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The effects of patient characteristics and stem alignment on distal femoral cortical hypertrophy after cemented polished tapered stem implantation

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

The objective of this study was to evaluate the results of over 10 years of total hip arthroplasty (THA) practice with ExeterTM stems and the clinical relevance of distal femoral cortical hypertrophy (DFCH).

Methods

We retrospectively reviewed 127 hips (120 patients) that had undergone THA with ExeterTM stems between 2004 and 2007. Kaplan–Meier survival analyses for the stem of all 127 hips were performed using different endpoints. Of 127 hips, 100 (94 patients) had complete 10-year follow-up data, including the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) as the patient-reported outcomes, and the clinical relevance of DFCH was analyzed using multivariable logistic regression analysis.

Results

The survival of the stem with the endpoint of re-operation for loosening, > 5-mm subsidence, and re-operation for any reason were 100%, 99.1% (95% CI 97.5–100%), and 98.3% (95% CI 96.0–100%), respectively. Of 100 hips followed completely for 10 years, DFCH occurred in 20 hips (20%). The satisfaction and pain visual analog scale of JHEQ revealed high satisfaction and less pain in patients with DFCH. By multivariate logistic regression analysis, body weight > 55 kg (odds ratio: 2.88, p = 0.035) and varus stem alignment (odds ratio: 6.56, p = 0.003) were found to be predictors for DFCH.

Conclusions

The incidence of DFCH with the ExeterTM stem was 20%. A body weight > 55 kg and varus stem alignment are predictors for future DFCH. DFCH with the ExeterTM stem indicates a good outcome with less hip pain.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hamamatsu Medical Center, 328 Tomitsuka-cho, Naka-ku, Hamamatsu, Shizuoka, 432-8580, Japan

    Toshiki Iwase, Daigo Morita & Genta Takemoto

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  1. Toshiki Iwase
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  2. Daigo Morita
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  3. Genta Takemoto
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Correspondence to Toshiki Iwase.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors. This study was conducted following approval by the Institutional Review Board of the authors’ institution (Approval No. H29-28).

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Informed consent was obtained from all individual participants included in the study.

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Iwase, T., Morita, D. & Takemoto, G. The effects of patient characteristics and stem alignment on distal femoral cortical hypertrophy after cemented polished tapered stem implantation. Eur J Orthop Surg Traumatol 30, 559–567 (2020). https://doi.org/10.1007/s00590-019-02605-1

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  • DOI: https://doi.org/10.1007/s00590-019-02605-1

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