Karl Philipp Kutzner1, Emanuel Ried2, Stefanie Donner3, Ralf Bieger4, Joachim Pfeil5, Tobias Freitag6. 1. Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20. 65189 Wiesbaden, Germany. Electronic address: kkutzner@joho.de. 2. Division of Trauma Surgery, University Hospital Zürich (USZ), University of Zürich, Rämistr. 100. 8091 Zürich, Switzerland. Electronic address: Emanuel.Ried@usz.ch. 3. Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20. 65189 Wiesbaden, Germany. Electronic address: sdonner@joho.de. 4. Department of Orthopaedic Surgery, University of Ulm (RKU), Oberer Eselsberg 45, 89081, Ulm, Germany. Electronic address: Ralf.Bieger@rku.de. 5. Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20. 65189 Wiesbaden, Germany. Electronic address: jpfeil@joho.de. 6. Department of Orthopaedic Surgery, University of Ulm (RKU), Oberer Eselsberg 45, 89081, Ulm, Germany. Electronic address: Tobias.Freitag@rku.de.
Abstract
BACKGROUND: Short-term results of several short-stem designs have indicated early axial migration. Mid- and long-term results for most designs are lacking. The objective of this study was to evaluate the mid-term migration pattern of a calcar-guided short stem five years postoperative. METHODS: Implant migration of 191 calcar-guided short stems was assessed by Ein-Bild-Roentgen-Analysis Femoral-Component- Analysis (EBRA-FCA) 5 years after surgery. Migration pattern of the whole group was analyzed and compared to the migration pattern of implants potentially being "at hazard" with a subsidence of more than 1.5 mm at 2 years postoperatively. Influence of preoperative Dorr types (A vs. B vs. C), age (<70 vs. >70 years), gender (female vs. male), weight (<90 kg vs. >90 kg), BMI (<30 vs. >30) and uni-vs. bilateral procedures on mid-term migration pattern was analyzed. Additionally outcome of varus- and valgus stem alignment was assessed. RESULTS: Mean axial subsidence was 1.5 mm (SD 1.48 mm) at final follow-up. Two years after surgery 73 short stems were classified "at hazard". Of these stems, 69 cases showed secondary stabilisation in the following period, whereas 4 cases presented unstable with more than 1 mm of further subsidence. Stem revision was not required neither in the group of implants with early stabilisation nor the group with pronounced early onset migration. Male gender and heavy-weight patients had a significant higher risk for axial migration, as well as extensive valgus stem alignment, whereas for Dorr type B, compared to A, no statistical difference could be observed. CONCLUSIONS: In most cases, even in the group of stems being "at hazard", settling could be documented. While different Dorr types did not show a statistically significant impact on axial migration, particularly in male and heavy-weight patients the risk of continuous subsidence is increased. In those 4 cases with further migration, undersizing of the stem could be recognized. At present, clinical consequences are still uncertain.
BACKGROUND: Short-term results of several short-stem designs have indicated early axial migration. Mid- and long-term results for most designs are lacking. The objective of this study was to evaluate the mid-term migration pattern of a calcar-guided short stem five years postoperative. METHODS: Implant migration of 191 calcar-guided short stems was assessed by Ein-Bild-Roentgen-Analysis Femoral-Component- Analysis (EBRA-FCA) 5 years after surgery. Migration pattern of the whole group was analyzed and compared to the migration pattern of implants potentially being "at hazard" with a subsidence of more than 1.5 mm at 2 years postoperatively. Influence of preoperative Dorr types (A vs. B vs. C), age (<70 vs. >70 years), gender (female vs. male), weight (<90 kg vs. >90 kg), BMI (<30 vs. >30) and uni-vs. bilateral procedures on mid-term migration pattern was analyzed. Additionally outcome of varus- and valgus stem alignment was assessed. RESULTS: Mean axial subsidence was 1.5 mm (SD 1.48 mm) at final follow-up. Two years after surgery 73 short stems were classified "at hazard". Of these stems, 69 cases showed secondary stabilisation in the following period, whereas 4 cases presented unstable with more than 1 mm of further subsidence. Stem revision was not required neither in the group of implants with early stabilisation nor the group with pronounced early onset migration. Male gender and heavy-weight patients had a significant higher risk for axial migration, as well as extensive valgus stem alignment, whereas for Dorr type B, compared to A, no statistical difference could be observed. CONCLUSIONS: In most cases, even in the group of stems being "at hazard", settling could be documented. While different Dorr types did not show a statistically significant impact on axial migration, particularly in male and heavy-weight patients the risk of continuous subsidence is increased. In those 4 cases with further migration, undersizing of the stem could be recognized. At present, clinical consequences are still uncertain.
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