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Does increased diameter of metal femoral head associated with highly cross-linked polyethylene augment stress on the femoral stem and cortical hypertrophy?

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Abstract

Purpose

Cortical hypertrophy (CH) after total hip arthroplasty (THA) is thought as a process of femoral cortical functional adaptation against the stem. However, no study has been performed to investigate the association between CH and femoral head size. The purpose of this study is to investigate the factors related to femoral CH around the cementless stem after THA.

Methods

THAs in 31 patients using 36-mm metal head and as a control, age-matched 62 THAs with 32-mm metal head have been analyzed. Radiographs were reviewed at four years to determine cortical thickness change from immediate post-operative one. Pre-operative and immediate post-operative radiographs were used to calculate the femoral morphology, canal fill ratio, stem alignment, and femoral and acetabular offset. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for CH.

Results

Patients with a 36-mm metal head had a significantly higher rate of severe CH (P = 0.001) than those with a 32-mm metal head. The multivariate logistic regression analysis with dependent variables of CH showed that the use of a 36-mm metal head had a significantly positive effect on CH. The odds ratio of a 36-mm metal head in mild CH was 2.517 (95% confidence interval, 1.032–6.143; P = 0.043), and that in severe CH was 8.273 (95% confidence interval, 2.679–25.551; P = 0.000). Age and the canal flare index were weakly and negatively influenced by mild CH.

Conclusions

The use of a 36-mm metal head was the dominant risk factor for CH.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Seiya Ishii, Yasuhiro Homma, Tomonori Baba, Yuichi Shirogane, Kazuo Kaneko & Muneaki Ishijima

Authors
  1. Seiya Ishii
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  2. Yasuhiro Homma
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  3. Tomonori Baba
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  4. Yuichi Shirogane
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  5. Kazuo Kaneko
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  6. Muneaki Ishijima
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Contributions

SI conceived the concept of this study. YH and SI designed the study. SI and YS obtained the data. SI wrote the initial draft. YH reviewed and edited the draft. SI and YH performed the statistical analysis. TB, KK, MI, and YH ensured the accuracy of the data and analysis.

Corresponding author

Correspondence to Yasuhiro Homma.

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This study was approved by the Inst. Ethical Review Board.

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The authors declare that they have no conflict of interest.

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Ishii, S., Homma, Y., Baba, T. et al. Does increased diameter of metal femoral head associated with highly cross-linked polyethylene augment stress on the femoral stem and cortical hypertrophy?. International Orthopaedics (SICOT) 45, 1169–1177 (2021). https://doi.org/10.1007/s00264-021-04994-7

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  • DOI: https://doi.org/10.1007/s00264-021-04994-7

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