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Long-term results of custom-made femoral stems

Langzeitergebnisse zu maßgefertigten Femurschäften

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Abstract

Background

The progress of 3D imaging and manufacturing of implants has made it possible to achieve a custom-made concept in THA. The custom-made cementless femoral stem provides optimal implant stability combined with restoration of the native hip mechanics.

Objective

The purpose of this study was to evaluate the long-term survivorship of custom-made hip femoral stems in two populations of patients undergoing THA: patients under 50 years old (young patients group) and patients with high-grade developmental dysplasia of the hip (DDH group).

Methods

A series of 232 primary custom-made cementless THA stems were retrospectively evaluated in patients less than 50 years old at the time of surgery and at follow-up after an average of 20 years. A second series of 26 custom-made cementless stem THAs for late DDH (21 patients) including only Crowe grade III and grade IV were also retrospectively evaluated with an average follow-up of 16 years. The clinical and radiological evaluations were performed preoperatively and at yearly intervals.

Results

For the young patient group, the follow-up ranged from 14 to 27 years. The HHS and the Merle D’Aubigne-Postel score significantly improved from preoperatively to a mean of 94.1 (range 48–100) and 15.9 (range 9–18), respectively. Taking stem revision for aseptic loosening as an endpoint, survivorship was 96.8% at 20 years (95% confidence interval, CI 95.1–98.5). For the DDH group, the follow-up ranged from 10 to 22 years. The mean HHS increased significantly from preoperative 49 ± 22 points to the most recent follow-up examination with 86 13 points and survivorship was 96.1% (95% CI, 92.7–99.9).

Conclusion

Custom-made femoral stems provide good functional outcome and long-term survivorship in two specific populations of patients undergoing THAs: patients under 50 years old with high expectations and patients with high-grade DDH.

Zusammenfassung

Hintergrund

Der Fortschritt der 3‑D-Bildgebung und der Herstellung von Implantaten hat es ermöglicht, ein maßgeschneidertes Konzept in der THA zu erreichen. Der maßgefertigte zementfreie Femurschaft bietet optimale Implantatstabilität bei gleichzeitiger Wiederherstellung der nativen Hüftmechanik.

Ziel

Das Ziel dieser Studie war es, die Langzeitüberlebensfähigkeit maßgefertigter Femurschäfte der Hüfte bei zwei Patientenpopulationen zu untersuchen, die sich einer Hüfttotalendoprothese (TEP) unterziehen: Patienten unter 50 Jahren (Gruppe junger Patienten) und Patienten mit hochgradiger Entwicklungsdysplasie der Hüfte (DDH-Gruppe).

Methoden

Eine Serie von 232 primären zementfreien maßgefertigten TEP-Schäften wurde bei Patienten unter 50 Jahren retrospektiv zum Zeitpunkt der Operation und nach durchschnittlich 20 Jahren Follow-up ausgewertet. Eine zweite Serie von 26 maßgefertigten zementfreien THA-Schäften für späte DDH (21 Patienten), darunter nur Crowe-Grad III und IV, wurde ebenfalls retrospektiv mit einem durchschnittlichen Follow-up von 16 Jahren ausgewertet. Die klinischen und radiologischen Auswertungen wurden präoperativ und in jährlichen Abständen durchgeführt.

Ergebnisse

Bei der jungen Patientengruppe reichte die Nachbeobachtung von 14 bis 27 Jahren. Der HHS- und der Merle-D’Aubigne-Postel-Score verbesserten sich signifikant von präoperativ auf einen Mittelwert von 94,1 (Range: 48–100) bzw. 15,9 (Range: 9–18). Nimmt man die Schaftrevision aufgrund aseptischer Lockerung als Endpunkt, so betrug die Überlebensrate nach 20 Jahren 96,8 % (95 % Konfidenzintervall, [KI] 95,1–98,5). Bei der DDH-Gruppe reichte die Nachbeobachtung von 10 bis 22 Jahren. Der mittlere HHS stieg signifikant von präoperativ 49 ± 22 Punkten bis zur letzten Nachuntersuchung mit 86 ± 13 Punkten, und die Überlebensrate betrug 96,1 % (95 % KI 92,7–99,9).

Schlussfolgerung

Maßfertigte Femurschäfte bieten gute funktionelle Ergebnisse und langfristige Überlebenschancen bei zwei spezifischen Patientenpopulationen, die sich einer TEP unterziehen: bei Patienten unter 50 Jahren mit hohen Erwartungen und bei Patienten mit hochgradiger DDH.

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Abbreviations

AP:

Anteroposterior

AVN:

Avascular necrosis

BMI:

Body mass index

CT:

Computed tomography

DDH:

Developmental dysplasia of the hip

FA:

Femoral anteversion

FO:

Femoral offset

GTO:

Greater trochanteric osteotomy

HHS:

Harris hip score

OA:

Osteoarthritis

THA:

Total hip arthroplasty

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Authors and Affiliations

  1. Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France

    Christophe Jacquet MD, Xavier Flecher MD, PhD, Charles Pioger MD, Maxime Fabre-Aubrespy MD, Matthieu Ollivier MD, PhD & Jean-Noel Argenson MD, PhD

Authors
  1. Christophe Jacquet MD
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  2. Xavier Flecher MD, PhD
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  3. Charles Pioger MD
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  4. Maxime Fabre-Aubrespy MD
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  5. Matthieu Ollivier MD, PhD
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  6. Jean-Noel Argenson MD, PhD
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Corresponding author

Correspondence to Jean-Noel Argenson MD, PhD.

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Conflict of interest

J.-N. Argenson is a consultant for Zimmer and Symbios. M. Ollivier is a consultant for Stryker and New-Clip Technics. X. Flecher is a consultant for Zimmer and Symbios. C. Jacquet, C. Pioger and M. Fabre-Aubrespy declare that they have no competing interests.

Ethical standards

All studies performed were in accordance with the ethical standards indicated in each case. The local ethics committee approved the study protocol prior to the investigation.

Additional information

Investigations performed at Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.

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Jacquet, C., Flecher, X., Pioger, C. et al. Long-term results of custom-made femoral stems. Orthopäde 49, 408–416 (2020). https://doi.org/10.1007/s00132-020-03901-z

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