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Fifty-six percent of proximal femoral cortical hypertrophies 6 to 10 years after Total hip arthroplasty with a short Cementless curved hip stem - a cause for concern?
BMC Musculoskelet Disord 2019; 20(1):261BM

Abstract

BACKGROUND

Thigh pain and cortical hypertrophies (CH) have been reported in the short term for specific short hip stem designs. The purpose of the study was to investigate 1) the differences in clinical outcome, thigh pain and stem survival for patients with and without CHs and 2) to identify patient and surgery-related factors being associated with the development of CHs.

METHODS

A consecutive series of 233 patients with 246 hips was included in the present retrospective diagnostic cohort study, who had received a total hip arthroplasty (THA) between December 2007 and 2009 with a cementless, curved, short hip stem (Fitmore, Zimmer, Warsaw, IN, USA). Clinical and radiographic follow-up, including the radiographic parameters for hip geometry reconstruction, were prospectively assessed 1, 3, and 6 to 10 years after surgery.

RESULTS

Cortical hypertrophies were observed in 56% of the hips after a mean of 7.7 years, compared to 53% after 3.3 years being mostly located in Gruen zone 3 and 5. There was no significant difference for the Harris Hip Score and UCLA score for patients with and without CHs. Only one patient with a mild CH in Gruen zone 5 and extensive heterotopic ossifications around the neck of the stem reported thigh pain. The Kaplan Meier survival rate after 8.6 years was 99.6% (95%-CI; 97.1-99.9%) for stem revision due to aseptic loosening and no association with CHs could be detected. Postoperative increase in hip offset was the only risk factor being associated with the development of CHs in the regression model (ΔHO; OR 1.1 (1.0-1.2); p = 0.001).

CONCLUSIONS

The percentage of cortical hypertrophies remained almost constant in the mid-term compared to the short-term with the present cementless short hip stem design. The high percentage of cortical hypertrophies seems not be a cause for concern with this specific implant in the mid-term.

LEVEL OF EVIDENCE

Diagnostic Level IV.

Authors+Show Affiliations

Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.Department of Orthopaedic and Trauma Surgery, Kepler University Hospital, Med Campus III Krankenhausstraβe 9, 4021, Linz, Austria.Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany. Michael.Maier@med.uni-heidelberg.de.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31142303

Citation

Innmann, Moritz M., et al. "Fifty-six Percent of Proximal Femoral Cortical Hypertrophies 6 to 10 Years After Total Hip Arthroplasty With a Short Cementless Curved Hip Stem - a Cause for Concern?" BMC Musculoskeletal Disorders, vol. 20, no. 1, 2019, p. 261.
Innmann MM, Weishorn J, Bruckner T, et al. Fifty-six percent of proximal femoral cortical hypertrophies 6 to 10 years after Total hip arthroplasty with a short Cementless curved hip stem - a cause for concern? BMC Musculoskelet Disord. 2019;20(1):261.
Innmann, M. M., Weishorn, J., Bruckner, T., Streit, M. R., Walker, T., Gotterbarm, T., ... Maier, M. W. (2019). Fifty-six percent of proximal femoral cortical hypertrophies 6 to 10 years after Total hip arthroplasty with a short Cementless curved hip stem - a cause for concern? BMC Musculoskeletal Disorders, 20(1), p. 261. doi:10.1186/s12891-019-2645-6.
Innmann MM, et al. Fifty-six Percent of Proximal Femoral Cortical Hypertrophies 6 to 10 Years After Total Hip Arthroplasty With a Short Cementless Curved Hip Stem - a Cause for Concern. BMC Musculoskelet Disord. 2019 May 29;20(1):261. PubMed PMID: 31142303.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fifty-six percent of proximal femoral cortical hypertrophies 6 to 10 years after Total hip arthroplasty with a short Cementless curved hip stem - a cause for concern? AU - Innmann,Moritz M, AU - Weishorn,Johannes, AU - Bruckner,Thomas, AU - Streit,Marcus R, AU - Walker,Tilman, AU - Gotterbarm,Tobias, AU - Merle,Christian, AU - Maier,Michael W, Y1 - 2019/05/29/ PY - 2018/12/19/received PY - 2019/05/20/accepted PY - 2019/5/31/entrez PY - 2019/5/31/pubmed PY - 2019/5/31/medline KW - Arthroplasty KW - Cementless KW - Cortical KW - Hip KW - Hypertrophy KW - Pain KW - Short KW - Stem KW - Thigh SP - 261 EP - 261 JF - BMC musculoskeletal disorders JO - BMC Musculoskelet Disord VL - 20 IS - 1 N2 - BACKGROUND: Thigh pain and cortical hypertrophies (CH) have been reported in the short term for specific short hip stem designs. The purpose of the study was to investigate 1) the differences in clinical outcome, thigh pain and stem survival for patients with and without CHs and 2) to identify patient and surgery-related factors being associated with the development of CHs. METHODS: A consecutive series of 233 patients with 246 hips was included in the present retrospective diagnostic cohort study, who had received a total hip arthroplasty (THA) between December 2007 and 2009 with a cementless, curved, short hip stem (Fitmore, Zimmer, Warsaw, IN, USA). Clinical and radiographic follow-up, including the radiographic parameters for hip geometry reconstruction, were prospectively assessed 1, 3, and 6 to 10 years after surgery. RESULTS: Cortical hypertrophies were observed in 56% of the hips after a mean of 7.7 years, compared to 53% after 3.3 years being mostly located in Gruen zone 3 and 5. There was no significant difference for the Harris Hip Score and UCLA score for patients with and without CHs. Only one patient with a mild CH in Gruen zone 5 and extensive heterotopic ossifications around the neck of the stem reported thigh pain. The Kaplan Meier survival rate after 8.6 years was 99.6% (95%-CI; 97.1-99.9%) for stem revision due to aseptic loosening and no association with CHs could be detected. Postoperative increase in hip offset was the only risk factor being associated with the development of CHs in the regression model (ΔHO; OR 1.1 (1.0-1.2); p = 0.001). CONCLUSIONS: The percentage of cortical hypertrophies remained almost constant in the mid-term compared to the short-term with the present cementless short hip stem design. The high percentage of cortical hypertrophies seems not be a cause for concern with this specific implant in the mid-term. LEVEL OF EVIDENCE: Diagnostic Level IV. SN - 1471-2474 UR - https://www.unboundmedicine.com/medline/citation/31142303/Fifty-six_percent_of_proximal_femoral_cortical_hypertrophies_6_to_10_years_after_Total_hip_arthroplasty_with_a_short_Cementless_curved_hip_stem_-_a_cause_for_concern L2 - https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-2645-6 DB - PRIME DP - Unbound Medicine ER -