A Long-term Comparative Study Between Two Different Designs of Cemented Stems: Distal-cylindrical Versus Distal-taper

Overview

Journal J Orthop

Specialty Orthopedics

Date 2018 Apr 17

PMID 29657466

Citations 1

Authors

Yuki Okutani

Koji Goto

Tomotoshi Kawata

Yaichiro Okuzu

Kazutaka So

Yutaka Kuroda

Shuichi Matsuda

Affiliations

Soon will be listed here.

Abstract

Introduction: The aim of this study was to calculate the wear rate of highly cross-linked polyethylene (HXLPE) and investigate long-term clinical and radiographic outcomes related to two femoral stem designs, the distal-cylindrical (DC) and distal-taper (DT) stems.

Materials And Methods: Outcomes for the DC and DT stems were evaluated in 110 patients, who underwent total hip arthroplasty using an HXLPE socket, over a 5-year follow-up period. There were 56 hips (53 patients) in the DC group and 60 hips (57 patients) in the DT group. Clinical outcomes were measured using the Japanese Orthopaedic Association (JOA) score and radiographic changes. Polyethylene wear rate was calculated using a computer software.

Results: The mean follow-up period was 135.7 and 124.0 months for the DC and DT groups, respectively. Both stem designs improved hip function. On radiographic assessment, osteolysis around the tip of the stem was more frequent in the DC than in the DT group. Three cases of aseptic loosening of the stem were identified in the DC group, and no cases were identified in the DT group. The 10-year stem survival, using aseptic loosening as the primary endpoint, was 94.1% and 100% for the DC and DT groups, respectively (p = 0.06). The polyethylene wear rate was comparable for both stem groups.

Conclusion: Better clinical outcomes were obtained with the DT stem than with the DC stem regardless of the equivalent polyethylene wear rate for the two designs. The DC shape of the stem may increase the risk of aseptic loosening.

Citing Articles

The superior accuracy of a novel method in total hip wear calculations following radiographic measurement.

So K, Goto K, Kawaguchi A, Kuroda Y, Matsuda S BMC Musculoskelet Disord. 2022; 23(1):130.

PMID: 35139851 PMC: 8826684. DOI: 10.1186/s12891-021-04964-5.

References

Barrack R, Mulroy Jr R, Harris W . Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review. J Bone Joint Surg Br. 1992; 74(3):385-9. DOI: 10.1302/0301-620X.74B3.1587883. View

Williams H, Browne G, Gie G, Ling R, Timperley A, Wendover N . The Exeter universal cemented femoral component at 8 to 12 years. A study of the first 325 hips. J Bone Joint Surg Br. 2002; 84(3):324-34. DOI: 10.1302/0301-620x.84b3.12261. View

Ise K, Kawanabe K, Tamura J, Akiyama H, Goto K, Nakamura T . Clinical results of the wear performance of cross-linked polyethylene in total hip arthroplasty: prospective randomized trial. J Arthroplasty. 2009; 24(8):1216-20. DOI: 10.1016/j.arth.2009.05.020. View

Gruen T, McNeice G, Amstutz H . "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979; (141):17-27. View

Akiyama H, Kawanabe K, Yamamoto K, So K, Kuroda Y, Nakamura T . Clinical outcomes of cemented double-tapered titanium femoral stems: a minimum 5-year follow-up. J Orthop Sci. 2011; 16(6):689-97. DOI: 10.1007/s00776-011-0154-z. View

Langlais F, Kerboull M, Sedel L, Ling R . The 'French paradox.'. J Bone Joint Surg Br. 2003; 85(1):17-20. DOI: 10.1302/0301-620x.85b1.13948. View

Espehaug B, Furnes O, Havelin L, Engesaeter L, Vollset S . The type of cement and failure of total hip replacements. J Bone Joint Surg Br. 2002; 84(6):832-8. DOI: 10.1302/0301-620x.84b6.12776. View

Ritter M, Fechtman R . Distal cortical hypertrophy following total hip arthroplasty. J Arthroplasty. 1988; 3(2):117-21. DOI: 10.1016/s0883-5403(88)80076-7. View

Johanson P, Digas G, Herberts P, Thanner J, Karrholm J . Highly crosslinked polyethylene does not reduce aseptic loosening in cemented THA 10-year findings of a randomized study. Clin Orthop Relat Res. 2012; 470(11):3083-93. PMC: 3462851. DOI: 10.1007/s11999-012-2400-x. View

10.

Glyn-Jones S, Gill H, Beard D, McLardy-Smith P, Murray D . Influence of stem geometry on the stability of polished tapered cemented femoral stems. J Bone Joint Surg Br. 2005; 87(7):921-7. DOI: 10.1302/0301-620X.87B7.16079. View

11.

Malchau H, Herberts P, Eisler T, Garellick G, Soderman P . The Swedish Total Hip Replacement Register. J Bone Joint Surg Am. 2002; 84-A Suppl 2:2-20. DOI: 10.2106/00004623-200200002-00002. View

12.

Fukui K, Kaneuji A, Sugimori T, Ichiseki T, Kitamura K, Matsumoto T . Wear comparison between a highly cross-linked polyethylene and conventional polyethylene against a zirconia femoral head: minimum 5-year follow-up. J Arthroplasty. 2010; 26(1):45-9. DOI: 10.1016/j.arth.2009.11.005. View

13.

Harris W, McGann W . Loosening of the femoral component after use of the medullary-plug cementing technique. Follow-up note with a minimum five-year follow-up. J Bone Joint Surg Am. 1986; 68(7):1064-6. View

14.

Kawanabe K, Tanaka K, Tamura J, Shimizu M, Onishi E, Iida H . Effect of alumina femoral head on clinical results in cemented total hip arthroplasty: old versus current alumina. J Orthop Sci. 2005; 10(4):378-84. DOI: 10.1007/s00776-005-0911-y. View

15.

Kimura G, Onishi E, Kawanabe K, Kazutaka S, Tsukanaka M, Akiyama H . Characteristic loosening of the distally straight cylindrical femoral stem. J Orthop Sci. 2014; 19(3):437-42. DOI: 10.1007/s00776-014-0538-y. View