Clinical and Radiological Outcomes of Rectangular Tapered Cementless Stem According to Proximal Femoral Geometry in Elderly Asian Patients

Purpose A retrospective analysis of mid- to long-term clinical and radiological outcomes of Korean patients over 60 years of age who underwent hip arthroplasty using a cementless rectangular tapered stem according to Dorr proximal femur geography. Materials and Methods From January 2007 to December 2013, 107 patients (112 hips) underwent hip arthroplasty using the C2 stem. The mean age of patients was 77.4 years (range, 60–91 years) and the mean follow-up duration was 91.1 months (range, 60–116 months). All patients were evaluated clinically and radiologically with special attention to Dorr femoral bone classification, implant fixation, radiolucent line (RLL), and thigh pain. Results All implants demonstrated radiographic evidence of stable fixation by bone ingrowth without any change in position. The mean Harris hip score improved from 65.5±16.0 (preoperative) to 90.5±15.9 (final follow-up) (P<0.001). Incidence of RLLs, stress shielding, and thigh pain was highest in patients with Dorr type A (RLL, P=0.021; stress shielding, P=0.030; thigh pain, P<0.001). One stem revision was performed due to deep infection. The Kaplan–Meier survival rate of the femoral stem was 97.6%. Conclusion The overall survival rate of the C2 stems was greater than 97%; there were no significant differences in survival of the C2 stem according to the Dorr classification. The incidences of RLL of thigh pain and RLL were significantly different among Dorr classifications and (highest in patients with Dorr type A).

[1]  Joong-Myung Lee,et al.  Hip Arthroplasty Using the Bencox® Hip System: An Evaluation of a Consecutive Series of One Thousand Cases , 2018, Hip & pelvis.

[2]  Hee Joong Kim,et al.  Cementless Total Hip Arthroplasty Using the COREN Hip System: A Minimum Five-Year Follow-up Study , 2018, Hip & pelvis.

[3]  Jung Taek Kim,et al.  Implant Design in Cementless Hip Arthroplasty , 2016, Hip & pelvis.

[4]  Ju-han Kim,et al.  Cementless Bipolar Hemiarthroplasty Using a Rectangular Cross-Section Stem for Unstable Intertrochanteric Fractures , 2013, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[5]  Y.H. Kim,et al.  A comparison of a conventional versus a short, anatomical metaphyseal-fitting cementless femoral stem in the treatment of patients with a fracture of the femoral neck. , 2012, The Journal of bone and joint surgery. British volume.

[6]  P. Korovessis,et al.  High medium-term survivorship and durability of Zweymüller-Plus total hip arthroplasty , 2011, Archives of Orthopaedic and Trauma Surgery.

[7]  D. Murray,et al.  The migration patterns of two versions of the Furlong cementless femoral stem: a randomised, controlled trial using radiostereometric analysis. , 2010, The Journal of bone and joint surgery. British volume.

[8]  Clifford W Colwell,et al.  Cementless femoral fixation in total hip arthroplasty. , 2010, American journal of orthopedics.

[9]  L. Kinzl,et al.  Long-term results for the uncemented Zweymuller/Alloclassic hip endoprosthesis. A 15-year minimum follow-up of 320 hip operations. , 2009, The Journal of arthroplasty.

[10]  P. Korovessis,et al.  High Medium-term Survival of Zweymüller SLR-Plus® Stem Used in Femoral Revision , 2009, Clinical orthopaedics and related research.

[11]  J. Ahn,et al.  Cementless Bipolar Hemiarthroplasty for Femoral Neck Fractures in Elderly Patients , 2008 .

[12]  B. Beynnon,et al.  Total hip arthroplasty with the Secur-Fit and Secur-Fit plus femoral stem design a brief follow-up report at 5 to 10 years. , 2008, The Journal of arthroplasty.

[13]  A. Kaider,et al.  Cementless total hip arthroplasty with the rectangular titanium Zweymuller stem. A concise follow-up, at a minimum of fifteen years, of a previous report. , 2012, The Journal of bone and joint surgery. American volume.

[14]  A. Kaider,et al.  Cementless total hip arthroplasty with the rectangular titanium Zweymüller stem : A concise follow-up, at a minimum of fifteen years, of a previous report , 2006 .

[15]  K. Zweymüller,et al.  Radiolucent lines and osteolysis along tapered straight cementless titanium hip stems: A comparison of 6-year and 10-year follow-up results in 95 patients , 2006, Acta orthopaedica.

[16]  J. Bilezikian,et al.  A referent bone mineral density database for Chinese American women , 2006, Osteoporosis International.

[17]  Todd V Swanson,et al.  The tapered press fit total hip arthroplasty: a European alternative. , 2005, The Journal of arthroplasty.

[18]  T. Swanson.  Benefits of Posterior Single-Incision Less-Invasive THA using the SL-Plus Cementless Stem , 2004 .

[19]  J. Moskal,et al.  Thigh Pain After Cementless Total Hip Arthroplasty: Evaluation and Management , 2002, The Journal of the American Academy of Orthopaedic Surgeons.

[20]  D. Jobard,et al.  Grit-blasted titanium femoral stem in cementless primary total hip arthroplasty: a 5- to 10-year multicenter study. , 2001, The Journal of arthroplasty.

[21]  J. Woo,et al.  Population Bone Mineral Density Measurements for Chinese Women and Men in Hong Kong , 2001, Osteoporosis International.

[22]  L. Dorr,et al.  Failure mechanisms of anatomic porous replacement I cementless total hip replacement. , 1997, Clinical orthopaedics and related research.

[23]  L. Dorr,et al.  Comparative results of a distal modular sleeve, circumferential coating, and stiffness relief using the Anatomic Porous Replacement II. , 1996, The Journal of arthroplasty.

[24]  E. Vresilovic,et al.  Incidence of thigh pain after uncemented total hip arthroplasty as a function of femoral stem size. , 1996, The Journal of arthroplasty.

[25]  M. Huo,et al.  Total hip arthroplasty using the Zweymuller stem implanted without cement. A prospective study of consecutive patients with minimum 3-year follow-up period. , 1995, The Journal of arthroplasty.

[26]  L. Dorr,et al.  Structural and cellular assessment of bone quality of proximal femur. , 1993, Bone.

[27]  A C Campbell,et al.  Thigh pain after cementless hip arthroplasty. Annoyance or ill omen. , 1992, The Journal of bone and joint surgery. British volume.

[28]  Engh Ca,et al.  The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. , 1988 .

[29]  C. Engh,et al.  The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. , 1988, Clinical orthopaedics and related research.

[30]  H. Amstutz,et al.  "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. , 1979, Clinical orthopaedics and related research.