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Aseptic stem loosening in primary THA: migration analysis of cemented and cementless fixation

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Abstract

Early migration has reportedly been predictive for later implant failure. Using four different migration patterns, this study aimed to analyse migration behaviour of the two types of implant fixation—cemented and cementless—throughout the process of loosening. Migrational behaviour of 69 revised stems (49 cemented, 20 uncemented) was analysed retrospectively with EBRA-FCA (Einzel-Bild-Röntgen-Analyse, Femoral Component Analysis). Uncemented stems failed after early and late onset migration alike, while late migration was the predominant pattern in cemented stems. Mean prosthetic failure after early migration occurred 5.8 (±4.4) years postoperatively due to insufficient primary stability. Initially stable stems with late onset migration were revised after 12.4 (±4.5) years. Measurement of early migration was found to be a valuable tool to screen short-term and mid-term failure. In the long run the method’s sensitivity decreased. Late onset migration, however, preceded long-term failure by a mean of three years.

Résumé

Le but de cette étude est de rapporter les migrations précoces en rapport avec une prévision d’échec des implants. Pour cela, nous avons utilisé quatre groupes de PTH avec différentes migrations à propos du devenir de deux types de fixation des implants, cimentés ou non cimentés. l’évolution de la migration sur 69 prothèses (pièces fémorales 49 cimentées, 20 non cimentées) ont été analysées de façon rétrospective selon la méthode EBRA-FCA les pièces fémorales non cimentées peuvent présenter des échecs précoces et tardifs, alors que les prothèses cimentées ne présentent que des échecs tardifs. L’échec le plus fréquent est la migration qui se fait en moyenne à 5,8 (±4,4) ans post-opératoire en relation avec une insuffisance de stabilité primaire. Les pièces fémorales stables ont une migration beaucoup plus tardive et ne sont révisées qu’après 12,4 ans (±4,5). la mesure de la migration précoce permet de dépister les échecs à court et moyen terme. La méthode décrite est fiable, les migrations tardives cependant sont précédées d’un échec à long terme et ont évolué pendant au moins trois ans avant la reprise.

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Acknowledgment

All authors certify that they have no commercial associations (e.g. consultancies, stock ownership, equity interest, patient/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. No funds have been received or will be received in connection with the submitted article. No professional or financial affiliations have been perceived or will be perceived to have biased the presentation.

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Authors and Affiliations

  1. Department of Orthopaedics, Innsbruck Medical University, Innsbruck, Austria

    Artur Kroell, Martin Krismer, Hannes Behensky, Bernd Stoeckl & Rainer Biedermann

  2. Division of Orthopedic Surgery, Adult Reconstruction Service, University of Ottawa, Ottawa, Canada

    Paul Beaulé

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  1. Artur Kroell
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  2. Paul Beaulé
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  3. Martin Krismer
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  4. Hannes Behensky
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  5. Bernd Stoeckl
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  6. Rainer Biedermann
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Correspondence to Rainer Biedermann.

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Kroell, A., Beaulé, P., Krismer, M. et al. Aseptic stem loosening in primary THA: migration analysis of cemented and cementless fixation. International Orthopaedics (SICOT) 33, 1501–1505 (2009). https://doi.org/10.1007/s00264-008-0701-1

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  • DOI: https://doi.org/10.1007/s00264-008-0701-1

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