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  • 1
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    Online Resource
    An isoelastic monoblock cup versus a modular metal-back cup: a matched-pair analysis of clinical and radiological results using Einzel-Bild-Röntgen-Analyse software
    Springer Science and Business Media LLC ; 2023
    In:  Archives of Orthopaedic and Trauma Surgery
    Details
    In: Archives of Orthopaedic and Trauma Surgery, Springer Science and Business Media LLC
    Abstract: Bone preservation and long-term survival are the main challenges in cementless total hip arthroplasty (THA). A good bone stock is especially important for adequate anchorage of the cup in revision cases. However, the optimal acetabular cup design for preserving good bone stock is still unclear. We aimed to compare clinical outcome, radiological alterations, migration, and wear at mid-term for two different cup types. Materials and methods This retrospective matched-pair study was performed using the data for 98 THA cases treated with a monoblock cup composed of vitamin E-blended highly cross-linked polyethylene (VEPE; monoblock group) or a modular cup composed of a highly cross-linked polyethylene (HXLPE) without an antioxidant (modular group). Clinical results were evaluated using the Harris Hip Score (HHS). The obtained radiographs were analyzed for radiological alterations, migration, and wear using Einzel-Bild-Röntgen-Analyse (EBRA) software. Results The mean follow-up duration was 73.2 ± 19.2 months (range: 32–108 months) and 60.5 ± 12.2 months (range: 20–84 months) in the monoblock and modular groups, respectively. HHS improved to 95.7 points in the monoblock group and 97.6 points in the modular group, without significant differences ( p  = 0.425). EBRA measurements were obtained in all cases. Acetabular bone alterations were not detected on radiological assessments. Mean cup migration was 1.67 ± 0.92 mm (range: 0.46–3.94 mm) and 1.24 ± 0.87 mm (range: 0.22–3.62 mm) in the monoblock and modular groups. The mean wear rate was 0.21 ± 0.18 mm (range: 0.00–0.70 mm) and 0.20 ± 0.13 mm (range: 0.00–0.50 mm) in the monoblock and modular groups. Both migration and wear pattern showed no significant differences ( p  = 0.741 and 0.243). None of the cases required revision surgery, yielding an implant survival rate of 100% in both groups. Conclusion The isoelastic press-fit monoblock VEPE cup and modular metal-back HXLPE cup showed equivalent mid-term wear and cup migration. Long-term studies are required to determine the effects of modularity, isoelasticity, and polyethylene stabilization with vitamin E on cup loosening and survival rates.
    Type of Medium: Online Resource
    ISSN: 1434-3916
    URL: Article
    DOI: 10.1007/s00402-023-05058-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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  • 2
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    Return to Sports and Recreational Activity After Single-Stage Bilateral Short-Stem Total Hip Arthroplasty: 5-Year Results of a Prospective Observational Study
    SAGE Publications ; 2019
    In:  Orthopaedic Journal of Sports Medicine Vol. 7, No. 9 ( 2019-09-01), p. 232596711987274-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 7, No. 9 ( 2019-09-01), p. 232596711987274-
    Abstract: Single-stage bilateral total hip arthroplasty (THA) is an alternative to staged unilateral THA in patients suffering from bilateral hip arthritis; however, there is still broad concern regarding the safety and reliability of this procedure. Short-stem THA has emerged in recent years. To date, no data are available on sports and recreational activity levels after single-stage bilateral short-stem THA in the general patient population. Hypothesis: Patients who have undergone single-stage bilateral short-stem THA return to a satisfying level of sports and recreational activity at midterm follow-up. Study Design: Case series; Level of evidence, 4. Methods: A total of 54 consecutive patients (108 hips) were prospectively included. Midterm follow-up was performed in 51 patients (94.4%). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and the Harris Hip Score (HHS) were assessed clinically after a mean of 5.2 years. After a mean of 4.9 years, activity levels were assessed using the University of California, Los Angeles (UCLA) activity scale via a questionnaire. Additionally, a detailed evaluation of sports behavior was conducted using an additional questionnaire. Pain and satisfaction with sporting ability were assessed using a visual analog scale (VAS). Complications and revisions were documented. Results: Patients had a mean WOMAC score of 98.0 (range, 60.0-100.0) and HHS score of 97.8 (range, 65.0-100.0) at final follow-up. The mean UCLA activity score was 4.7 (range, 2.0-10.0). An increasing number of patients were active in sports at follow-up compared with before surgery (76.5% vs 60.8%, respectively); 2 patients (3.9%) stopped participating in sports on a regular basis, and 10 (19.6%) commenced with sports after surgery. The most popular activities before surgery were cycling (31.4%), hiking (29.4%), swimming (21.6%), and fitness/weight training (15.7%). At follow-up, most patients were engaged in cycling (35.3%) and fitness/weight training (33.3%), followed by swimming (25.5%) and hiking (19.6%). The duration (hours per week) and frequency (times per week) of sporting activities remained stable. The mean VAS pain level during sports was 1.3 (range, 0.0-7.0). No revision surgery had to be performed. Conclusion: After single-stage bilateral short-stem THA, the study patients returned to satisfying levels of activity at midterm follow-up. Postoperatively, few patients were engaged in high-impact sports; however, more patients commenced with lower impact activities. Satisfaction with sporting abilities was high, and the complication rate in total was low.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967119872746
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 3
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    Outcome of an “Enhanced Recovery” Program in Contemporary Total Hip Arthroplasty in Germany
    Georg Thieme Verlag KG ; 2020
    In:  Zeitschrift für Orthopädie und Unfallchirurgie Vol. 158, No. 02 ( 2020-04), p. 214-220
    Details
    In: Zeitschrift für Orthopädie und Unfallchirurgie, Georg Thieme Verlag KG, Vol. 158, No. 02 ( 2020-04), p. 214-220
    Abstract: Einleitung Ein stationärer Aufenthalt von bis zu 10 Tagen nach Implantation einer Hüfttotalendoprothese ist in Deutschland nach wie vor keine Seltenheit, zumeist gefolgt von einer stationären Rehabilitationsmaßnahme. International bereits weit verbreitete Konzepte zur raschen Genesung („Enhanced Recovery“) gewinnen auch hierzulande zunehmend an Popularität. Das Ziel der Studie war die Darstellung der Inhalte eines neu eingeführten Enhanced-Recovery-Konzeptes in der modernen Hüftendoprothetik und die Untersuchung der Ergebnisse über einen Zeitraum von 6 Monaten. Material und Methoden In dieser monozentrischen, prospektiven Beobachtungsstudie eines konsekutiven Patientenkollektivs eines einzelnen Operateurs wurden zwischen Januar 2016 und Juli 2016 103 Hüft-TEP-Patienten eingeschlossen und mittels eines neu eingeführten ganzheitlichen Enhanced-Recovery-Konzeptes behandelt. Nach 6 Wochen und 6 Monaten erfolgte eine klinische Untersuchung hinsichtlich der Funktion, des Schmerzes, der Zufriedenheit sowie möglicher Komplikationen. Ergebnisse Das Ziel einer Entlassung am 4. postoperativen Tag konnte bei 61,2% der Patienten erreicht werden bei einer mittleren postoperativen stationären Verweildauer von 4,9 Tagen. Nach 6 Wochen bzw. 6 Monaten zeigten sich hervorragende klinische Ergebnisse mit einer hohen Patientenzufriedenheit. Die Komplikationsquote stellte sich gering dar. Es zeigte sich im Mittel ein Abfall der Hämoglobinkonzentration um 2,1 g/dl. Eine Fissur des Femurschaftes unterhalb des Implantates konnte konservativ durch Entlastung für insgesamt 6 Wochen zur Ausheilung gebracht werden. Eine in der Rehabilitation aufgetretene Lungenembolie konnte ebenfalls erfolgreich ausbehandelt werden. Nach 6 Monaten zeigte sich in einem Fall eine Bursitis trochanterica. Diskussion Die stationäre Aufenthaltsdauer kann durch ganzheitliche Enhanced-Recovery-Konzepte gesenkt werden, ohne gleichzeitig die Risiken für Patienten zu erhöhen. In Deutschland werden solche Konzepte zunehmend eine breite Anwendung finden.
    Type of Medium: Online Resource
    ISSN: 1864-6697 , 1864-6743
    URL: Article
    DOI: 10.1055/a-0946-2523
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
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    detail.hit.zdb_id: 2304338-6
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  • 4
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    Zementfreie Kurzschaftprothesen in der Hüftendoprothetik: Möglichkeiten und Limits
    Georg Thieme Verlag KG ; 2023
    In:  Zeitschrift für Orthopädie und Unfallchirurgie Vol. 161, No. 04 ( 2023-08), p. 396-404
    Details
    In: Zeitschrift für Orthopädie und Unfallchirurgie, Georg Thieme Verlag KG, Vol. 161, No. 04 ( 2023-08), p. 396-404
    Abstract: In recent decades, a large number of cementless short stems have been introduced to the market. The concept aims at saving soft tissue using minimally invasive surgery and at the same time preserving as much bone as possible. In particular, the latest generation of short stems, which are implanted using a calcar-guided round-the-corner technique, are attracting increasing attention. An individualised resection level allows individual stem alignment and thus an ideal reconstruction of the hip anatomy. The early clinical results of short-stem total hip arthroplasty (THA) are promising and have led to an expansion of the indications and limitations for the use of short stems. In particular, the individual positioning in valgus or varus and the resulting individual metaphyseal or metadiaphyseal anchorage offers various possibilities to reconstruct even abnormal joint morphologies. Consequently, short stems are increasingly used in patients with complex anatomical variations or in cases of osteonecrosis of the femoral head. In some various cases, they can also be used in revision or conversion arthroplasty. In some patients, short stems can also be used after femoral neck fracture. Currently, scientific data on those areas of indication of short-stem THA is scarce.
    Type of Medium: Online Resource
    ISSN: 1864-6697 , 1864-6743
    URL: Article
    DOI: 10.1055/a-1678-7684
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
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    detail.hit.zdb_id: 2304338-6
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  • 5
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    One-stage bilateral versus unilateral short-stem total hip arthroplasty: A matched-pair analysis of 216 hips
    Elsevier BV ; 2021
    In:  Journal of Orthopaedics Vol. 27 ( 2021-09), p. 130-136
    Details
    In: Journal of Orthopaedics, Elsevier BV, Vol. 27 ( 2021-09), p. 130-136
    Type of Medium: Online Resource
    ISSN: 0972-978X
    URL: Article
    DOI: 10.1016/j.jor.2021.09.008
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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  • 6
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    Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases
    Springer Science and Business Media LLC ; 2019
    In:  Journal of Orthopaedics and Traumatology Vol. 20, No. 1 ( 2019-12)
    Details
    In: Journal of Orthopaedics and Traumatology, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2019-12)
    Abstract: In recent years, a variety of short stems have been introduced. To date, mid- and long-term results of calcar-guided short-stem designs have been rarely available. Materials and methods Two hundred and sixteen calcar-guided short stems were included in combination with a cementless cup in a prospective study. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfaction on visual analogue scale (VAS) were assessed during a median follow-up of 61.7 months. Standardised radiographs were analysed at predefined time points regarding radiological alterations such as bone resorption and remodelling, radiolucency, osteolysis and cortical hypertrophy using modified Gruen zones. Results At mid-term follow-up, no revision surgery of the stem had to be performed in the whole collective. At 5 years, HHS was 97.8 (SD 4.7), satisfaction on VAS was 9.7 (SD 0.7), rest pain on VAS was 0.1 (SD 0.5), and load pain on VAS was 0.6 (SD 1.2). Compared to the 2-year results, femoral bone resorption increased significantly at the 5-year follow-up (3.9% versus 42.3%). Rate of femoral cortical hypertrophy remained stable, occurring in a total of 9 hips (4.5%). At the 5-year follow-up, 2 stems (1.0%) showed non-progressive radiolucent lines with a maximum width of 2 mm. Signs of osteolysis were not observed. Compared to the 2-year follow-up, no further subsidence was observed. Conclusions The rate of stem revision (0%) at the mid-term follow-up was remarkable and indicates the principle of using a calcar-guided short stem as being a safe procedure. However, signs of bone-remodelling, indicating some amount of stress-shielding, must be acknowledged at 5 years depending on stem alignment and type of anchorage. Level of evidence IV, Prospective observational study Trial registration German Clinical Trials Register, DRKS00012634, 07/07/2017 (retrospectively registered)
    Type of Medium: Online Resource
    ISSN: 1590-9921 , 1590-9999
    URL: Article
    DOI: 10.1186/s10195-019-0537-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2034945-2
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  • 7
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    „Downsizing“ in der Hüfttotalendoprothetik: Ein Kurzschaft als Revisionsimplantat
    Springer Science and Business Media LLC ; 2022
    In:  Der Orthopäde Vol. 51, No. 3 ( 2022-03), p. 230-238
    Details
    In: Der Orthopäde, Springer Science and Business Media LLC, Vol. 51, No. 3 ( 2022-03), p. 230-238
    Abstract: Kurzschäfte haben in der primären Hüfttotalendoprothetik (Hüft-TEP) im letzten Jahrzehnt stetig an Popularität gewonnen. Obwohl zementfreie Kurzschäfte nicht primär für den Einsatz als Revisionsimplantate konzipiert sind, stellt das „Downsizing“ der Femurkomponente bei fehlgeschlagener konventioneller Hüft-TEP bei ausgewählten Indikationen potenziell eine Behandlungsalternative dar. Methoden In dieser retrospektiven Fallserie werden 6 Patienten vorgestellt, die nach einer fehlgeschlagenen Hüft-TEP unter Nutzung eines kalkargeführten Kurzschafts revidiert wurden. Die mittlere Nachbeobachtungszeit betrug 3,32 Jahre (SD 0,63). Der Gesundheitszustand wurde mit dem EQ-5D-5L-Score bewertet. Die von den Patienten berichteten Ergebnisse (PROMs) wurden mit dem Harris Hip Score (HHS) und dem Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) erfasst. Schmerz und Zufriedenheit wurden mit Hilfe der visuellen Analogskala (VAS) erfasst. Die radiologische Analyse erfolgte durch die Bewertung hinsichtlich, Sinterung, Osteolysen, „stress shielding“ und Anzeichen von aseptischer Lockerung. Komplikationen wurden dokumentiert. Ergebnisse Beim letzten Follow-up betrug der mittlere EQ-5D-5L-Index 0,851 (SD 0,098). Die klinischen Ergebnisse waren bei 4 Patienten ausgezeichnet (HHS ≥ 90) und bei 2 Patienten befriedigend (HHS 71 und 79). Der mittlere WOMAC-Score betrug 9,20 % (SD 12,61). Schmerz und Zufriedenheit auf der VAS lagen bei 1,00 (SD 1,15) bzw. 9,17 (SD 0,37). Es traten keine größeren Komplikationen auf. Bis heute war keine weitere Revisionsoperation erforderlich. Radiologisch zeigten sich keine Anzeichen von Sinterung, aseptischen Lockerungen, „stress shielding“ und Frakturen. Schlussfolgerung Die vorliegende Fallserie legt nahe, dass bei fehlgeschlagener konventioneller Hüft-TEP das „Downsizing“ als Behandlungsoption in ausgewählten Fällen in Betracht gezogen werden kann.
    Type of Medium: Online Resource
    ISSN: 0085-4530 , 1433-0431
    URL: Article
    DOI: 10.1007/s00132-021-04168-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 3122958-X
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  • 8
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    Primary stability of calcar-guided short-stem total hip arthroplasty in the treatment of osteonecrosis of the femoral head: migration analysis using EBRA-FCA
    Springer Science and Business Media LLC ; 2020
    In:  Archives of Orthopaedic and Trauma Surgery Vol. 140, No. 12 ( 2020-12), p. 2091-2100
    Details
    In: Archives of Orthopaedic and Trauma Surgery, Springer Science and Business Media LLC, Vol. 140, No. 12 ( 2020-12), p. 2091-2100
    Abstract: Osteonecrosis of the femoral head (ONFH) is a disabling condition that often results in secondary arthritis necessitating total hip arthroplasty (THA). Short-stem THA has constantly gained popularity. It remains controversial, whether ONFH represents a risk factor for failure after the implantation of short stems with pronounced metaphyseal anchorage. The potential spread of the osteonecrotic area and bone marrow edema into the metaphyseal bone might result in compromised stability. Early implant migration is considered predictive of subsequent aseptic loosening. The purpose of this study was a migration analysis of a modern, calcar-guided short-stem implant in patients with ONFH in a mid-term follow-up. Materials and methods This retrospective analysis investigated the migration pattern of 45 calcar-guided short stems in patients with ONFH, using Einzel-Bild-Roentgen-Analyse Femoral-Component-Analysis (EBRA-FCA). Influencing factors such as ARCO categories, age, gender, body weight and BMI were analyzed. Complications and adverse events were documented. Results At mid-term [48.1 months (SD 20.7 months)], mean axial migration was 1.56 mm (SD 1.77 mm). Mean migration rate stabilized after 2 years. No influence of ARCO categories, age and BMI was found. A tendency of increased axial migration was observed in male patients and in overweight patients. No revision surgeries had to be performed during follow-up. Conclusion The results indicate a migration pattern comparable to that of primary osteoarthritis patients with slight initial migration under full load followed by subsequent stabilization in the metaphyseal femur. The 100% survival rate at mid-term supports the usage of this short-stem design in patients with ONFH.
    Type of Medium: Online Resource
    ISSN: 0936-8051 , 1434-3916
    URL: Article
    DOI: 10.1007/s00402-020-03610-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 1458452-9
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  • 9
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    Can hip resurfacing be safely revised with short-stem total hip arthroplasty? A case series of six patients
    Elsevier BV ; 2021
    In:  Journal of Orthopaedics Vol. 24 ( 2021-03), p. 274-279
    Details
    In: Journal of Orthopaedics, Elsevier BV, Vol. 24 ( 2021-03), p. 274-279
    Type of Medium: Online Resource
    ISSN: 0972-978X
    URL: Article
    DOI: 10.1016/j.jor.2021.03.007
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2240839-3
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  • 10
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    The concept of a cementless isoelastic monoblock cup made of highly cross-linked polyethylene infused with vitamin E: radiological analyses of migration and wear using EBRA and clinical outcomes at mid-term follow-up
    Springer Science and Business Media LLC ; 2021
    In:  BMC Musculoskeletal Disorders Vol. 22, No. 1 ( 2021-12)
    Details
    In: BMC Musculoskeletal Disorders, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2021-12)
    Abstract: The newest generation of cementless titanium-coated, isoelastic monoblock cup with vitamin E-blended highly cross-linked polyethylene (HXLPE) was introduced to the market in 2009. The aim of the present study was to obtain mid-term follow-up data including migration and wear analyses. Methods This prospective study investigated 101 primary total hip arthroplasty (THA) cases in 96 patients treated at a single institution. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) and pain and satisfication on a visual analogue scale (VAS) were assessed at a mean follow-up of 79.0 months. Migration and wear were assessed using Einzel-Bild-Roentgen-Analyse (EBRA) software. Radiological acetabular bone alterations and complications were documented. Results At mid-term follow-up (mean 79.0 months, range: 51.8–101.7), 81 cases with complete clinical and radiological data were analyzed. Utilisable EBRA measurements were obtained for 42 hips. The mean HHS was 91.1 (range 38.0–100.0), VAS satisfaction was 9.6 (range 6.0–10.0), VAS rest pain was 0.2 (range 0.0–4.0), and VAS load pain was 0.6 (range 0.0–9.0). Mean migration was 0.86 mm (range: 0.0–2.56) at 24 months and 1.34 mm (range: 0.09–3.14) at 5 years, and the mean annual migration rate was 0.22 (range: − 0.24–1.34). The mean total wear was 0.4 mm (range: 0.03–1.0), corresponding to a mean annual wear rate of 0.06 mm per year (range: 0.0–0.17). Radiographic analysis did not reveal any cases of osteolysis, and no revision surgeries had to be performed. Conclusions After using vitamin-E blended HXLPE in cementless isoelastic monoblock cups, there were no obvious signs of osteolysis or aseptic loosening occurred. No patients required revision surgery after mid-term follow-up. Cup migration and wear values were well below the benchmarks considered predictive for potential future failure. Trial registration The trial registration number on ClinicalTrials.gov : NCT04322916 (retrospectively registered at 26.03.2020).
    Type of Medium: Online Resource
    ISSN: 1471-2474
    URL: Article
    DOI: 10.1186/s12891-021-03981-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2041355-5
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