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High Incidence of Migration with Poor Initial Fixation of the Accolade® Stem

  • Symposium: Papers Presented at the Annual Meetings of The Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Numerous cementless femoral stem design variations are in clinical use. Because initial implant instability and micromotion are associated with aseptic loosening of the femoral component, migration analysis provides an early assessment of implant survivorship.

Questions/purposes

We determined the (1) migration pattern of the Accolade® cementless femoral stem; (2) clinical factors predisposing to stem migration; (3) self-reported patient outcomes; and (4) our current rate of aseptic stem loosening.

Methods

We retrospectively analyzed 81 femoral stems for aseptic migration using Ein-Bild-Roentgen-Analyse-femoral component analysis. Postoperatively, patients completed the WOMAC and SF-12 questionnaires. We assessed radiographic factors potentially associated with subsidence: indices of bone shape and quality, canal fill of the implant, and radiographic signs of loosening. Minimum followup was 24 months (mean, 29 months; range, 24–48 months).

Results

The average subsidence at 24 months was 1.3 mm (range, 0–1.5 mm). In the first 2 years, 36% of stems subsided more than 1.5 mm. Large stem size was associated with subsidence. Radiolucent lines (> 1.5 mm in three zones) were present in 10% of stems and associated with lower questionnaire scores. The 5-year survivorship for aseptic loosening of the 367 stems was 97% with revision as end point and 95% for radiographic failure.

Conclusions

The high incidence of migration and stems with radiographic failure raises concerns about patient clinical function and long-term survivorship of this stem design. This migration pattern may be due to poor initial stability with a subsequent lack of osseointegration. Our results differ from radiographic findings and clinical durability of other similar cementless stem designs.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

We thank Mr. Steve Doucette for his assistance with analysis of our data and for preparing the figure and tables for this manuscript.

Author information

Authors and Affiliations

  1. Adult Reconstruction, The Ottawa Hospital, 501 Smyth Road, Room W1646, Ottawa, ON, K1H 8L6, Canada

    Craig A. White MD, Sasha Carsen MD, Kevin Rasuli BSc, Robert J. Feibel MD, FRCSC, Paul R. Kim MD, FRCSC & Paul E. Beaulé MD, FRCSC

Authors
  1. Craig A. White MD
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  2. Sasha Carsen MD
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  3. Kevin Rasuli BSc
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  4. Robert J. Feibel MD, FRCSC
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  5. Paul R. Kim MD, FRCSC
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  6. Paul E. Beaulé MD, FRCSC
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Corresponding author

Correspondence to Paul E. Beaulé MD, FRCSC.

Additional information

PRK is a consultant for Stryker Orthopaedics (Mahwah, NJ, USA). All remaining authors certify that they, or a member of their immediate family, have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or the device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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White, C.A., Carsen, S., Rasuli, K. et al. High Incidence of Migration with Poor Initial Fixation of the Accolade® Stem. Clin Orthop Relat Res 470, 410–417 (2012). https://doi.org/10.1007/s11999-011-2160-z

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  • DOI: https://doi.org/10.1007/s11999-011-2160-z

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