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High 10-year survival rate with an anatomic cementless stem (SPS).

Sariali E, Mouttet A, Mordasini P, Catonné Y - Clin. Orthop. Relat. Res. (2012)

Bottom Line: All stems appeared radiographically stable and one stem was graded nonintegrated but stable.Five patients had revision surgery: one on the femoral side (for posttraumatic fracture) and four on the acetabular side.Considering stem revision for aseptic loosening as the end point, survivorship was 100% (range, 95.4%-99.9%) at 10 years.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Hôpital Pitié Salpétrière, 47-83 Bd de l'Hôpital, 75013, Paris, France. hedisari@yahoo.fr

ABSTRACT

Background: Proximal cementless fixation using anatomic stems reportedly increases femoral fit and avoids stress-shielding. However, thigh pain was reported with the early stem designs. Therefore, a new anatomic cementless stem design was based on an average three-dimensional metaphyseal femoral shape. However, it is unclear whether this stem reduces the incidence of thigh pain.

Questions/purposes: We asked whether this stem design was associated with a low incidence of thigh pain and provided durable fixation and high function.

Methods: One hundred seventy-one patients (176 THAs) who had the anatomic proximal hydroxyapatite-coated stem implanted were reviewed. Eleven (6%) patients were lost to followup and 34 (20%) died without revision surgery. We used the Harris hip score (HHS) to assess pain and function. We evaluated femoral stem fixation and stability with the score of Engh et al. and also calculated a 10-year survival analysis. We assessed 126 patients (131 hips) at a mean followup of 10 years (range, 8-11 years)

Results: At last followup, two patients described slight thigh pain that did not limit their physical activities. All stems appeared radiographically stable and one stem was graded nonintegrated but stable. Five patients had revision surgery: one on the femoral side (for posttraumatic fracture) and four on the acetabular side. Considering stem revision for aseptic loosening as the end point, survivorship was 100% (range, 95.4%-99.9%) at 10 years.

Conclusion: This anatomic cementless design using only metaphyseal fixation with a wide mediolateral flare, a sagittal curvature, and torsion, allowed durable proximal stem stability and fixation.

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The anatomic cementless SPS stem is shown.
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Fig2: The anatomic cementless SPS stem is shown.

Mentions: We retrospectively reviewed all 171 patients (176 hips) who underwent THA between September 1, 1997 and December 31, 1998, using the SPS anatomic proximally hydroxyapatite (HA)-coated stem (Symbios, Yverdon-les-Bains, Switzerland) (Fig. 2) and an HA-coated acetabular component with zirconia-ceramic and UHMWPE liner (Symbios). During the study period all patients having THA were treated with the same implants. The indications for these particular implants were: (1) primary osteoarthritis, (2) developmental dysplasia of the hip (DDH), avascular necrosis, (3) inflammatory arthritis, or (3) posttraumatic osteoarthritis. The contraindications were: (1) revision THA, or (2) hip fractures. There were 102 women and 69 men, with a mean age of 73 years (range, 35–83 years) at the time of surgery and a mean BMI of 26 kg/m2 (range, 17–35 kg/m2); 83 (49%) patients were overweight and 25 (15%) were obese. Diagnoses included primary osteoarthritis (132 [75%]), DDH (18 [10%]), osteonecrosis (14 [8%]), inflammatory arthritis (10 [6%]), or posttraumatic osteoarthritis (two [1%]). Eleven patients (6%) were lost to followup and 34 (20%) died without any revision surgery performed. This left 126 patients (131 hips) for review. The minimum followup was 8 years (mean, 10 years; range, 8–11 years).Fig. 2


High 10-year survival rate with an anatomic cementless stem (SPS).

Sariali E, Mouttet A, Mordasini P, Catonné Y - Clin. Orthop. Relat. Res. (2012)

The anatomic cementless SPS stem is shown.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369068&req=5

Fig2: The anatomic cementless SPS stem is shown.
Mentions: We retrospectively reviewed all 171 patients (176 hips) who underwent THA between September 1, 1997 and December 31, 1998, using the SPS anatomic proximally hydroxyapatite (HA)-coated stem (Symbios, Yverdon-les-Bains, Switzerland) (Fig. 2) and an HA-coated acetabular component with zirconia-ceramic and UHMWPE liner (Symbios). During the study period all patients having THA were treated with the same implants. The indications for these particular implants were: (1) primary osteoarthritis, (2) developmental dysplasia of the hip (DDH), avascular necrosis, (3) inflammatory arthritis, or (3) posttraumatic osteoarthritis. The contraindications were: (1) revision THA, or (2) hip fractures. There were 102 women and 69 men, with a mean age of 73 years (range, 35–83 years) at the time of surgery and a mean BMI of 26 kg/m2 (range, 17–35 kg/m2); 83 (49%) patients were overweight and 25 (15%) were obese. Diagnoses included primary osteoarthritis (132 [75%]), DDH (18 [10%]), osteonecrosis (14 [8%]), inflammatory arthritis (10 [6%]), or posttraumatic osteoarthritis (two [1%]). Eleven patients (6%) were lost to followup and 34 (20%) died without any revision surgery performed. This left 126 patients (131 hips) for review. The minimum followup was 8 years (mean, 10 years; range, 8–11 years).Fig. 2

Bottom Line: All stems appeared radiographically stable and one stem was graded nonintegrated but stable.Five patients had revision surgery: one on the femoral side (for posttraumatic fracture) and four on the acetabular side.Considering stem revision for aseptic loosening as the end point, survivorship was 100% (range, 95.4%-99.9%) at 10 years.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Hôpital Pitié Salpétrière, 47-83 Bd de l'Hôpital, 75013, Paris, France. hedisari@yahoo.fr

ABSTRACT

Background: Proximal cementless fixation using anatomic stems reportedly increases femoral fit and avoids stress-shielding. However, thigh pain was reported with the early stem designs. Therefore, a new anatomic cementless stem design was based on an average three-dimensional metaphyseal femoral shape. However, it is unclear whether this stem reduces the incidence of thigh pain.

Questions/purposes: We asked whether this stem design was associated with a low incidence of thigh pain and provided durable fixation and high function.

Methods: One hundred seventy-one patients (176 THAs) who had the anatomic proximal hydroxyapatite-coated stem implanted were reviewed. Eleven (6%) patients were lost to followup and 34 (20%) died without revision surgery. We used the Harris hip score (HHS) to assess pain and function. We evaluated femoral stem fixation and stability with the score of Engh et al. and also calculated a 10-year survival analysis. We assessed 126 patients (131 hips) at a mean followup of 10 years (range, 8-11 years)

Results: At last followup, two patients described slight thigh pain that did not limit their physical activities. All stems appeared radiographically stable and one stem was graded nonintegrated but stable. Five patients had revision surgery: one on the femoral side (for posttraumatic fracture) and four on the acetabular side. Considering stem revision for aseptic loosening as the end point, survivorship was 100% (range, 95.4%-99.9%) at 10 years.

Conclusion: This anatomic cementless design using only metaphyseal fixation with a wide mediolateral flare, a sagittal curvature, and torsion, allowed durable proximal stem stability and fixation.

Show MeSH
Related in: MedlinePlus