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High grade femoral stem subsidence in uncemented hip hemiarthroplasty - A radiographic analysis and an early prediction while treating femoral neck fractures

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Abstract

Purpose

Femoral component subsidence is a known risk factor affecting almost all hip replacements using a collarless, cement-less stems. High grade subsidence >5mm is functionally limiting to the patient. Early analysis and prediction of this complication on the immediate post-operative radiographs will help surgeons to opt for alternative solutions to mitigate this complication.

Methods

A retrospective study including 116 patients, who underwent cement-less bipolar hemi-arthroplasties treated from 2020-2022 were included in the study. Body Mass Index (BMI) and pre-operative American Society Anesthesiologist (ASA) score was retrieved from the medical records. Post operative radiographs on postoperative day two, at four weeks and at eight weeks were evaluated. Dorr’s score, initial subsidence ratio (ISR) , stem angulation, proximal stem-canal fit (PSCF) ratio, distal stem-canal fit (DSCF) ratio, medial flare modifier (MFM) were recorded.

Results

A total of 18 patients showed subsidence over 5mm on radiographs evaluated at four weeks. The mean high-grade stem subsidence was 13.5mm +/- 2.67. Evaluating their respective postoperative day two radiographs- ISR was >1 in 16 out of 18 patients (89%), PSCF ratio <0.75 in 83% and DSCF ratio <0.5 in 78% patients. All these patients had a neutral/negative MFM. BMI >25 (p<0.05) and ASA >3 (p<0.001) correlated with a higher degree of stem subsidence.

Conclusion

A lower BMI and ASA score accompanied by a positive MFM were protective factors against femoral stem subsidence. A higher ISR along with a PSCF ratio <0.75 and DSCF ratio <0.5, were highly predictive of stem subsidence over 5 mm.

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References

  1. Leiss F, Götz JS, Meyer M, Maderbacher G, Reinhard J, Parik L, Grifka J, Greimel F (2022) Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing. Arch Orthop Trauma Surg 142(4):673–680. https://doi.org/10.1007/s00402-021-03913-0 Epub 2021 May 21. PMID: 34019145; PMCID: PMC8924083

    Article  PubMed  Google Scholar 

  2. Campbell D, Mercer G, Nilsson KG, Wells V, Field JR, Callary SA (2011) Early migration characteristics of a hydroxyapatite-coated femoral stem: an RSA study. Int Orthop 35(4):483–488. https://doi.org/10.1007/s00264-009-0913-z Epub 2009 Dec 13. PMID: 20012862; PMCID: PMC3066322

    Article  PubMed  Google Scholar 

  3. Froimson MI, Garino J, Machenaud A, Vidalain JP (2007) Minimum 10-year results of a tapered, titanium, hydroxyapatite-coated hip stem: an independent review. J Arthroplasty 22(1):1–7. https://doi.org/10.1016/j.arth.2006.03.003

    Article  PubMed  Google Scholar 

  4. Selvaratnam V, Shetty V, Sahni V (2015) Subsidence in Collarless Corail Hip Replacement. Open Orthop J 29(9):194–197. https://doi.org/10.2174/1874325001509010194 PMID: 26069515; PMCID: PMC4460213

    Article  Google Scholar 

  5. Ström H, Nilsson O, Milbrink J, Mallmin H, Larsson S (2007) Early migration pattern of the uncemented CLS stem in total hip arthroplasties. Clin Orthop Relat Res 45(4):127–132. https://doi.org/10.1097/01.blo.0000238785.98606.9d

    Article  Google Scholar 

  6. Al-Najjim M, Khattak U, Sim J, Chambers I (2016) Differences in subsidence rate between alternative designs of a commonly used uncemented femoral stem. J Orthop 13(4):322–326. https://doi.org/10.1016/j.jor.2016.06.026 PMID: 27436922; PMCID: PMC4939397

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ries C, Boese CK, Dietrich F, Miehlke W, Heisel C (2019) Femoral stem subsidence in cementless total hip arthroplasty: a retrospective single-centre study. Int Orthop 43(2):307–314. https://doi.org/10.1007/s00264-018-4020-x Epub 2018 Jun 18

    Article  PubMed  Google Scholar 

  8. Vidalain JP (2011) Twenty-year results of the cementless Corail stem. Int Orthop 35(2):189–194. https://doi.org/10.1007/s00264-010-1117-2 Epub 2010 Sep 3. PMID: 20814676; PMCID: PMC3032112

    Article  PubMed  Google Scholar 

  9. Butt AJ, Weeks G, Curtin W, Kaar K (2005) Early experience with uncemented primary total hip arthroplasty using Corail stems and Duraloc cups. J Bone Jt Surg Br 87-B(3):269

    Google Scholar 

  10. Khatib YSO, Mendes DG, Said M (2002) Corail stem for total hip arthroplasty: 11 years of imaging follow-up. J Bone Jt Surg Br 84-B(3):301

    Google Scholar 

  11. Osseointegrated titanium implants, 1981, Albrektsson T, Brånemark PI, Hansson HA, Lindström J. Requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man. Acta Orthop Scand, 52(2). 155-170. https://doi.org/10.3109/17453678108991776.

    Article  Google Scholar 

  12. Galante J, Rostoker W, Lueck R, Ray RD (1971) Sintered fiber metal composites as a basis for attachment of implants to bone. J Bone Joint Surg Am 53(1):101–114

    Article  CAS  PubMed  Google Scholar 

  13. Gema A, Irianto KA, Setiawati R (2021) Femoral Stem Subsidence and its Associated Factors after Cementless Bipolar Hemiarthroplasty in Geriatric Patients. Malays Orthop J 15(1):63–71. https://doi.org/10.5704/MOJ.2103.010 PMID: 33880150; PMCID: PMC8043629

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Song JH, Jo WL, Lee KH, Cho YJ, Park J, Oh S (2019) Subsidence and perioperative periprosthetic fractures using collarless hydroxyapatite-coated stem for displaced femoral neck fractures according to Dorr type. J Orthop Surg (Hong Kong) 27(3):2309499019877530. https://doi.org/10.1177/2309499019877530

    Article  PubMed  Google Scholar 

  15. Kinjo S, Sands LP, Lim E, Paul S, Leung JM (2012) Prediction of postoperative pain using path analysis in older patients. J Anesth 26(1):1–8. https://doi.org/10.1007/s00540-011-1249-6 Epub 2011 Oct 20. PMID: 22012171; PMCID: PMC3720127

    Article  PubMed  Google Scholar 

  16. Chen LH, Liang J, Chen MC, Wu CC, Cheng HS, Wang HH, Shyu YL (2017) The relationship between preoperative American Society of Anesthesiologists Physical Status Classification scores and functional recovery following hip-fracture surgery. BMC Musculoskelet Disord 18(1):410. https://doi.org/10.1186/s12891-017-1768-x PMID: 29017476; PMCID: PMC5635509

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pentlow AK, Heal JS (2012) Subsidence of collarless uncemented femoral stems in total hips replacements performed for trauma. Injury 43(6):882–885. https://doi.org/10.1016/j.injury.2011.11.011 Epub 2011 Dec 15

    Article  PubMed  Google Scholar 

  18. Dalury DF, Kelley TC, Adams MJ (2012) Modern proximally tapered uncemented stems can be safely used in Dorr type C femoral bone. J Arthroplasty 27(6):1014–1018. https://doi.org/10.1016/j.arth.2011.12.019 Epub 2012 Feb 8

    Article  PubMed  Google Scholar 

  19. Zang J, Uchiyama K, Moriya M, Li Z, Fukushima K, Yamamoto T, Takahira N, Takaso M, Liu J, Feng W (2018) Long-term clinical and radiographic results of the cementless Spotorno stem in Japanese patients: A more than 15-year follow-up. J Orthop Surg (Hong Kong) 26(1):2309499017750310. https://doi.org/10.1177/2309499017750310

    Article  PubMed  Google Scholar 

  20. Kutzner KP, Freitag T, Donner S, Kovacevic MP, Bieger R (2017) Outcome of extensive varus and valgus stem alignment in short-stem THA: clinical and radiological analysis using EBRA-FCA. Arch Orthop Trauma Surg 137(3):431–439. https://doi.org/10.1007/s00402-017-2640-z Epub 2017 Feb 2. PMID: 28154993; PMCID: PMC5310617

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ikemura S, Motomura G, Hamai S (2022) Tapered wedge stems decrease early postoperative subsidence following cementless total hip arthroplasty in Dorr type C femurs compared to fit-and-fill stems. J Orthop Surg Res 17(1):223

    Article  PubMed  PubMed Central  Google Scholar 

  22. Jämsen E, Eskelinen A, Peltola M, Mäkelä K (2014) High early failure rate after cementless hip replacement in the octogenarian. Clin Orthop Relat Res 472(9):2779–2789. https://doi.org/10.1007/s11999-014-3641-7 Epub 2014 Apr 26. PMID: 24771260; PMCID: PMC4117887

    Article  PubMed  PubMed Central  Google Scholar 

  23. Okike K, Chan PH, Prentice HA, Paxton EW, Burri RA (2020) Association Between Uncemented vs Cemented Hemiarthroplasty and Revision Surgery Among Patients With Hip Fracture. JAMA 323(11):1077–1084. https://doi.org/10.1001/jama.2020.1067

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kristensen TB, Dybvik E, Kristoffersen M, Dale H, Engesæter LB, Furnes O, Gjertsen JE (2020) Cemented or Uncemented Hemiarthroplasty for Femoral Neck Fracture? Data from the Norwegian Hip Fracture Register. Clin Orthop Relat Res 478(1):90–100. https://doi.org/10.1097/CORR.0000000000000826 PMID: 31855192; PMCID: PMC7000039

    Article  PubMed  Google Scholar 

  25. Figved W, Opland V, Frihagen F, Jervidalo T, Madsen JE, Nordsletten L (2009) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop Relat Res 467(9):2426–2435. https://doi.org/10.1007/s11999-008-0672-y Epub 2009 Jan 7. PMID: 19130162; PMCID: PMC2866935

    Article  PubMed  PubMed Central  Google Scholar 

  26. Piggott RP, Lyons R, Murphy CG, Curtin W (2018) Total Hip Replacement Revision in a Single Brand Small Cementless Stem - Our Experience after the Findings of the National Joint Registry. Arch Bone Jt Surg 6(6):501–507 PMID: 30637305; PMCID: PMC6310183

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank Dr. Indrakshi Basak with statistics and data charting.

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Authors and Affiliations

  1. Department of Orthopaedics, College of Medicine & JNM Hospital, Kalyani, West Bengal, India

    Kaustav Mukherjee, Tushar Kanti Ghorai & Ajay Kumar

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  1. Kaustav Mukherjee
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  2. Tushar Kanti Ghorai
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  3. Ajay Kumar
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Contributions

Kaustav Mukherjee designed and conceptualized the study and wrote the initial draft, Tushar Kanti Ghorai participated in data collection and statistics, Ajay Kumar helped with the figure file and final manuscript preparation. All authors read and approved the final manuscript.

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Correspondence to Kaustav Mukherjee.

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Site of study- College of Medicine & JNM Hospital, Kalyani, West Bengal, India

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Mukherjee, K., Ghorai, T.K. & Kumar, A. High grade femoral stem subsidence in uncemented hip hemiarthroplasty - A radiographic analysis and an early prediction while treating femoral neck fractures. International Orthopaedics (SICOT) 47, 1591–1599 (2023). https://doi.org/10.1007/s00264-023-05791-0

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