The use of a standard-length conical tapered stem in hip revision arthroplasty to address Paprosky type I–II femoral defects: a prospective study of 87 patients

Introduction Low-grade femoral defects in revision total hip arthroplasty (rTHA) might be preferably treated with a primary implant. Almost no previous study reported the use of standard-length conical tapered (SLCT) stems in these cases. We analyzed a series of cases using a SLCT stem in rTHA with...

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Veröffentlicht in:Archives of orthopaedic and trauma surgery 2023-09, Vol.143 (9), p.5945-5955
Hauptverfasser: Innocenti, Matteo, Smulders, Katrijn, Andreotti, Mattia, Willems, Jore H., Van Hellemondt, Gijs, Nijhof, Marc W.
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container_end_page 5955
container_issue 9
container_start_page 5945
container_title Archives of orthopaedic and trauma surgery
container_volume 143
creator Innocenti, Matteo
Smulders, Katrijn
Andreotti, Mattia
Willems, Jore H.
Van Hellemondt, Gijs
Nijhof, Marc W.
description Introduction Low-grade femoral defects in revision total hip arthroplasty (rTHA) might be preferably treated with a primary implant. Almost no previous study reported the use of standard-length conical tapered (SLCT) stems in these cases. We analyzed a series of cases using a SLCT stem in rTHA with Paprosky type I–II femoral defects. The purpose of the study was to determine clinical and radiographic outcomes in this series of rTHA. Materials and methods We prospectively followed 87 patients undergoing a femoral component rTHA: 53 Paprosky type I and 34 type II femoral defects. Patient-reported measures (Oxford Hip Score, EQ-5D, VAS pain during rest and activity) were administered at baseline, 1 and 2 years post-operatively. Radiographic subsidence overtime was scored. Kaplan–Meier curves were used to evaluate the subsidence over time, the complication-free survival, and the implant survivorship with reoperation and stem revision as endpoints. Results The mean follow-up was 72.5 (SD ± 23.9) months. All PROMs significatively improved over time. The average subsidence was 2.8 (SD ± 3.2), 3.6 (SD ± 4.4), and 4.0 (SD ± 4.9) mm at 4, 12, and 24 months respectively. 6 stems had subsidence > 10 mm. The survival without complication was 0.85 (95% CI 0.94–0.77), while the implant survival without reoperation was 0.83 (95% CI 0.95–0.72). The overall stem survival rate was 93.7% (95% CI 0.91–0.97) at 2 years. Conclusion The use of a SLCT stem in rTHA with Paprosky type I–II femoral defects demonstrated good survival with low subsidence rates during the first 2 years after surgery. Surgeons should consider the use of this primary prosthesis as a potential treatment during stem revision in cases with limited femoral bone loss.
doi_str_mv 10.1007/s00402-023-04797-y
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Almost no previous study reported the use of standard-length conical tapered (SLCT) stems in these cases. We analyzed a series of cases using a SLCT stem in rTHA with Paprosky type I–II femoral defects. The purpose of the study was to determine clinical and radiographic outcomes in this series of rTHA. Materials and methods We prospectively followed 87 patients undergoing a femoral component rTHA: 53 Paprosky type I and 34 type II femoral defects. Patient-reported measures (Oxford Hip Score, EQ-5D, VAS pain during rest and activity) were administered at baseline, 1 and 2 years post-operatively. Radiographic subsidence overtime was scored. Kaplan–Meier curves were used to evaluate the subsidence over time, the complication-free survival, and the implant survivorship with reoperation and stem revision as endpoints. Results The mean follow-up was 72.5 (SD ± 23.9) months. All PROMs significatively improved over time. The average subsidence was 2.8 (SD ± 3.2), 3.6 (SD ± 4.4), and 4.0 (SD ± 4.9) mm at 4, 12, and 24 months respectively. 6 stems had subsidence &gt; 10 mm. The survival without complication was 0.85 (95% CI 0.94–0.77), while the implant survival without reoperation was 0.83 (95% CI 0.95–0.72). The overall stem survival rate was 93.7% (95% CI 0.91–0.97) at 2 years. Conclusion The use of a SLCT stem in rTHA with Paprosky type I–II femoral defects demonstrated good survival with low subsidence rates during the first 2 years after surgery. Surgeons should consider the use of this primary prosthesis as a potential treatment during stem revision in cases with limited femoral bone loss.</description><identifier>ISSN: 1434-3916</identifier><identifier>ISSN: 0936-8051</identifier><identifier>EISSN: 1434-3916</identifier><identifier>DOI: 10.1007/s00402-023-04797-y</identifier><identifier>PMID: 36806987</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Hip Arthroplasty ; Joint surgery ; Medicine ; Medicine &amp; Public Health ; Orthopedics</subject><ispartof>Archives of orthopaedic and trauma surgery, 2023-09, Vol.143 (9), p.5945-5955</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-9d221c02a6efcf05553b96e10744156fcedc56b6312613f6992329242a094ad63</citedby><cites>FETCH-LOGICAL-c475t-9d221c02a6efcf05553b96e10744156fcedc56b6312613f6992329242a094ad63</cites><orcidid>0000-0001-9604-2042</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00402-023-04797-y$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00402-023-04797-y$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36806987$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Innocenti, Matteo</creatorcontrib><creatorcontrib>Smulders, Katrijn</creatorcontrib><creatorcontrib>Andreotti, Mattia</creatorcontrib><creatorcontrib>Willems, Jore H.</creatorcontrib><creatorcontrib>Van Hellemondt, Gijs</creatorcontrib><creatorcontrib>Nijhof, Marc W.</creatorcontrib><title>The use of a standard-length conical tapered stem in hip revision arthroplasty to address Paprosky type I–II femoral defects: a prospective study of 87 patients</title><title>Archives of orthopaedic and trauma surgery</title><addtitle>Arch Orthop Trauma Surg</addtitle><addtitle>Arch Orthop Trauma Surg</addtitle><description>Introduction Low-grade femoral defects in revision total hip arthroplasty (rTHA) might be preferably treated with a primary implant. Almost no previous study reported the use of standard-length conical tapered (SLCT) stems in these cases. We analyzed a series of cases using a SLCT stem in rTHA with Paprosky type I–II femoral defects. The purpose of the study was to determine clinical and radiographic outcomes in this series of rTHA. Materials and methods We prospectively followed 87 patients undergoing a femoral component rTHA: 53 Paprosky type I and 34 type II femoral defects. Patient-reported measures (Oxford Hip Score, EQ-5D, VAS pain during rest and activity) were administered at baseline, 1 and 2 years post-operatively. Radiographic subsidence overtime was scored. Kaplan–Meier curves were used to evaluate the subsidence over time, the complication-free survival, and the implant survivorship with reoperation and stem revision as endpoints. Results The mean follow-up was 72.5 (SD ± 23.9) months. All PROMs significatively improved over time. The average subsidence was 2.8 (SD ± 3.2), 3.6 (SD ± 4.4), and 4.0 (SD ± 4.9) mm at 4, 12, and 24 months respectively. 6 stems had subsidence &gt; 10 mm. The survival without complication was 0.85 (95% CI 0.94–0.77), while the implant survival without reoperation was 0.83 (95% CI 0.95–0.72). The overall stem survival rate was 93.7% (95% CI 0.91–0.97) at 2 years. Conclusion The use of a SLCT stem in rTHA with Paprosky type I–II femoral defects demonstrated good survival with low subsidence rates during the first 2 years after surgery. Surgeons should consider the use of this primary prosthesis as a potential treatment during stem revision in cases with limited femoral bone loss.</description><subject>Hip Arthroplasty</subject><subject>Joint surgery</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Orthopedics</subject><issn>1434-3916</issn><issn>0936-8051</issn><issn>1434-3916</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9UkuO1DAUjBCIGQYuwAJZYsMm4F_smA1CIz4tjQSLYW257ZeOhyQOttNSdtyBG3A0ToKbHoaBBSt_ql7Ve3ZV1WOCnxOM5YuEMce0xpTVmEsl6_VOdUo44zVTRNy9tT-pHqR0hTGhrcL3qxMmWixUK0-r75c9oCUBCh0yKGUzORNdPcC0yz2yYfLWDCibGSK4gsOI_IR6P6MIe598mJCJuY9hHkzKK8oBGecipIQ-mjmG9LncrTOgzY-v3zYb1MEYYlF00IHN6WUxPbDmcvB7KAaLWw-9tBLNJnuYcnpY3evMkODR9XpWfXr75vL8fX3x4d3m_PVFbblscq0cpcRiagR0tsNN07CtEkCw5Jw0orPgbCO2ghEqCOuEUpRRRTk1WHHjBDurXh1152U7FnLxLp3qOfrRxFUH4_XfyOR7vQt7TTDnSkheFJ5dK8TwZYGU9eiThWEwE4QlaSplq6RilBbq03-oV2GJU5lP07YRggtODoL0yLLljVKE7qYbgvUhA_qYAV0yoH9lQK-l6MntOW5Kfn96IbAjIRVo2kH84_0f2Z-98cB_</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Innocenti, Matteo</creator><creator>Smulders, Katrijn</creator><creator>Andreotti, Mattia</creator><creator>Willems, Jore H.</creator><creator>Van Hellemondt, Gijs</creator><creator>Nijhof, Marc W.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-9604-2042</orcidid></search><sort><creationdate>20230901</creationdate><title>The use of a standard-length conical tapered stem in hip revision arthroplasty to address Paprosky type I–II femoral defects: a prospective study of 87 patients</title><author>Innocenti, Matteo ; 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Almost no previous study reported the use of standard-length conical tapered (SLCT) stems in these cases. We analyzed a series of cases using a SLCT stem in rTHA with Paprosky type I–II femoral defects. The purpose of the study was to determine clinical and radiographic outcomes in this series of rTHA. Materials and methods We prospectively followed 87 patients undergoing a femoral component rTHA: 53 Paprosky type I and 34 type II femoral defects. Patient-reported measures (Oxford Hip Score, EQ-5D, VAS pain during rest and activity) were administered at baseline, 1 and 2 years post-operatively. Radiographic subsidence overtime was scored. Kaplan–Meier curves were used to evaluate the subsidence over time, the complication-free survival, and the implant survivorship with reoperation and stem revision as endpoints. Results The mean follow-up was 72.5 (SD ± 23.9) months. All PROMs significatively improved over time. The average subsidence was 2.8 (SD ± 3.2), 3.6 (SD ± 4.4), and 4.0 (SD ± 4.9) mm at 4, 12, and 24 months respectively. 6 stems had subsidence &gt; 10 mm. The survival without complication was 0.85 (95% CI 0.94–0.77), while the implant survival without reoperation was 0.83 (95% CI 0.95–0.72). The overall stem survival rate was 93.7% (95% CI 0.91–0.97) at 2 years. Conclusion The use of a SLCT stem in rTHA with Paprosky type I–II femoral defects demonstrated good survival with low subsidence rates during the first 2 years after surgery. Surgeons should consider the use of this primary prosthesis as a potential treatment during stem revision in cases with limited femoral bone loss.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>36806987</pmid><doi>10.1007/s00402-023-04797-y</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-9604-2042</orcidid><oa>free_for_read</oa></addata></record>
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subjects Hip Arthroplasty
Joint surgery
Medicine
Medicine & Public Health
Orthopedics
title The use of a standard-length conical tapered stem in hip revision arthroplasty to address Paprosky type I–II femoral defects: a prospective study of 87 patients
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