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Comparison of canal fill and radiolucent line formation between two fully coated, hydroxyapatite tapered stems: a 2-year follow-up after total hip arthroplasty

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Comparison between fully hydroxyapatite (HA)-coated stems with differing geometry are lacking in the total hip arthroplasty (THA) literature. This study aimed to compare femoral canal fill, radiolucency formation, and 2-year implant survivorship between two commonly used, HA-coated stems.

Methods

All primary THAs performed with two fully HA-coated stems (Polar stem, Smith&Nephew, Memphis, TN and Corail stem, DePuy-Synthes, Warsaw, IN) with a minimum 2-year radiographic follow-up were identified. Radiographic measures of proximal femoral morphology based on the Dorr classification and femoral canal fill were analyzed. Radiolucent lines were identified by Gruen zone. Perioperative characteristics and 2-year survivorship were compared between stem types.

Results

A total of 233 patients were identified with 132 (56.7%) receiving the Polar stem (P) and 101 (43.3%) receiving the Corail stem (C). No differences were observed with respect to proximal femoral morphology. Femoral stem canal fill at the middle third of the stem was greater for P stem patients than for C stem patients (P stem; 0.80 ± 0.08 vs. C stem; 0.77 ± 0.08, p = 0.002), while femoral stem canal fill at the distal third of the stem and presence of subsidence were comparable between groups. A total of six and nine radiolucencies were observed in P stem and C stem patients, respectively. Revision rate at 2-year (P stem; 1.5% vs C stem; 0.0%, p = 0.51) and latest follow-up (P stem; 1.5% vs C stem; 1.0%, p = 0.72) did not differ between groups.

Conclusion

Greater canal fill at the middle third of the stem was observed for the P stem compared to the C stem, however, both stems demonstrated robust and comparable freedom from revision at 2-year and latest follow-up, with low incidences of radiolucent line formation. Mid-term clinical and radiographic outcomes for these commonly used, fully HA-coated stems remain equally promising in THA despite variations in canal fill.

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Data availability

Data is protected by our institutions IRB protocol but could be de-identifed and available on request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. No direct funding or support was received for this work.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Orthopedic Hospital, NYU Langone Health, 301 East 17Th Street, 14Th Floor Suite 1402, New York, NY, 10003, USA

    Ittai Shichman, Kyle W. Lawrence, Emily Berzolla, Carlos Sandoval Hernandez, Ran Schwarzkopf & Matthew S. Hepinstall

  2. Division of Orthopedic Surgery, Sourasky Medical Center, Sackler School of Medicine, Tel- Aviv, Israel

    Ittai Shichman, Rani Man-El, Yaniv Warschawski & Nimrod Snir

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Contributions

This study conceptualization and conception was made by MH. Methodology and study design was suggested and supervised by RS and YW. Material preparation, data collection and analysis were performed by IS, KL, EM, CSH, RME and NS. The first draft of the manuscript was written by IS, KL AND NS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ittai Shichman.

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Conflict of interest

Dr. RS is a paid consultant for Smith&Nephew and InteliJoint and has stock options in Intelijoint and Gauss Surgical. Dr. MH is a paid consultant for Stryker and Exactech and receives research support from Exactech. Drs. IS, KL, EB, CSH, RME, YW and NS have not financial disclosures.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of NYU University (IRB i17- 01223).

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Shichman, I., Lawrence, K.W., Berzolla, E. et al. Comparison of canal fill and radiolucent line formation between two fully coated, hydroxyapatite tapered stems: a 2-year follow-up after total hip arthroplasty. Arch Orthop Trauma Surg 143, 6945–6954 (2023). https://doi.org/10.1007/s00402-023-04944-5

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