Sasha Carsen, MD
Kevin Rasuli, BSc
Robert J. Feibel, MD, FRCSC
Paul R. Kim, MD, FRCSC
Paul E. Beaulé, MD, FRCSC
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 2/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-2160-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

High Incidence of Migration with Poor Initial Fixation of the Accolade^® Stem

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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