J Korean Orthop Assoc.  2017 Oct;52(5):419-427. 10.4055/jkoa.2017.52.5.419.

Cementless Total Hip Arthroplasty Using Dual Offset Titanium Tapered Stem: At Least 7-Year Follow-Up

• Lee KH
• Lee KH
• Noh J
• Kho SJ

• KMID: 2393514
• DOI: http://doi.org/10.4055/jkoa.2017.52.5.419

Abstract

PURPOSE
The purpose of current study is to evaluate the midterm results of cementless primary total hip arthroplasty (THA) using a dual offset titanium tapered stem.
MATERIALS AND METHODS
A retrospective analysis of 102 cases (84 patients), with a minimum of 7-year clinical follow-up, was performed. All of the cases consisted of patients who underwent primary cementless THA, using a dual offset titanium tapered stem in The Catholic University of Korea, Bucheon St. Mary's Hospital between July 2004 and May 2009. Clinical results were analyzed via the Harris hip score, level of thigh pain, squeaking around hip joint, and complication rate. Radiologic results were examined with stability and location of inserted prosthesis, hypertrophy of femoral cortex, and osteolysis.
RESULTS
Out of the 102 cases (84 patients; 47 males and 37 females), with the mean age of 55.9 years (range, 27-79 years) and mean follow-up period of 99.2 months (range, 84-132 months). The mean Harris hip score was 53.8 preoperatively (range, 26-75) and improved to 93.5 postoperatively (range, 74-100) (p=0.000). All of the cases gained stable bony fixation on the final follow-up, including 2 cases of intra-operative proximal femur fracture. Calcar remodeling was observed in 94 cases, however, they were irrelevant with stem stability. Cortical hypertrophy of femur was seen in 12 cases and thigh pain in 4 cases; nonetheless, they were not relevant (p=0.067). There was 1 case of squeaking sound during joint movement. Hip dislocation occurred in 1 case early after the procedure, but the event was due to excessive anteversion of the acetabular cup, in which a revisional replacement procedure of the acetabular cup was conducted. No sign of ceramic breakage was observed. There were 2 cases of heterotrophic ossification.
CONCLUSION
Results from a 7-year follow-up of cementless THA using dual offset titanium tapered stem were encouraging in both clinical and radiologic evaluations.

Keyword

total hip arthroplasty; cementless; dual offset; titanium tapered stem

MeSH Terms

Acetabulum
Arthroplasty, Replacement, Hip*
Ceramics
Femur
Follow-Up Studies*
Gyeonggi-do
Hip
Hip Dislocation
Hip Joint
Humans
Hypertrophy
Joints
Korea
Male
Osteolysis
Prostheses and Implants
Retrospective Studies
Thigh
Titanium*
Titanium

Figure

• 

  Figure 1 Heterotrophic ossification occurred during the follow-up period after intraoperative periprosthetic fracture from a total hip replacement arthroplasty procedure with proximal femoral stem. (A) Neglected intraoperative periprosthetic fracture (Vancouver type A3) was observed (white arrowheads) on the radiograph taken 1 day after the surgical operation. (B) Circlage wiring fixation was performed 3 days after the surgery. (C) Femoral stem looks stable yet with heterotrophic ossification (black arrowhead) of Brook classification21) grade 2, 12 years after the surgery.

• 

  Figure 2 Anterior hip dislocation occurred 3 days after the surgery. (A) Radiograph taken immediately after the surgery was observed with 50 degrees of the inclinication angle and 42 degrees of the acetabular cup anteversion. (B) Anterior hip dislocation was seen 1 day after the surgery. (C) Revisional replacement of acetabular cup was done 3 days after the primary procedures, and the inclination angle was decreased to 40 degrees and the anteversion angle was decreased to 25 degrees.

• 

  Figure 3 Example of stable bony fixation. (A) Simple anteroposterior and lateral radiographs of the hip joint. (B) Anteroposterior and lateral radiographs of the hip joint taken 10 years after the surgery; calcar remodeling (white arrowhead) was observed.

• 

  Figure 4 Cortical hypertrophy around the stem proximal area. (A) Simple anteroposterior and lateral radiographs of the hip joint taken immediately after the surgery. (B) Anteroposterior and lateral radiographs of the hip joint taken 9 years after the surgery; Zones 5 and 10 were classified by Gruen et al.17) showed cortical hypertrophy (white arrowheads).

• 

  Figure 5 Kaplan-Meier survivorship curve with accompanying 95% confidence intervals for the endpoint of survivorship for any revision or additional fixation during primary surgery.

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