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Femoral stem subsidence in cementless total hip arthroplasty: a retrospective single-centre study

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Abstract

Purpose and hypothesis

Subsidence is a known reason for early failure of total hip arthroplasty (THA). In particular, cementless THA might be vulnerable to migration. The present study analysed femoral stem subsidence after primary cementless THA. Prosthetic and anatomical risk factors for early femoral stem subsidence were evaluated.

Methods

Two hundred thirty-one consecutive patients who underwent primary cementless THA in a single centre were retrospectively analysed. Post-operative results were evaluated in consideration of prosthetic and anatomical properties in correlation with subsidence on standing pelvic anteroposterior radiographs. Stem type and design, demographic data, BMI, canal flare index (CFI) and canal fill ratio (CFR) were evaluated.

Results

The subsidence rate was significantly higher in collarless femoral stems [3.1 mm (SD 2.8 mm) vs. 1.9 mm (SD 1.5 mm); p = 0.013] while the anatomical type of the proximal femur as described by the canal flare index did not influenced subsidence (p = 0.050). Also, the canal fill ratio showed no significant correlation with subsidence at any level.

Conclusions

In the present study, stem subsidence was significantly higher in the collarless group compared to collared stems. No anatomical parameter (CFI and CFR) could be identified as risk factor for subsidence. Neither age nor BMI influenced subsidence in this cohort. Still, subgroup analysis indicated a sex-dependent role of BMI. Prospective studies of large cohorts should address the problem of subsidence in the future.

Level of evidence

Retrospective therapeutic study, Level IV.

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Acknowledgements

We thank Dr. N. Venkatesh Kumar for measurements and data acquisition.

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Author notes

  1. Christian Ries and Christoph Kolja Boese contributed equally to this work.

Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Christian Ries & Christoph Kolja Boese

  2. ARCUS Kliniken Pforzheim, Rastatter Str. 17-19, 75179, Pforzheim, Germany

    Florian Dietrich & Wolfgang Miehlke

  3. Orthopädie Kurpfalz, Bahnhofstr. 51, 67346, Speyer, Germany

    Christian Heisel

Authors
  1. Christian Ries
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  2. Christoph Kolja Boese
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  3. Florian Dietrich
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  5. Christian Heisel
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Correspondence to Christian Ries.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Ries, C., Boese, C.K., Dietrich, F. et al. Femoral stem subsidence in cementless total hip arthroplasty: a retrospective single-centre study. International Orthopaedics (SICOT) 43, 307–314 (2019). https://doi.org/10.1007/s00264-018-4020-x

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  • DOI: https://doi.org/10.1007/s00264-018-4020-x

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