Clin Orthop Surg.  2017 Sep;9(3):255-262. 10.4055/cios.2017.9.3.255.

Porous Femoral Fixation in Total Hip Arthroplasty with Short Anatomical Stem: Radiographic Evaluation

• Patil S
• Luis C
• Finn H

• KMID: 2412260
• DOI: http://doi.org/10.4055/cios.2017.9.3.255

Abstract

BACKGROUND
Hip prostheses with short anatomical stems were designed for metaphyseal fixation and to spare bone stock. We present a study of a short anatomical femoral stem used in all age groups of patients with Dorr A and B type of femora.
METHODS
We reviewed radiographs of 85 hips in 74 patients who had a cementless total hip arthroplasty with a short anatomical 80 mm femoral stem designed to achieve pure metaphyseal fixation. A ream-only technique was used for femoral canal preparation in all patients. At each follow-up, radiological evaluation was performed for stem alignment, proximal metaphyseal fill, subsidence, status of biological fixation of the femoral stem, heterotrophic ossification, radiolucency, osteolysis, and limb length discrepancy of the stem. Acetabular components were evaluated for positioning, acetabular bone coverage, and radiolucent and osteolytic lesions.
RESULTS
The final mean alignment of femoral stem was 2° valgus. The average intramedullary fill by the stem at the proximal level of the lesser trochanter was 93% in the coronal plane and 88% in the sagittal plane. No components were considered to be undersized. Thirteen hips (15.2%) presented radiolucent lines (10 hips < 1 mm in width and 3 hips [3.5%] 2 mm in width) and 100% of them were not progressive with respect to the last follow-up radiograph. All of the stems had excellent fixation by demonstrating bone ingrowth at the latest follow-up. At the last follow-up, heterotopic ossification was noted in 5 hips. The mean preoperative limb length discrepancy was 9.3 mm and the mean postoperative discrepancy was 3.8 mm. The mean acetabular component angle of the 85 components was 41.2° with a mean anteversion of 22.1°. At the last follow-up, there were no revisions of the femoral component. One patient, 25 months after the index operation, required an acetabular component revision because of recurrent hip dislocation. There were no radiological signs of loosening in any of the short-stem prostheses at the last examination.
CONCLUSIONS
The short, metaphyseal-fitting anatomic cementless femoral stem provided stable fixation without relying on diaphyseal fixation.

Keyword

Arthroplasty; Replacement; Hip

MeSH Terms

Acetabulum/diagnostic imaging
Adult
Aged
Arthroplasty, Replacement, Hip/*methods
Female
Femur/diagnostic imaging/*pathology
Hip Joint/*diagnostic imaging
*Hip Prosthesis
Humans
Male
Middle Aged
Radiography
Treatment Outcome

Figure

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  Fig. 1 Sagittal (A) and coronal (B) views of a cementless Balance Microplasty Stem (Biomet) that has a modified 3-degree bi-planar taper geometry. The proximal 80% portion of the stem is circumferentially coated with porous plasma spray.

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  Fig. 2 Schematic of a ream-only technique. (A) Removal of the calcar metaphyseal cancellous bone using a 3-degree conical reamer. (B) Removal of the cancellous bone in the greater trochanter, avoiding varus positioning of the femoral component.

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  Fig. 3 Preoperative and postoperative radiographs of the right hip of a female who was 65 years old at the time of the right primary total hip replacement. (A and B) Preoperative anteroposterior and lateral radiographs demonstrating osteoarthritis of the hip with partial loss of the joint space and formation of osteophytes. (C and D) Anteroposterior and lateral radiographs at 2 years after total hip replacement with use of a cementless hip Balance Microplasty Stem (Biomet) and a M2A-Magnum (Biomet) metal-on-metal acetabular component. Note the excellent osseointegration and absence of radiolucent lines at the implant-bone interface.

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  Fig. 4 Gruen's zones. Zones 1 and 2 were divided by a line through 50% of the lateral porous-coated area of the stem. Zones 6 and 7 represented the same areas on the medial side. Zones 3, 4, and 5 included the lateral smooth portion, the distal smooth portion, and the medial smooth portion of the stem, respectively.

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