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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Demographic characteristics influencing the stem subsidence in total hip arthroplasty: an imaging study
Filippo Migliorini1,2, Nicola Maffulli3,4,5, Marco Pilone3,6
1Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Clinic Aachen, RWTH Aachen University Medical Centre, Pauwelsstraße 30, 52064, Aachen, Germany. migliorini.md@gmail.com.
Insights
Patient weight, age, and time after hip replacement surgery are linked to increased stem subsidence. Stem subsidence in total hip arthroplasty (THA) is not influenced by patient height or sex.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Arthroplasty Research
Background:
- Total hip arthroplasty (THA) aims to restore function and alleviate pain.
- Understanding factors influencing implant performance, such as stem subsidence, is crucial for long-term success.
- Patient demographic characteristics may play a role in the stability of cementless hip implants.
Purpose of the Study:
- To investigate the influence of patient demographic characteristics (age, height, weight, sex) on femoral stem subsidence in cementless total hip arthroplasty (THA).
- To examine the relationship between the duration since THA implantation and the extent of stem subsidence.
- To identify potential risk factors for increased stem subsidence in patients receiving specific cementless THA stems.
Main Methods:
- Retrospective analysis of 294 patients undergoing two-staged bilateral THA between 2016 and 2023.
- Utilized cementless DePuy collarless Corail stems for all THA procedures.
- Measured stem subsidence using specific anatomical landmarks (points A and B) on serial radiographs.
Main Results:
- Mean stem subsidence was 2.1 mm at point A and 3.1 mm at point B.
- A weak positive association was found between patient weight, age, and follow-up duration with increased stem subsidence.
- No significant association was observed between patient height or sex and the amount of stem subsidence.
Conclusions:
- Cementless DePuy collarless Corail stems exhibit an average subsidence of approximately 2.6 mm after 14.4 months.
- Increased patient weight, older age, and longer follow-up periods are associated with greater stem subsidence.
- Patient height and sex do not appear to influence stem subsidence in this THA cohort.
Introduction:
The present study evaluated whether patient demographic characteristics influence the subsidence of the stem in total hip arthroplasty (THA). The following characteristics were evaluated: age, height, weight, and sex. The association between the time elapsed from the THA implantation and the amount of stem subsidence was also investigated.
Methods:
The records of patients who underwent THA in the period between 2016 and 2023 were accessed. All patients underwent two-staged bilateral THA using cementless DePuy collarless Corail (DePuy Synthes, Raynham, MA, USA) stems. The following parameters were measured and compared to assess stem subsidence: distance from the proximal femur at the stem bone interface and the medial apex of the regular triangle built within the trochanter minor (point A); distance from the medial apex of the regular triangle built within the trochanter minor and the distal portion of the femoral stem (point B).
Results:
Overall, 294 patients were included. 62% (182 of 294 patients) were women. 45% (134 of 296 THAs) were on the right side. The mean age was 64.9 ± 10.4 years. The mean BMI was 28.3 ± 5.1 kg/m2. The mean length of the follow-up was 14.4 ± 11.0 months. The mean subsidence in point A was 2.1 mm (P < 0.0001), and that in point B was 3.1 mm (P < 0.0001). There was evidence of a weak positive association between patient weight (P < 0.0001), age (P = 0.03), follow-up (P = 0.002) and the amount of stem subsidence. Patient height did not demonstrate any association with the amount of stem subsidence (P = 0.07). There was no difference in stem subsidence between women and men (P = 0.9).
Conclusion:
Stem subsidence in THA using cementless DePuy collarless Corail implants is approximately 2.6 mm after 14.4 months. Greater patient weight, age, and longer time elapsed from THA implantation were associated with greater stem subsidence. Patient height and sex did not demonstrate any influence on the amount of stem subsidence. These results must be considered in light of the limitations of the present study.
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