Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2015

Open Access 01-12-2015 | Research article

Cortical hypertrophy with a short, curved uncemented hip stem does not have any clinical impact during early follow-up

Authors: Michael W. Maier, Marcus R. Streit, Moritz M. Innmann, Marlis Krüger, Jan Nadorf, J. Philippe Kretzer, Volker Ewerbeck, Tobias Gotterbarm

Published in: BMC Musculoskeletal Disorders | Issue 1/2015

Login to get access

Abstract

Background

Short stems have become more and more popular for cementless total hip arthroplasty in the past few years. While conventional, uncemented straight stems for primary total hip arthroplasty (THA) have shown high survival rates in the long term, it is not known whether uncemented short stems represent a reasonable alternative. As cortical hypertrophy has been reported for short stems, the aim of this study was to determine the radiographic prevalence of cortical hypertrophy and to assess the clinical outcome of a frequently used short, curved hip stem.

Methods

We retrospectively studied the clinical and radiographic results of our first 100 consecutive THAs (97 patients) using the Fitmore® hip stem. Mean age at the time of index arthroplasty was 59 years (range, 19 – 79 years). Clinical outcome and radiographic results were assessed with a minimum follow-up of 2 years, and Kaplan-Meier survivorship analysis was used to estimate survival for different endpoints.

Results

After a mean follow-up of 3.3 years (range, 2.0 – 4.4 years), two patients (two hips) had died, and three patients (four hips) were lost to follow-up. Kaplan-Meier analysis estimated a survival rate of 100 % at 3.8 years, with revision for any reason as the endpoint. No femoral component showed radiographic signs of loosening. No osteolysis was detected. Cortical hypertrophy was found in 50 hips (63 %), predominantly in Gruen zone 3 and 5. In the cortical hypertrophy group, two patients (two hips; 4 %) reported some thigh pain in combination with pain over the greater trochanter region during physical exercise (UCLA Score 6 and 7). There was no significant difference concerning the clinical outcome between the cortical hypertrophy and no cortical hypertrophy group.

Conclusions

The survival rate and both clinical and the radiographic outcome confirm the encouraging results for short, curved uncemented stems. Postoperative radiographs frequently displayed cortical hypertrophy but it had no significant effect on the clinical outcome in the early follow-up. Further clinical and radiographic follow-up is necessary to detect possible adverse, long-term, clinical effects of cortical hypertrophy.
Literature
1.
McLaughlin JR, Lee KR. Total hip arthroplasty with an uncemented tapered femoral component. J Bone Joint Surg Am. 2008;90:1290–6.CrossRefPubMed
2.
Belmont Jr PJ, Powers CC, Beykirch SE, Hopper Jr RH, Engh Jr CA, Engh CA. Results of the anatomic medullary locking total hip arthroplasty at a minimum of twenty years. A concise follow-up of previous reports. J Bone Joint Surg Am. 2008;90:1524–30.CrossRefPubMed
3.
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;467:2297–304.CrossRefPubMedPubMedCentral
4.
Hallan G, Lie SA, Furnes O, Engesaeter LB, Vollset SE, Havelin LI. Medium- and long-term performance of 11,516 uncemented primary femoral stems from the Norwegian arthroplasty register. J Bone Joint Surg (Br). 2007;89:1574–80.CrossRef
5.
Aldinger PR, Jung AW, Pritsch M, Breusch S, Thomsen M, Ewerbeck V, et al. Uncemented grit-blasted straight tapered titanium stems in patients younger than fifty-five years of age. Fifteen to twenty-year results. J Bone Joint Surg Am. 2009;91:1432–9.CrossRefPubMed
6.
Ellison B, Berend KR, Lombardi Jr AV, Mallory TH. Tapered titanium porous plasma-sprayed femoral component in patients aged 40 years and younger. J Arthroplasty. 2006;21:32–7.CrossRefPubMed
7.
Eskelinen A, Remes V, Helenius I, Pulkkinen P, Nevalainen J, Paavolainen P. Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish Arthroplasty Register. Acta Orthop. 2006;77:57–70.CrossRefPubMed
8.
Yerasimides JG. Use of the Fitmore(R) hip stem bone-preserving system for the minimally invasive anterior-supine approach in hip replacement. Am J Orthop (Belle Mead NJ). 2010;39:13–6.
9.
Kim YH, Park JW, Kim JS. Is diaphyseal stem fixation necessary for primary total hip arthroplasty in patients with osteoporotic bone (Class C bone)? J Arthroplasty. 2013;28(1):139-46.e1. doi: 10.​1016/​j.​arth.​2012.​04.​002. Epub 2012 Jun 6.
10.
Zimmer W, Ind. Fitmore® hip stem - surgical technique. 2007.
11.
Pipino F, Molfetta L, Grandizio M. Preservation of the femoral neck in hip arthroplasty: result of a 13– to 17-year follow-up. J Orthop Traumatol. 2000;1:31–9.CrossRef
12.
Morrey BF, Adams RA, Kessler M. A conservative femoral replacement for total hip arthroplasty. A prospective study. J Bone Joint Surg (Br). 2000;82:952–8.CrossRef
13.
Santori FS, Santori N. Mid-term results of a custom-made short proximal loading femoral component. J Bone Joint Surg (Br). 2010;92:1231–7.CrossRef
14.
Gustke K. Short stems for total hip arthroplasty: initial experience with the Fitmore stem. J Bone Joint Surg (Br). 2012;94-B:47–51.CrossRef
15.
Watson-Jones R. Fractures of the neck of the femur. Br J Surg. 1936;23:787–808.CrossRef
16.
Bauer R, Kerschbaumer F, Poisel S, Oberthaler W. The transgluteal approach to the hip joint. Arch Orthop Trauma Surg. 1979;95:47–9.CrossRefPubMed
17.
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–55.PubMed
18.
Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13:890–5.CrossRefPubMed
19.
Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;(198):43–9.
20.
Naal FD, Impellizzeri FM, Leunig M. Which is the best activity rating scale for patients undergoing total joint arthroplasty? Clin Orthop Relat Res. 2009;467:958–65.CrossRefPubMed
21.
Terwee CB, Bouwmeester W, van Elsland SL, de Vet HC, Dekker J. Instruments to assess physical activity in patients with osteoarthritis of the hip or knee: a systematic review of measurement properties. Osteoarthr Cartil. 2011;19:620–33.CrossRefPubMed
22.
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;15:1833–40.PubMed
23.
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.
24.
Streit MR, Innmann MM, Merle C, Bruckner T, Aldinger PR, Gotterbarm T. Long-term (20– to 25-year) results of an uncemented tapered titanium femoral component and factors affecting survivorship. Clin Orthop Relat Res. 2013;471:3262–9.CrossRefPubMedPubMedCentral
25.
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.
26.
Engh CA, Glassman AH, Suthers KE. The case for porous-coated hip implants. The femoral side. Clin Orthop Relat Res. 1990;(261):63–81.
27.
Malchau H, Karrholm J, Wang YX, Herberts P. Accuracy of migration analysis in hip arthroplasty. Digitized and conventional radiography, compared to radiostereometry in 51 patients. Acta Orthop Scand. 1995;66:418–24.CrossRefPubMed
28.
Brooker AF, Bowerman JW, Robinson RA, Riley Jr LH. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–32.PubMed
29.
Whiteside LA, White SE, McCarthy DS. Effect of neck resection on torsional stability of cementless total hip replacement. Am J Orthop (Belle Mead NJ). 1995;24:766–70.
30.
Jasty M, Krushell R, Zalenski E, O’Connor D, Sedlacek R, Harris W. The contribution of the nonporous distal stem to the stability of proximally porous-coated canine femoral components. J Arthroplasty. 1993;8:33–41.CrossRefPubMed
31.
Santori FS, Manili M, Fredella N, Tonci Ottieri M, Santori N. Ultra-short stems with proximal load transfer: clinical and radiographic results at five-year follow-up. Hip Int. 2006;16 Suppl 3:31–9.PubMed
32.
Santori N, Albanese CV, Learmonth ID, Santori FS. Bone preservation with a conservative metaphyseal loading implant. Hip Int. 2006;16 Suppl 3:16–21.PubMed
33.
Gulow J, Scholz R, FreiherrvonSalis-Soglio G. [Short-stemmed endoprostheses in total hip arthroplasty]. Orthopade. 2007;36:353–9.CrossRefPubMed
34.
Pipino F, Molfetta L. Femoral neck preservation in total hip replacement. Ital J Orthop Traumatol. 1993;19:5–12.PubMed
35.
Rohrl SM, Li MG, Pedersen E, Ullmark G, Nivbrant B. Migration pattern of a short femoral neck preserving stem. Clin Orthop Relat Res. 2006;448:73–8.CrossRefPubMed
36.
Kolb A, Grubl A, Schneckener CD, Chiari C, Kaider A, Lass R, et al. Cementless total hip arthroplasty with the rectangular titanium Zweymuller stem: a concise follow-up, at a minimum of twenty years, of previous reports. J Bone Joint Surg Am. 2012;94:1681–4.CrossRefPubMed
37.
Brown TE, Larson B, Shen F, Moskal JT. Thigh pain after cementless total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2002;10:385–92.CrossRefPubMed
38.
Glassman AH, Bobyn JD, Tanzer M. New femoral designs: do they influence stress shielding? Clin Orthop Relat Res. 2006;453:64–74.CrossRefPubMed
39.
Bieger R, Ignatius A, Decking R, Claes L, Reichel H, Durselen L. Primary stability and strain distribution of cementless hip stems as a function of implant design. Clin Biomech (Bristol, Avon). 2012;27:158–64.CrossRef
40.
Pepke W, Nadorf J, Ewerbeck V, Streit MR, Kinkel S, Gotterbarm T, et al. Primary stability of the Fitmore stem: biomechanical comparison. Int Orthop. 2014;38:483–8.CrossRefPubMed
41.
Finsen V, Anda S. Accuracy of visually estimated bone mineralization in routine radiographs of the lower extremity. Skelet Radiol. 1988;17:270–5.CrossRef
42.
West JD, Mayor MB, Collier JP. Potential errors inherent in quantitative densitometric analysis of orthopaedic radiographs. A study after total hip arthroplasty. J Bone Joint Surg Am. 1987;69:58–64.PubMed
43.
Brand RA, Yoder SA, Pedersen DR. Interobserver variability in interpreting radiographic lucencies about total hip reconstructions. Clin Orthop Relat Res. 1985;(192):237–9.
44.
Albanese CV, Rendine M, De Palma F, Impagliazzo A, Falez F, Postacchini F, et al. Bone remodelling in THA: a comparative DXA scan study between conventional implants and a new stemless femoral component. A preliminary report. Hip Int. 2006;16 Suppl 3:9–15.PubMed
45.
Speirs AD, Heller MO, Taylor WR, Duda GN, Perka C. Influence of changes in stem positioning on femoral loading after THR using a short-stemmed hip implant. Clin Biomech (Bristol, Avon). 2007;22:431–9.CrossRef
46.
Tsao A, Pesut T, Peacock C, Tucci M, Buckhalter RA. Bone sparing surgical options for total hip replacement. Biomed Sci Instrum. 2003;39:284–8.PubMed
47.
Lazarinis S, Mattsson P, Milbrink J, Mallmin H, Hailer NP. A prospective cohort study on the short collum femoris-preserving (CFP) stem using RSA and DXA. Primary stability but no prevention of proximal bone loss in 27 patients followed for 2 years. Acta Orthop. 2013;84:32–9.CrossRefPubMedPubMedCentral
48.
Kress AM, Schmidt R, Nowak TE, Nowak M, Haeberle L, Forst R, et al. Stress-related femoral cortical and cancellous bone density loss after collum femoris preserving uncemented total hip arthroplasty: a prospective 7-year follow-up with quantitative computed tomography. Arch Orthop Trauma Surg. 2012;132:1111–9.CrossRefPubMed
Metadata
Title
Cortical hypertrophy with a short, curved uncemented hip stem does not have any clinical impact during early follow-up
Authors
Michael W. Maier
Marcus R. Streit
Moritz M. Innmann
Marlis Krüger
Jan Nadorf
J. Philippe Kretzer
Volker Ewerbeck
Tobias Gotterbarm
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2015
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-015-0830-9

Other articles of this Issue 1/2015

BMC Musculoskeletal Disorders 1/2015 Go to the issue

Research article

Improvement of spontaneous locomotor activity with JAK inhibition by JTE-052 in rat adjuvant-induced arthritis

Research article

Clinical and radiographic outcomes of a trabecular titanium™ acetabular component in hip arthroplasty: results at minimum 5 years follow-up

Research article

Do COX-2 inhibitors provide additional pain relief and anti-inflammatory effects in patients with rheumatoid arthritis who are on biological disease-modifying anti-rheumatic drugs and/or corticosteroids? Post-hoc analyses from a randomized clinical trial with etoricoxib

Research article

Identification and characterization of human nucleus pulposus cell specific serotypes of adeno-associated virus for gene therapeutic approaches of intervertebral disc disorders

Study protocol

A multi-centre randomized controlled trial comparing arthroscopic osteochondroplasty and lavage with arthroscopic lavage alone on patient important outcomes and quality of life in the treatment of young adult (18–50) Femoroacetabular impingement

Research article

Vastus medialis oblique and vastus lateralis activity during a double-leg semisquat with or without hip adduction in patients with patellofemoral pain syndrome