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Tapered stems one-third proximally coated have higher complication rates than cylindrical two-third coated stems in patients with high hip dislocation undergoing total hip arthroplasty with step-cut shortening osteotomy - 29/11/17

Doi : 10.1016/j.otsr.2017.01.010 
V. Emre Ozden , G. Dikmen, B. Beksac, I. Remzi Tozun
 Acibadem University, Faculty of Medicine, Acıbadem Maslak Hospital, Department of Orthopedics and Traumatology, Maslak, 34457 Istanbul, Turkey 

Corresponding author at: Acibadem University, Faculty of Medicine, Acıbadem Maslak Hospital, Department of Orthopedics and Traumatology, Büyükdere Cad 40 Maslak, 34457 Istanbul, Turkey.Acibadem University, Faculty of Medicine, Acıbadem Maslak Hospital, Department of Orthopedics and TraumatologyBüyükdere Cad 40 MaslakIstanbul34457Turkey

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Abstract

Background

The results of cementless stems in total hip arthroplasty (THA) done because of congenital dislocation with step-cut osteotomy is not well known, particularly the influence of the design and the role of extent of porous coating. Therefore we performed a retrospective study to evaluate the mid to long-term results THA performed with a single type acetabular component and different geometry and fixation type stems with ceramic bearings in the setting of step-cut subtrochanteric osteotomy in high hip dislocated (HHD) patients. We asked if the stem type affect the outcomes in terms of (1) intra and postoperative complication rates (2) radiographic outcomes (3) prosthesis survival in step-cut subtrochanteric shortening osteotomy.

Hypothesis

The type of the stem, whether cylindrical or tapered does not affect the outcome if the femoral canal fit and fill is obtained and the step-cut femoral shortening osteotomy is primarily fixed.

Materials and methods

Forty-five hips in 35 patients with a mean follow up of 10 years (range, 7–14 years) were evaluated. The single type cementless cup was placed at the level of the true acetabulum, a step-cut shortening femoral osteotomy was performed and reconstruction was performed with two different types of tapered stem in twenty-two hips (Synergy™ and Image™ proximally coated, Smith and Nephew, Menphis, TN, USA) and one type of cylindrical stem (Echelon™ with 2/3 coated, Smith and Nephew, Menphis, TN, USA) in twenty-three hips. Harris hip scores (HHS) and a University of California Los Angeles (UCLA) activity scores were calculated for all patients and successive X-rays were evaluated regarding component loosening and osteolysis, along with complications related to bearing, step-cut osteotomy and stem types.

Results

Forty-one hips (91%) had good and excellent clinical outcome according to HHS. The mean UCLA activity scores improved from 3.2±0.6 points (range, 2–4) preoperatively to 6.3 points±0.5 (range, 5–7) at the latest follow-up. The mean femoral shortening was 36±10mm (range, 20–65mm). Four (9%) dislocations were observed. There were five (11%) intra-operative femoral fractures and three (7%) cases of non-union, which were observed in tapered stems. Cylindrical stems had superior neutral alignment primarily. With any stem revision as the end point, cylindrical stems had a higher survival rate (100%) than all tapered stems (82%; 95% confident interval [CI] 77–97%) at ten years. With any revision as the end point, the 10-year survival rate for acetabular component (Reflection-Ceramic Interfit) and for femoral components were 98% (95% CI, 85–99%) and 91% (95% CI, 78–97%), respectively.

Conclusions

There were more implant related complications in HHD patients undergoing THA when tapered stems with 1/3 proximal coating were used to reconstruct a step cut osteotomized femur, compared to cylindrical stems 2/3 coated.

Level of evidence

IV, retrospective study.

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Keywords : Tapered stem, Cylindrical stem, Crowe type-IV dislocation, Modified Cochin type IV–V, Step-cut femoral shortening, Ceramic on ceramic


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Vol 103 - N° 4

P. 569-577 - juin 2017 Retour au numéro
Article précédent Article précédent
  • The influence of spine-hip relations on total hip replacement: A systematic review
  • C. Rivière, J.-Y. Lazennec, C. Van Der Straeten, E. Auvinet, J. Cobb, S. Muirhead-Allwood
| Article suivant Article suivant
  • Global fit concept in revision hip arthroplasty for cementless press-fit femoral stems
  • F. Canovas, P. LeBeguec, J. Batard, F. Gaillard, L. Dagneaux

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