Primary stability of calcar-guided short-stem total hip arthroplasty in the treatment of osteonecrosis of the femoral he
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HIP ARTHROPLASTY
Primary stability of calcar‑guided short‑stem total hip arthroplasty in the treatment of osteonecrosis of the femoral head: migration analysis using EBRA‑FCA Yama Afghanyar1 · Christoph Danckwardt1 · Miriam Schwieger1 · Uwe Felmeden1 · Philipp Drees2 · Jens Dargel1 · Philipp Rehbein1 · Karl Philipp Kutzner1,2 Received: 7 May 2020 / Accepted: 25 September 2020 © The Author(s) 2020
Abstract Introduction 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. Keywords Osteonecrosis of the femoral head · Short stem arthroplasty · Total hip arthroplasty · Optimys · EBRA · Migration
Introduction Osteonecrosis of the femoral head (ONFH) is a disabling condition that usually results in progressive femoral head collapse and end-stage secondary arthritis of the hip [1]. ONFH often affects young adults aged between 35 and * Karl Philipp Kutzner [email protected] 1
Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189 Wiesbaden, Germany
Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
2
55 years [2]. Factors for the compromised blood supply of the femoral head, which is suspected to be the trigger of ONFH, include smoking, alcohol, various lipid metabolism disorders, corticosteroid therapy
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