Global radiological score for femoral cementless revision stem
- 309 Downloads
The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) revision with cementless stems using a numeric global radiological score (GRxS) that summarizes two previously validated scores: secondary bone stock (SBS) and osseointegration–secondary stability (O-SS).
One hundred fifty cases of THA were evaluated at a mean follow-up of 6.5 ± 3.7 years. The GRxS combines the SBS, which evaluated cortical bone thickness, bone density and bone defects in each Gruen zone and the O-SS, which evaluated the location and extent of a single radiolucent line. To calculate the GRxS, the SBS and O-SS were each expressed on a 10-point scale and given equal weighing. The final result was a number out of 20. The GRxS was used to assign a radiological grade to each THA case: very good (20), good (18–15), average (13–12), or poor (≤ 10). The numerical mean (Nm) was calculated for each grade. The inter- and intra-observer reproducibility was evaluated.
The inter-observer reproducibility was good (0.8) and the intra-observer reproducibility was very good (0.9). The GRxS was considered very good in 46 cases (Nm 20), good in 57 cases (Nm 16.6), average in 25 cases and poor in 22 cases. There was a significant relationship between the GRxS and the Harris Hip and Postel Merle d’Aubigné scores (p < 0.0001), and the initial bone stock (p = 0.0001).
The GRxS is reliable and reproducible. This information can be used by surgeons to adapt the surgical technique to bone characteristics (especially during revision cases) and to compare the outcomes of different implant designs.
KeywordsHip Osseointegration Bone stock Arthroplastie Revision
We are grateful to Mathias Goldschild for his work, Henri Migaud and Daniel de Menezes for their advice on this study, Anne Ingels for the statistical analysis and Joanne Archambault for editorial assistance.
Compliance with ethical standards
Conflict of interest statement
FC certifies that he has or may receive payments or benefits from a commercial entity (Zimmer Educational)and that he has or may receive payments or benefits from a commercial entity (Zimmer Educational).
SP certifies that he has or may receive payments or benefits from a commercial entity (Corin/Tornier).
JG certifies that he has or may receive payments or benefits from a commercial entity (Microport).
FB certifies that he has or may receive payments or benefits from a commercial entity (Amplitude) that should be not perceived as a potential conflict of interest.
PLB certifies that he has or may receive payments or benefits from a commercial entity (Zimmer GmbH) that should be perceived as a potential conflict of interest.
Ethical board review statement
Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
- 4.Gruen TA, McNeice GM, Amstutz HC (1979) Modes of failure of cemented stem-type femoral components. A radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27Google Scholar
- 11.Kavanagh BF, Fitzgerald RH Jr (1985) Clinical and roentgenographic assessment of total hip arthroplasty. A new hip score. Clin Orthop Relat Res 193:133–140Google Scholar
- 15.Epinette JA, Geesink R, et le groupe AGORA (1994) Proposition d’un nouveau système d’évaluation radiologique des prothèses fémorales non cimentées: le score ARA. Cahiers d’enseignement de la SOFCOT 50(p):107–120Google Scholar