Inadequate Metadiaphyseal Fill of a Modern Taper-Wedge Stem Increases Subsidence and Risk of Aseptic Loosening: Technique and Distal Canal Fill Matter!

The Journal of Arthroplasty
Lucian C WarthRobert M Meneghini

Abstract

Adequate interference fit and mechanical stability through optimal surgical technique are essential to prevent subsidence and loosening in cementless total hip arthroplasty. The purpose of this study is to determine the effect of surgical technique on radiographic subsidence and subsequent stability of a modern taper-wedge cementless stem. A retrospective review of 250 consecutive cementless primary total hip arthroplasties performed by 2 surgeons was completed. Surgeon A vigorously broached, maximizing the mediolateral stem dimension and confirmed final broach stability with a torsional test, whereas Surgeon B did not. All patients received identical taper-wedge stems. Preoperative bone morphology (canal flare index), postoperative subsidence, and canal fill were radiographically assessed. Canal flare index was not different between groups (P = .747). There was significantly less subsidence at 1 month for Surgeon A (0.3 vs 1.3 mm, P < .001). Additional subsidence at 1 year occurred in only 0.8% of Surgeon A (1/119) compared to 51.6% of Surgeon B stems (33/64, P < .001). Surgeon technique and canal fill measured at 60 mm below the lesser trochanter were the only variables predictive for subsidence, where Surgeon A and B had a m...Continue Reading

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Citations

Jan 13, 2021·The Journal of Bone and Joint Surgery. American Volume·Amit AtreyUNKNOWN GAIA (Global Arthroplasty Infection Association) Registry Group
Jun 29, 2021·Acta Orthopaedica·Hannu T Aro
Feb 5, 2021·Bone & Joint Open·Jeffrey R McLaughlinMary Ann Johnson
Aug 28, 2021·International Orthopaedics·Masanori FujiiYasuharu Nakashima

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