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Complex Primary Total Hip Arthroplasty: Small Stems for Big Challenges.

ABSTRACT: Total hip arthroplasty is one of the most successful operations in all of medicine. Femoral deformities from malunion, prior osteotomy, and retained surgical implants all present unique challenges. Corrective osteotomy and hardware removal add significant morbidity to an operation that typically has a fast recovery. Short stems can be used in these cases to spare patients' increased morbidity. We present a case-based illustration and surgical technique for the use of short stems in complex primary total hip arthroplasty with femoral deformity and retained hardware. We discuss how these implants can spare significant morbidity, show radiographic examples of their use, and present short-term outcomes.

SUBMITTER: Bostian PA

PROVIDER: S-EPMC7994729 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Complex Primary Total Hip Arthroplasty: Small Stems for Big Challenges.

Bostian Phillip A PA Grisez Brian T BT Klein Adam E AE Frye Benjamin M BM

Arthroplasty today 20210323

Total hip arthroplasty is one of the most successful operations in all of medicine. Femoral deformities from malunion, prior osteotomy, and retained surgical implants all present unique challenges. Corrective osteotomy and hardware removal add significant morbidity to an operation that typically has a fast recovery. Short stems can be used in these cases to spare patients' increased morbidity. We present a case-based illustration and surgical technique for the use of short stems in complex prima ...[more]

PMID: 33786353

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Project description:BackgroundThe introduction of new devices for total hip arthroplasty (THA) offers surgeons the ability to address deficits in the portfolio. However, once introduced, data regarding the performance of devices is not publicly available until their use is widespread.Purpose/questionsThe objective of this study was to compare the clinical and radiographic performance, including patient reported outcomes and radiographic evidence of osseointegration, subsidence, and stress shielding, of the newer Actis femoral component to the Corail stem (DePuy Synthes, Warsaw, IN, USA), which has an extensive clinical history.MethodsThis short-term, retrospective cohort study was a single surgeon series of 330 anterior approach THAs, consisting of 165 cases using the Actis stem and 165 cases using the Corail stem. Both devices were cementless, titanium, tapered, hydroxyapatite-coated stems. They differed in geometry, neck choices, broach philosophy, and collar availability. Data was obtained for 1 year following THA. Functional outcomes were measured with the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR.) survey. Complications were recorded from patient charts, and radiographic analysis was performed for signs of osseointegration, subsidence, and stress shielding.ResultsThe groups shared similar demographic characteristics except the Actis population was younger with fewer women. The complication rate did not significantly vary, and no patient required revision within the first year. Radiographically, one patient in each group demonstrated subsidence. No cases exhibited radiolucent lines, and the prevalence of stress shielding at 1 year was comparable. HOOS, JR. scores did not significantly vary at 8 weeks or 1 year.ConclusionThe Actis stem does not carry an increased risk of device-related complications compared with the Corail implant. Although aspects of bone remodeling differed between groups, Actis achieved radiographic signs of bone ingrowth at the 1-year mark and performed well clinically, with equivalent patient reported outcome scores to the Corail stem.

Dataset Information

Complex Primary Total Hip Arthroplasty: Small Stems for Big Challenges.

Publications

Complex Primary Total Hip Arthroplasty: Small Stems for Big Challenges.

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