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Is there any difference between tapered titanium stems with similar geometry and hydroxyapatite coating?

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Abstract

Purpose

Several tapered stems with similar geometry and extensive hydroxyapatite coating have recently been introduced. It is not clear, however, whether they share the same design or whether they exhibit any difference that might affect their clinical performances. In this study, we analysed five tapered stems fully coated with hydroxyapatite to establish whether they exhibit similar geometric features and may therefore be used indifferently when a cementless stem is indicated.

Methods

The length of the stem, the coronal and sagittal diameters, the length of the stem shoulder and the metadiaphyseal angle were measured. The ratio between the proximal and distal coronal diameters of the stem and that between the proximal and distal cross-sectional areas were calculated as a flare index and tapered index, respectively.

Results

The proximal coronal diameter ranged between 24.9 and 28 mm in the smaller size and between 34 and 38.4 mm in the largest sizes. The proximal sagittal diameter ranged between 10.2 and 11.8 in the smallest size and between 14.4 and 17.2 in the largest. A significant difference was found between stems of different brands in the flare index, tapered index, length of stem shoulder and metadiaphyseal angle.

Conclusions

Lookalike tapered stems with extensive HA coating actually exhibit significant differences in several geometric features potentially affecting their clinical performances. As a result, these stems should not be used indifferently, but rather they should be selected on the basis of the femoral morphology of the operated patient.

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References

  1. 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 22:1–7

    Article  Google Scholar 

  2. Hallan G, Lie SA, Furnes O, Engesaeter LB, Vollset SE, Havelin LI (2007) Medium- and long-term performance of 11.516 uncemented primary femoral stems from the Norwegian arthroplasty register. J Bone Joint Surg Br 89:1574–1580

    Article  CAS  Google Scholar 

  3. Vidalain J-P (2011) Twenty-year results of cementless Corail stem. Int Orthop 35:189–194

    Article  Google Scholar 

  4. Bloebaum RD, Zou L, Bachus KN, Shea KG, Hofmann AA, Dunn HK (1997) Analysis of particles in acetabular components from patients with osteolysis. Clin Orthop Relat Res 338:109–118

    Article  Google Scholar 

  5. Collier JP, Surprenant VA, Mayor MB, Wrona M, Jensen RE, Surprenant HP (1993) Loss of hydroxyapatite coating on retrieved, total hip components. J Arthroplasty 8(4):389–393

    Article  CAS  Google Scholar 

  6. Rbkkum M, Registad A, Johansson CB (2002) HA particles can be released from well-fixed HA-coated stems. Histopathology of biopsies from 20 hips 2–8 years after implantation. Acta Orthop Scand 73:298

    Article  Google Scholar 

  7. Sudhahar TA, Morapudi S, Branes K (2009) Evaluation of subsidence between collarless and collared corail femoral cementless total hip replacement. J Orthop 6(2):e3

    Google Scholar 

  8. Callary SA, Campbell DG, Mercer GE, Nilsson KG, Field JR (2012) The 6-year migration characteristics of a hydroxyapatite-coated femoral stem: a radiostereometric analysis study. J Arthroplasty 27:1344–1348

    Article  Google Scholar 

  9. 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

    Article  Google Scholar 

  10. Pentlow AK, Heal JS (2012) Subsidence of collarless uncemented femoral stems in total hips replacements performed for trauma. Injury Int J Care Injured 43:882–885

    Article  Google Scholar 

  11. Selvaratnam V, Shetty V, Sahni V (2015) Subsidence in collarless Corail hip replacement. The Open Orthop J 9:194–197

    Article  Google Scholar 

  12. Faisal M, Thomas G, Young SK (2011) Subsidence of the Corail femoral component in the elderly. A retrospective radiological review. Hip Int 21:325–329. https://doi.org/10.5301/HIP.2011.8409

    Article  PubMed  Google Scholar 

  13. Hirata Y, Inaba Y, Kobayashi N, Ike H, Fujimaki H, Saito T (2013) Comparison of mechanical stress and change in bone mineral density between two types of femoral implant using finite element analysis. J Arthroplasty 28:1731–1735

    Article  Google Scholar 

  14. Huiskes R (1999) The various stress patterns of press-fit, ingrown, and cemented femoral stems. Clin Orthop Relat Res 261:27–38

    Google Scholar 

  15. Sano K, Ito K, Yamamoto K (2008) Changes of bone mineral density after cementless total hip arthroplasty with two different stems. Int Orthop 32(2):167

    Article  Google Scholar 

  16. van der Wal BC, de Kramer BJ, Grimm B, Vencken W, Heyligers IC, Tonino AJ (2008) Femoral fit in ABG-II hip stems, influence on clinical outcome and bone remodeling: a radiographic study. Arch Orthop Trauma Surg 128(10):1065

    Article  Google Scholar 

  17. Capello WN, D’Antonio JA, Geesink RG, Feinberg JR, Naughton M (2009) Late remodeling around a proximally HA-coated tapered titanium femoral component. Clin Orthop Rel Res 467:155–165

    Article  Google Scholar 

  18. Cooper HJ, Jacob AP, Rodriguez JA (2011) Distal fixation of proximally coated tapered stems may predispose to a failure of osteointegration. J Arthroplasty 26:78–83

    Article  Google Scholar 

  19. Mueller LA, Nowak TE, Haeberle L, Mueller LP, Kress A, Voelk M et al (2010) Progressive femoral cortical and cancellous bone density loss after uncemented tapered-design stem fixation. A 6-year follow-up. Acta Orthop 81:171–177

    Article  Google Scholar 

  20. Panisello JJ, Herrero L, Canales V, Herrera H, Martínez A, Mateo J (2009) Long-term remodeling in proximal femur around a hydroxyapatite-coated anatomic stem ten years densitometric follow-up. J Arthroplasty 24:56–64

    Article  Google Scholar 

  21. Cinotti G, Della Rocca A, Sessa P, Ripani FR, Giannicola G (2013) Thigh pain, subsidence and survival using a short cementless femoral stem with pure metaphyseal fixation at minimum 9-year follow-up. Orthop Traumatol Surg Res 99(1):30–36. https://doi.org/10.1016/j.otsr.2012.09.016

    Article  CAS  PubMed  Google Scholar 

  22. Kim Y-H (2008) The results of a proximally-coated Cementless femoral component in total hip replacement. A five-to 12-year follow-up. J Bone Joint Surg Br 90:299–305

    Article  Google Scholar 

  23. Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH (1993) Structural and cellular assessment of bone quality of proximal femur. Bone 14:231–242

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, University “La Sapienza”, Piazzale Aldo Moro, 5 00185, Rome, Italy

    G. Cinotti, F. Romana Ripani & G. Giannicola

  2. Department of Public Health and Infectious Diseases, University “La Sapienza”, Piazzale Aldo Moro, 5 00185, Rome, Italy

    G. La Torre

  3. Orthopaedic Department, San Filippo Neri Hospital, Rome, Italy

    G. Mazzotta

Authors
  1. G. Cinotti
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  2. G. Mazzotta
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  3. F. Romana Ripani
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  4. G. La Torre
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  5. G. Giannicola
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Contributions

GC has planned the study, analysed data and written the manuscript. GM and FRR performed the measurements on the all series of stems; GLT performed statistical analysis and contributed to the data interpretation; GG was a major contributor in the planning of the study, analysis of data and writing the manuscript.

Corresponding author

Correspondence to G. Cinotti.

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Sources of support

The involved companies provided the stems analysed.

Conflict of interests

The authors declare that they have no competing interests in this section.

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Cinotti, G., Mazzotta, G., Ripani, F.R. et al. Is there any difference between tapered titanium stems with similar geometry and hydroxyapatite coating?. Musculoskelet Surg 103, 275–281 (2019). https://doi.org/10.1007/s12306-018-00586-8

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  • DOI: https://doi.org/10.1007/s12306-018-00586-8

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