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Pneumatic femoral broaching decreases post-operative subsidence of a cementless taper-wedge stem

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Abstract

Purpose

Stem subsidence is a known cause of early failure in cementless total hip arthroplasty (THA). The aim of this study was to determine the usefulness of pneumatic femoral broaching in preventing post-operative subsidence of a proximally porous-coated, taper-wedge stem.

Methods

We reviewed 169 cases of primary THA with a single taper-wedge stem. Eighty THAs performed using pneumatic broaching were compared with 89 THAs performed using manual broaching in terms of postoperative canal fill ratio (CFR) at three levels, stem subsidence at one year post-operation, and stem fixation at latest follow-up (median, 24 months).

Results

The median CFRs were higher in the pneumatic group than in the manual group at all levels (p < 0.05). The median stem subsidence at one year after THA was lower in the pneumatic group than in the manual group (0.2 mm vs. 0.6 mm, p = 0.007). A multivariate analysis determined a decreased CFR at 60 mm below the lesser trochanter and the manual broaching as independent factors affecting post-operative stem subsidence. At the latest follow-up, all stems showed stable fixation by bone ingrowth in both groups.

Conclusion

Our results showed that the pneumatic broaching device was useful in maximizing the mediolateral canal filling and initial stability and minimizing the subsidence of taper-wedge stems.

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Availability of data and materials

All data and material pertaining to the study are made available upon request.

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Funding

This study was funded by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (No. JP18K09109).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi. Higashi-ku, Fukuoka, 812-8582, Japan

    Masanori Fujii, Kenji Kitamura, Satoshi Ikemura, Satoshi Hamai, Goro Motomura & Yasuharu Nakashima

Authors
  1. Masanori Fujii
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  2. Kenji Kitamura
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  3. Satoshi Ikemura
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  4. Satoshi Hamai
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  5. Goro Motomura
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  6. Yasuharu Nakashima
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by Masanori Fujii and Kenji Kitamura. The first draft of the manuscript was written by Masanori Fujii, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Masanori Fujii.

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Ethics approval

Each author certifies that his institution approved the human protocol for this investigation and that all investigation was conducted in conformity with the 1964 Helsinki Declaration. Ethical approval for this study was obtained from the Graduate School of Medical Sciences, Kyushu University (No. 30–91).

Consent to participate and publish

Ethical approval for this study was obtained from the Graduate School of Medical Sciences, Kyushu University (No. 30–91).

Competing interests

The authors declare no competing interests.

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This work was performed at the Department of Orthopaedic Surgery, Kyushu University Hospital.

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Fujii, M., Kitamura, K., Ikemura, S. et al. Pneumatic femoral broaching decreases post-operative subsidence of a cementless taper-wedge stem. International Orthopaedics (SICOT) 46, 233–240 (2022). https://doi.org/10.1007/s00264-021-05196-x

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  • DOI: https://doi.org/10.1007/s00264-021-05196-x

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