Preparation of the Femoral Bone Cavity for Cementless Stems: Broaching vs Compaction. A Five-Year Randomized Radiostereometric Analysis and Dual Energy X-Ray Absorption Study

被引:18
作者
Hjorth, Mette H. [1 ]
Kold, Soren [2 ]
Soballe, Kjeld [1 ]
Langdahl, Bente L. [3 ]
Nielsen, Poul T. [2 ]
Christensen, Poul H. [2 ]
Stilling, Maiken [1 ]
机构
[1] Aarhus Univ Hosp, Dept Orthopaed, THG, Aarhus, Denmark
[2] Aalborg Univ Hosp, Dept Orthopaed, Aalborg, Denmark
[3] Aarhus Univ Hosp, Dept Endocrinol & Internal Med, THG, Aarhus, Denmark
关键词
femoral bone preparation technique; cementless femoral stem; radiostereometric analyses; dual X-ray energy absorption; compaction; broaching; TOTAL HIP-ARTHROPLASTY; HYDROXYAPATITE-COATED IMPLANTS; CANINE GAP MODEL; ENHANCES FIXATION; FOLLOW-UP; CANCELLOUS BONE; FRACTURES; SURVIVAL; TITANIUM; REGISTER;
D O I
10.1016/j.arth.2016.12.029
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Short-term experimental and animal studies have confirmed superior fixation of cement-less implants inserted with compaction compared to broaching of the cancellous bone. Methods: Forty-four hips in 42 patients (19 men) were randomly operated using cementless hydroxyapatite-coated Bi-Metric stems. Patients were followed with radiostereometric analysis at baseline, 6 and 12 weeks, 1, 2, and 5 years, and measurements of periprosthetic bone mineral density at baseline, 1, 2, and 5 years. Complications during the study period and clinical outcome measures of Harris Hip Score were recorded at mean 7 years (5-8.8) after surgery. Results: Absolute migrations of medio/lateral translations between the broaching group and the compaction group of mean 0.14 mm (standard deviation [SD] 0.10) vs mean 0.30 mm (SD 0.27) (P = .01) at 1 year, and of mean 0.13 mm (SD 0.10) vs 0.34 mm (0.31) (P = .01) at 5 years were different. Absolute valgus/varus rotations of mean 0.12 degrees (SD 0.13 degrees) in the broaching group were less than mean 0.35 degrees (0.45 degrees) in the compaction group (P < .01) at 1 year, but at 5 years no difference was observed (P = .19). Subsidence and retroversion were similar between groups at all follow-ups (P > .13). The compaction group had significantly less bone loss than the broaching group in Gruen zone 3 (distal-lateral to the stem) at 1 and 5 years. No further differences in bone mineral density changes were found between groups up to 5 years after surgery. Complications throughout the period and clinical outcome measures of Harris Hip Score were similar at 7 years (5-8.8) after surgery. Conclusion: We found increased migration when preparing the bone with compaction compared with broaching in cementless femoral stems. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:1894 / 1901
页数:8
相关论文
共 43 条
[1]  
Altman D.G., 2009, PRACTICAL STAT MED R
[2]   Low BMD affects initial stability and delays stem osseointegration in cementless total hip arthroplasty in women A 2-year RSA study of 39 patients [J].
Aro, Hannu T. ;
Alm, Jessica J. ;
Moritz, Niko ;
Makinen, Tatu J. ;
Lankinen, Petteri .
ACTA ORTHOPAEDICA, 2012, 83 (02) :107-114
[3]   Total hip arthroplasty with an uncemented hydroxyapatite-coated tapered titanium stem:: results at a minimum of 10 years' follow-up in 104 hips [J].
Bodén, H ;
Salemyr, M ;
Sköldenberg, O ;
Ahl, T ;
Adolphson, P .
JOURNAL OF ORTHOPAEDIC SCIENCE, 2006, 11 (02) :175-179
[4]   Unstable versus stable uncemented femoral stems:: a radiological study of periprosthetic bone changes in two types of uncemented stems with different concepts of fixation [J].
Bodén, H ;
Adolphson, P ;
Öberg, M .
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, 2004, 124 (06) :382-392
[5]   Fractures of the greater trochanter following total hip replacement [J].
Brun, Ole-Christian L. ;
Maansson, Lukas .
HIP INTERNATIONAL, 2013, 23 (02) :143-146
[6]   How many patients? How many limbs? Analysis of patients or limbs in the orthopaedic literature: Asystematic review [J].
Bryant, D ;
Havey, TC ;
Roberts, R ;
Guyatt, G .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2006, 88A (01) :41-45
[7]   Use of bone compaction in total knee arthroplasty [J].
Channer, MA ;
Glisson, RR ;
Seaber, AV ;
Vail, TP .
JOURNAL OF ARTHROPLASTY, 1996, 11 (06) :743-749
[8]  
Chareancholvanich K, 2002, CLIN ORTHOP RELAT R, P290
[9]   The predictive value of radiostereometric analysis for stem survival in total hip arthroplasty. A systematic review [J].
de Vries, Lieke M. A. ;
van der Weegen, Walter ;
Pilot, Peter ;
Stolarczyk, Piotr A. ;
Sijbesma, Thea ;
Hoffman, Erik L. .
HIP INTERNATIONAL, 2014, 24 (03) :215-222
[10]   Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register - 4661 primary replacements followed for 0-22 years [J].
Eskelinen, A ;
Remes, V ;
Helenius, I ;
Pulkkinen, P ;
Nevalainen, J ;
Paavolainen, P .
ACTA ORTHOPAEDICA, 2005, 76 (01) :28-41