Tags

Type your tag names separated by a space and hit enter

Long-term survival of the cemented Müller CDH stem: a minimum follow-up of 10 years.
Arch Orthop Trauma Surg 2018; 138(10):1471-1477AO

Abstract

INTRODUCTION

Total hip arthroplasty in patients with altered anatomy of the hip and femur, such as in congenital dysplasia of the hip, is challenging and often requires specially designed stems. Müller straight stems have shown excellent long-term results; however, long-term data on the analogous cemented Müller CDH stem are still missing. The aim of this study was to analyze long-term survival, identify potential risk factors for aseptic loosening, and analyze radiological outcome of the cemented Müller CDH stems.

MATERIALS AND METHODS

Between 01/1985 and 06/2005, 95 Müller CDH stems (Zimmer, Winterthur, Switzerland) made up of 3 different materials were cemented using 2 different bone cements: 38 of stainless steel/high-viscosity cement, 31 of a cobalt-chrome-based alloy (CoCr)/low-viscosity cement, and 26 of a titanium-based alloy (Ti)/low-viscosity cement. All patients had a prospective clinical and radiological follow-up according to the standards of our institution. The cumulative incidence for revision of the stem was calculated using a competing risk model. To identify demographic and implant-related risk factors for aseptic loosening of the stem, a multivariate regression model for competing risks was performed.

RESULTS

The cumulative risk of revision at 15 years was 12.5% (95% CI 6.6-20.5%) for aseptic loosening of the stem as endpoint, with marked differences for the various stem materials used: stainless steel 2.7% (0.2-12.3%), CoCr 12.9% (4.0-27.3%), and Ti 24.5% (9.6-43.1%). Regression modeling revealed that Ti stems in combination with low-viscosity cement (HR 10.2) and implantation with an axis deviation greater than 3° (HR 3.8) are risk factors for aseptic loosening.

CONCLUSIONS

Long-term survival of the cemented Müller CDH stem is comparable to other Müller-type straight stems and uncemented implants. Similar to the original Ti Müller straight stem, the Ti Müller CDH stem also showed an increased risk for aseptic loosening and should, therefore, no longer be used.

Authors+Show Affiliations

Clinic for Orthopedics and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland.Clinic for Orthopedics and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland.Clinic for Orthopedics and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland.Clinic for Orthopedics and Trauma Surgery, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland. martin.clauss@ksbl.ch.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30046893

Citation

Salentiny, Yves, et al. "Long-term Survival of the Cemented Müller CDH Stem: a Minimum Follow-up of 10 Years." Archives of Orthopaedic and Trauma Surgery, vol. 138, no. 10, 2018, pp. 1471-1477.
Salentiny Y, Zwicky L, Ochsner PE, et al. Long-term survival of the cemented Müller CDH stem: a minimum follow-up of 10 years. Arch Orthop Trauma Surg. 2018;138(10):1471-1477.
Salentiny, Y., Zwicky, L., Ochsner, P. E., & Clauss, M. (2018). Long-term survival of the cemented Müller CDH stem: a minimum follow-up of 10 years. Archives of Orthopaedic and Trauma Surgery, 138(10), pp. 1471-1477. doi:10.1007/s00402-018-3009-7.
Salentiny Y, et al. Long-term Survival of the Cemented Müller CDH Stem: a Minimum Follow-up of 10 Years. Arch Orthop Trauma Surg. 2018;138(10):1471-1477. PubMed PMID: 30046893.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term survival of the cemented Müller CDH stem: a minimum follow-up of 10 years. AU - Salentiny,Yves, AU - Zwicky,Lukas, AU - Ochsner,Peter E, AU - Clauss,Martin, Y1 - 2018/07/25/ PY - 2017/11/22/received PY - 2018/7/27/pubmed PY - 2018/12/12/medline PY - 2018/7/27/entrez KW - Aseptic loosening KW - CDH KW - Cemented stem KW - Hip dysplasia KW - Risk factors KW - Total hip arthroplasty SP - 1471 EP - 1477 JF - Archives of orthopaedic and trauma surgery JO - Arch Orthop Trauma Surg VL - 138 IS - 10 N2 - INTRODUCTION: Total hip arthroplasty in patients with altered anatomy of the hip and femur, such as in congenital dysplasia of the hip, is challenging and often requires specially designed stems. Müller straight stems have shown excellent long-term results; however, long-term data on the analogous cemented Müller CDH stem are still missing. The aim of this study was to analyze long-term survival, identify potential risk factors for aseptic loosening, and analyze radiological outcome of the cemented Müller CDH stems. MATERIALS AND METHODS: Between 01/1985 and 06/2005, 95 Müller CDH stems (Zimmer, Winterthur, Switzerland) made up of 3 different materials were cemented using 2 different bone cements: 38 of stainless steel/high-viscosity cement, 31 of a cobalt-chrome-based alloy (CoCr)/low-viscosity cement, and 26 of a titanium-based alloy (Ti)/low-viscosity cement. All patients had a prospective clinical and radiological follow-up according to the standards of our institution. The cumulative incidence for revision of the stem was calculated using a competing risk model. To identify demographic and implant-related risk factors for aseptic loosening of the stem, a multivariate regression model for competing risks was performed. RESULTS: The cumulative risk of revision at 15 years was 12.5% (95% CI 6.6-20.5%) for aseptic loosening of the stem as endpoint, with marked differences for the various stem materials used: stainless steel 2.7% (0.2-12.3%), CoCr 12.9% (4.0-27.3%), and Ti 24.5% (9.6-43.1%). Regression modeling revealed that Ti stems in combination with low-viscosity cement (HR 10.2) and implantation with an axis deviation greater than 3° (HR 3.8) are risk factors for aseptic loosening. CONCLUSIONS: Long-term survival of the cemented Müller CDH stem is comparable to other Müller-type straight stems and uncemented implants. Similar to the original Ti Müller straight stem, the Ti Müller CDH stem also showed an increased risk for aseptic loosening and should, therefore, no longer be used. SN - 1434-3916 UR - https://www.unboundmedicine.com/medline/citation/30046893/Long_term_survival_of_the_cemented_Müller_CDH_stem:_a_minimum_follow_up_of_10_years_ L2 - https://dx.doi.org/10.1007/s00402-018-3009-7 DB - PRIME DP - Unbound Medicine ER -