Wayne T Hoskins1, Roger J Bingham2, Michelle Lorimer3, Richard N de Steiger4. 1. Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Traumaplasty.Melbourne, East Melbourne, Victoria, Australia. 2. Traumaplasty.Melbourne, East Melbourne, Victoria, Australia; Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Victoria, Australia. 3. Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia. 4. Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia; Department of Surgery, Epworth Healthcare, The University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: The cementless Corail is one of the most commonly used stems in total hip arthroplasty (THA). The aim of this study was to investigate whether there was a difference in revision rate for smaller stems. METHODS: All primary THA procedures recorded by the Australian Joint Replacement Registry from September 1999 to December 2017 performed for osteoarthritis using the Corail stem, a cementless acetabular cup, modern bearing surfaces (ceramic/ceramic, ceramic/cross-linked polyethylene, and metal/cross-linked polyethylene), and 28 mm, 32 mm, and 36 mm head sizes were included. The primary outcome measure was femoral component revision. Data were analyzed and adjusted for age, gender, and head size. Further analysis investigated the effects of surgical approach. RESULTS: There was 41,265 primary THAs recorded. The cumulative percent revision (CPR) at 13 years was 7.7% (5.5, 10.7) for stem sizes 8 and 9 and 3.0% (2.4, 3.8) for sizes 10-20 (P < .001). When adjusted for age and gender, the sizes 8 and 9 collared (hazard ratio [HR]: 6.22 [3.84-10.06], P < .001) and collarless (HR: 3.28 [2.41-4.45], P < .001) had a higher CPR than the collared and collarless size 10-20. The size 8 and 9 stems performed with an anterior approach had the highest CPR (HR: 14.44 [6.21-33.56], P < .001). The main reason for revision of size 8 and 9 femoral stems was loosening (65.2%, compared to 31.5% for 10-20 femoral stems). CONCLUSIONS: Smaller Corail stems have 4 times the rate of revision compared with the larger femoral sizes with loosening being the most common diagnosis. This is most evident when using an anterior approach.
BACKGROUND: The cementless Corail is one of the most commonly used stems in total hip arthroplasty (THA). The aim of this study was to investigate whether there was a difference in revision rate for smaller stems. METHODS: All primary THA procedures recorded by the Australian Joint Replacement Registry from September 1999 to December 2017 performed for osteoarthritis using the Corail stem, a cementless acetabular cup, modern bearing surfaces (ceramic/ceramic, ceramic/cross-linked polyethylene, and metal/cross-linked polyethylene), and 28 mm, 32 mm, and 36 mm head sizes were included. The primary outcome measure was femoral component revision. Data were analyzed and adjusted for age, gender, and head size. Further analysis investigated the effects of surgical approach. RESULTS: There was 41,265 primary THAs recorded. The cumulative percent revision (CPR) at 13 years was 7.7% (5.5, 10.7) for stem sizes 8 and 9 and 3.0% (2.4, 3.8) for sizes 10-20 (P < .001). When adjusted for age and gender, the sizes 8 and 9 collared (hazard ratio [HR]: 6.22 [3.84-10.06], P < .001) and collarless (HR: 3.28 [2.41-4.45], P < .001) had a higher CPR than the collared and collarless size 10-20. The size 8 and 9 stems performed with an anterior approach had the highest CPR (HR: 14.44 [6.21-33.56], P < .001). The main reason for revision of size 8 and 9 femoral stems was loosening (65.2%, compared to 31.5% for 10-20 femoral stems). CONCLUSIONS: Smaller Corail stems have 4 times the rate of revision compared with the larger femoral sizes with loosening being the most common diagnosis. This is most evident when using an anterior approach.
Authors: Wayne Hoskins; Sophia Rainbird; Michelle Lorimer; Stephen E Graves; Roger Bingham Journal: Clin Orthop Relat Res Date: 2022-03-01 Impact factor: 4.755
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