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Cementless femoral stems with lower canal fill ratio have similar mid-term to long-term outcomes to those with adequate fill ratio in Dorr type C femurs

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

Abstract

Background

Lower canal fill ratio was reported to correlate with aseptic loosening in many studies. However, the most widely used standard of fill ratio seemed inapplicable to Dorr type C femurs. We aimed to adapt the method of measuring the fill ratio in Dorr type C femurs and compare the outcomes among patients with different fill ratios.

Methods

Twenty patients with Corail stems implanted in their Dorr type C femurs received spectrum CT to evaluate the whole-stem's fill ratio. Pearson Correlation Coefficient was calculated to assess the correlation between the fill ratio in X-ray film and spectrum CT. Then 87 THAs were involved in this study, divided into the fill ratio ≤ 80% group and the fill ratio > 80% group. Clinical and radiological outcomes were evaluated with a mean follow-up of 8.2 years.

Results

Fill ratio at 2 cm below the lesser trochanter in anterior–posterior X-ray film correlated with the whole-stem's fill ratio (r = 0.50, P = 0.02). Survival rate of stem, function scores, and radiological outcomes between the two groups showed no significant difference. In the fill ratio > 80% group, intraoperative fracture was significantly higher (19% VS 5%, P < 0.05).

Conclusion

Patients with lower fill ratios at 2 cm below the lesser trochanter did not have poorer functional scores or more subsidence, but had a lower intraoperative fracture rate. The revision rates of the two groups presented no significant difference, but this result need to be confirmed in larger cohort in the future. In Dorr type C femurs, risk of fracture and the special morphology of the femur should be noted, and high fill ratio is not the most decisive factor for stem size selecting.

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Availability of data and materials

The authors confirm that the data supporting the findings of this study are available within the article.

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Funding

This study was funded by the National Natural Science Foundation of China Program (No. 81974347) and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (NO. Z20191008).

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Authors and Affiliations

  1. Department of Orthopedics, Orthopedic Reseach Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China

    Mingyang Li, Yi Zeng, Yuangang Wu, Yuan Liu, Limin Wu & Bin Shen

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  1. Mingyang Li
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  2. Yi Zeng
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  3. Yuangang Wu
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  4. Yuan Liu
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  5. Limin Wu
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  6. Bin Shen
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Contributions

Mingyang Li, Bin Shen conceived and designed the analysis. Yi Zeng, Yuangang Wu collected the data. Yuan Liu, Limin Wu performed the analysis. Mingyang Li, Bin Shen wrote the paper.

Corresponding author

Correspondence to Bin Shen.

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All authors declared that there is no conflict of interest.

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Ethical approval was obtained from the institutional review board of West China Hospital (Chengdu, Sichuan Province, China).

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All included patients provided informed consent.

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Li, M., Zeng, Y., Wu, Y. et al. Cementless femoral stems with lower canal fill ratio have similar mid-term to long-term outcomes to those with adequate fill ratio in Dorr type C femurs. Arch Orthop Trauma Surg 142, 1265–1273 (2022). https://doi.org/10.1007/s00402-021-03916-x

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