Stem selection in THA

CASE: A 62-year-old man who underwent total hip arthroplasty (THA) 17 years earlier presented with a fractured uncemented extensively coated diaphyseal engaging femoral stem. Treatment options, including revision surgery, were discussed, and the patient elected for nonoperative treatment. At 2 years of follow-up, the patient is asymptomatic, radiographs are stable, and he lives an active lifestyle without restrictions. CONCLUSION: Fractures of well-fixed femoral prostheses are rare complications of THA and almost universally require revision surgery...

AIMS: We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty. METHODS: We retrospectively reviewed the data of 112 PFFs, of which 47 (42%) B1 and 27 (24%) B2 PFFs were treated with internal fixation, whereas 38 (34%) B2 fractures underwent revision arthroplasty...

A further increase in the number of total hip arthroplasty (THA) is predicted, in particular the number of young THA patients has raised and with it their demands. There is no standardized evidence-based rehabilitation program and no reliable guidelines for sports activities after THA. Stretching and strengthening gymnastics are routinely performed in rehabilitation and aerobics as a sport after THA. The aim of the investigation was to determine the in vivo force and moments acting on the hip prosthesis during gymnastics and aerobic exercises to provide a source for evidence-based recommendations...

BACKGROUND: Whether different body positions during surgery affect postoperative stem alignment in total hip arthroplasty (THA) remains unclear. The purpose of this study was to clarify differences in tapered wedge stem alignment between supine and lateral positions in THA under the modified Watson-Jones anterolateral approach. METHODS: We reviewed 242 consecutive, primary cementless THAs performed with ceramic-on-cross-linked polyethylene via the modified Watson-Jones approach in either supine or lateral positions between 2009 and 2015 (supine group: 113 cases; lateral group: 129 cases)...

Background and purpose - It is believed that in uncemented primary total hip arthroplasty (THA) the anchorage of the stem is dependent on the level of bone mineral density (BMD) of the femoral bone. This is one of the reasons for the widely accepted agreement that a cemented solution should be selected for people with osteoporosis or age > 75 years. We evaluated whether preoperative BMD of the femur bone is related to femoral stem migration in uncemented THA.Patients and methods - We enrolled 62 patients (mean age 64 years (range 49-74), 34 males) scheduled for an uncemented THA...

BACKGROUND: Most North American surgeons predominantly use uncemented stems in primary total hip arthroplasties (THAs) and reserve cemented stems for selected older patients and those with poor bone quality. However, data on this "selective use" strategy for cemented stems in the population at risk for periprosthetic fracture and implant loosening are limited. The purpose of this study was to describe implant survivorship, complications, and radiographic results of a specific collarless, polished, tapered cemented stem (Exeter; Stryker) used selectively in a predominantly elderly population undergoing primary THA...

INTRODUCTION: Autologous stem cell progenitor implantation into necrotic lesions of the femoral head has previously been described as a potential treatment for avascular necrosis (AVN), on the basis that there is a reduced number of functioning stem cells in the marrow within the necrotic segment. We present a case series of patients with AVN that underwent core decompression with autologous stem cell implantation using a new device. METHODS: The records and imaging of patients with AVN of the femoral head treated by a single surgeon were retrospectively reviewed...

Background: The usage of short stems in primary total hip arthroplasty (THA) has constantly gained popularity over the last decade, however, to date, short stems are not eligible to be used as revision implants. The aim of this study was to retrospectively evaluate the outcome of revision surgery of failed hip resurfacing arthroplasty (HRA) using short-stem THA. Methods: In a single center, retrospective analysis, 6 consecutive patients who were treated with a calcar-guided short stem after failure of HRA were evaluated...

BACKGROUND: The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients' scores were assessed. Surgical tips to enhance outcomes were reviewed. METHODS: 45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki...

BACKGROUND: Dual mobility (DM) total hip arthroplasty (THA) implants have been advocated for patients at risk for impingement due to abnormal spinopelvic mobility. Impingement against cobalt-chromium acetabular bearings, however, can result in notching of titanium femoral stems. This study investigated the incidence of femoral stem notching associated with DM implants and sought to identify risk factors. METHODS: A multicenter retrospective study reviewed 256 modular and 32 monoblock DM components with minimum 1-year clinical and radiographic follow-up, including 112 revisions, 4 conversion THAs, and 172 primary THAs...

BACKGROUND: Total hip arthroplasty (THA) presents as an excellent treatment for the osteoarthritic hip, demonstrating good survival rates. However, aseptic loosening and infection are the main causes of operative revision. The methods used in revision surgery are non-modular or modular THA implants. In addition to the abovementioned revision reasons for THA, this treatment could be associated with the possibility of femoral stem fracture, especially in the modular system. The topic of material failure has been focused on in the public media...

BACKGROUND: Total hip arthroplasty (THA) for femoral neck fracture (FNF) appears to provide superior functional outcomes compared to hemiarthroplasty in selected active, elderly patients; however, the historical tradeoff has been higher risk of complications including dislocation. We aimed to describe implant survivorship and reasons for failure after THA for FNFs. METHODS: We identified 217 FNFs treated with THA from 2000 to 2017 from our institutional total joint registry (during the same time period 2039 FNFs were treated with hemiarthroplasty)...

BACKGROUND: Childhood hip infections can result in serious sequelae during adulthood, including persistent pain, functional limitations, and premature THA. When THA is performed in patients who had hip joint infections during childhood, surgeons surmise these arthroplasties are at an increased risk of complications and incomplete recovery. However, the degree to which this is true is not well characterized and has varied across a large number of small, retrospective studies. QUESTIONS/PURPOSES: (1) What proportion of THAs performed in patients who had pediatric septic arthritis result in periprosthetic joint infection? (2) What are the Harris hip scores associated with these reconstructions? (3) What proportion of these patients develop complications after THA? (4) What proportion of patients undergo revision after these THAs? METHODS: For this systematic review, we searched the MEDLINE (PubMed), Scopus, and CINAHL (EbscoHost) electronic databases...

OBJECTIVE: Stem anteversion in total hip arthroplasty (THA) has been measured using two different distal references, the posterior condyle (PC) or the transepicondylar axis (TEA). The reliability, the difference in value between these two techniques, and the possible confounding factors are scarcely known. Aims of this work were to assess (1) the intraclass correlation and the difference between the two measurement techniques and (2) the possible influence of condylar dysmorphisms on the anteversion value discrepancy...

PURPOSE OF REVIEW: To describe the (1) indications, (2) preoperative precautions, and (3) stepwise technical details of modern femoral stem cemented fixation. RECENT FINDINGS: Femoral stem cementation provides excellent implant longevity with a low periprosthetic fracture rate among patients with compromised bone quality or aberrant anatomy. Unfamiliarity with the details of modern cementation techniques among trainees who may lack frequent exposure to cementing femoral stems may preclude them from offering this viable option to suitable patients in later stages of their careers...

Osteonecrosis of the femoral head (ONFH) is a progressive disease with a complex etiology and unclear pathogenesis, resulting in severe hip pain and dysfunction mainly observed in young patients. Although total hip arthroplasty (THA) is the most effective treatment for patients with ONFH in the terminal stage, the results of THA in young patients or active populations are often not favorable, with some complications related to the prosthesis. With the development of biotechnology, an increasing number of studies pay attention to use of stem cells for the treatment of ONFH...

Background: Hereditary multiple exostoses (HME) is an autosomal dominant disorder. The lesion in the proximal femoral metaphysis can bring about hip dysplasia and subsequent degenerative arthritis. Due to its rare prevalence, there have been a few case reports of total hip arthroplasty (THA) for osteoarthritis secondary to HME. The aim of this study was to report mid- to long-term outcomes of THA in HME patients and discuss special considerations that should be taken into account during surgery...

OBJECTIVE: To investigate the effect of total hip arthroplasty(THA) with the prosthesis of 127° small neck stem angle and 135° large neck stem angle. METHODS: From January 2014 to June 2016, 84 patients with THA were selected, including 44 males and 40 females, aged 45 to 72(53.4±8.1) years old, 68 patients with necrosis of the femoral head(32 on the left and 36 on the right), 16 patients with serious osteoarthritis of the hip caused by other reasons, and the course of disease was 9 to 36 (24...

INTRODUCTION: Short stems are not all the same and do not meet the same objectives in terms of shape, fixation and biomechanics. The Taperloc Microplasty™ is a shortened stem. In France, no articles have been published on this subject and very few articles are available in the international literature. We therefore decided to analyse results for this stem after a mean follow-up of 61 months, asking the following questions: (1) Is the survival of the Taperloc Microplasty™ at least equivalent to the best conventional cementless prostheses on the market, i...

BACKGROUND: Revision of a failed total hip arthroplasty (THA) poses technical challenges. The use of primary stems for revision can be advantageous for maintaining bone stock and reducing complications: small case series have reported promising results in the short-term to mid-term follow-up. The aim of this study was to evaluate the long-term clinical and functional results and survivorship of a consecutive series of THA femoral component revisions using a conical primary cementless stem (PCS)...