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Risk factors for unsuccessful acetabular press-fit fixation at primary total hip arthroplasty - 07/11/17

Doi : 10.1016/j.otsr.2017.06.004 
U. Brulc, V. Antolič, B. Mavčič
 University Medical Centre Ljubljana and Faculty of Medicine, Department of Orthopaedic Surgery, Zaloška cesta 9, SI-1000 Ljubljana, Slovenia 

Corresponding author.

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Abstract

Background

Surgeon at primary total hip arthroplasty sometimes cannot achieve sufficient cementless acetabular press-fit fixation and must resort to other fixation methods. Despite a predominant use of cementless cups, this issue is not fully clarified, therefore we performed a large retrospective study to: (1) identify risk factors related to patient or implant or surgeon for unsuccessful intraoperative press-fit; (2) check for correlation between surgeons’ volume of operated cases and the press-fit success rate.

Hypothesis

Unsuccessful intra-operative press-fit more often occurs in older female patients, particular implants, due to learning curve and low-volume surgeons.

Materials and methods

Retrospective observational cohort of prospectively collected intraoperative data (2009–2016) included all primary total hip arthroplasty patients with implant brands that offered acetabular press-fit fixation only. Press-fit was considered successful if acetabulum was of the same implant brand as the femoral component without additional screws or cement. Logistic regression models for unsuccessful acetabular press-fit included patients’ gender/age/operated side, implant, surgeon, approach (posterior n=1206, direct-lateral n=871) and surgery date (i.e. learning curve).

Results

In 2077 patients (mean 65.5 years, 1093 females, 1163 right hips), three different implant brands (973 ABG-II™-Stryker, 646 EcoFit™ Implantcast, 458 Procotyl™ L-Wright) were implanted by eight surgeons. Their unsuccessful press-fit fixation rates ranged from 3.5% to 23.7%. Older age (odds ratio 1.01 [95% CI: 0.99–1.02]), female gender (2.87 [95% CI: 2.11–3.91]), right side (1.44 [95% CI: 1.08–1.92]), surgery date (0.90 [95% CI: 1.08–1.92]) and particular implants were significant risk factors only in three surgeons with less successful surgical technique (higher rates of unsuccessful press-fit with Procotyl™-L and EcoFit™ [P=0.01]). Direct-lateral hip approach had a lower rate of unsuccessful press-fit than posterior hip approach (P<0.01), but there was no correlation between surgeons’ volume and rate of successful press-fit (Spearman's rho=0.10, P=0.82). Subcohort of 961 patients with 5–7-years follow-up indicated higher early/late cup revision rates with unsuccessful press-fit.

Discussion

Success of press-fit fixation depends entirely on the surgeon and surgical approach. With proper operative technique, the unsuccessful press-fit fixation rate should be below 5% and the impact of patients’ characteristics or implants on press-fit fixation is then insignificant. Findings of huge variability in operative technique between surgeons of the presented study emphasize the need for surgeon-specific data stratification in arthroplasty studies and indicate the possibility of false attribution of clinically observed phenomena to patient-related factors in pooled data of large centers or hip arthroplasty registers.

Level of evidence

Level III, retrospective observational case control study.

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Keywords : Total hip arthroplasty, Press fit fixation, Risk factors


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Vol 103 - N° 7

P. 993-997 - novembre 2017 Retour au numéro
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