We sought to determine the short to medium-term clinical and radiographic outcomes using a short stem in young adults with a proximal femoral deformity (PFD). We prospectively studied 31 patients (35 hips) with PFDs treated with an uncemented primary THA using a short stem with cervicometaphyseal fixation between 2011–2018. There were 19 male (23 hips) and 12 female (12 hips) patients, with a mean BMI of 26.7±4.1 kg/m2. Twelve cases had a previous surgical procedure, and six of them were failed childhood osteotomies. Mean age of the series was 44±12 years, mean follow-up was 81±27 months and no patients were lost to follow-up. PFDs were categorized according to a modified Berry´s classification. Average preoperative leg-length discrepancy (LLD) was −16.3 mm (−50 to 2). At a mean time of 81 months of follow-up, survival rate was 97% taking revision of the stem for any reason and 100% for aseptic loosening as endpoints. No additional femoral osteotomy was required in any case. Average surgical time was 66 minutes (45 to 100). There was a significant improvement in the mHHS score when comparing preoperative and postoperative values (47.3±10.6 vs. 92.3±3.7, p=0.0001). Postoperative LLD was in average 1 mm (−9 to 18) (p=0.0001). According to Engh's criteria, all stems were classified as stable without signs of loosening. Postoperative complications included 1 pulmonary embolism, 1 neurogenic sciatic pain, 1 transient sciatic nerve palsy that recovered completely after six months, and 2 acute periprosthetic joint infections. One patient suffered a Vancouver B2 periprosthetic femoral fracture 45 days after surgery and was revised with a modular distally fixed uncemented fluted stem. A type 2B short stem evidenced promising outcomes at short to medium-term follow up in young adult patients with PFDs, avoiding the need for corrective osteotomies and a revision stem.
Although there is some clinical evidence of ceramic bearings being associated with a lower infection rate after total hip arthroplasty (THA), available data remains controversial since this surface is usually reserved for young, healthy patients. Therefore, we investigated the influence of five commonly-used biomaterials on the adhesion potential of four biofilm-producing bacteria usually detected in infected THAs. In this in-vitro research, we evaluated the ability of We found no differences on global bacterial adhesion between the different surfaces. In this study, ceramic bearings appeared not to be related to a lower bacterial adhesion than other biomaterials. However, different adhesive potentials among bacteria may play a major role on infection's inception.
Following a total hip arthroplasty (THA), early hospital readmission rates of 3–8% are considered as ‘acceptable’ in terms of medical care cost policies. Surprisingly, the impact of readmissions on mortality has not been priorly portrayed. Therefore, we aimed to analyse the mortality of unplanned readmissions after primary THA at a high-volume Argentinian center. We prospectively analysed 90-day readmissions of 815 unilateral, elective THA patients operated between 2010–2014 whose medical insurance was the one offered by our institution. Mean follow-up was 51 months (range, 37–84). Median age was 69 (IQR, 62–77). We stratified our sample into readmitted and non-readmitted cohorts. Through a Cox proportional hazard model, we compared demographic characteristics, clinical comorbidities, surgical outcomes and laboratory values between both groups in order to determine association with mortality. We found 37 (4.53%) readmissions at a median time of 40.44 days (IQR: 17.46–60.69). Factors associated with readmission were: hospital stay (p=0.00); surgical time (p=0.01); chronic renal insufficiency (p=0.03); ASA class 4 (p=0.00); morbid obesity (p=0.006); diabetes (p=0.04) and a high Charlson Index (p=0.00). Overall mortality rate of the series was 3.31% (27/815). Median time to mortality was 455.5 days (IQR: 297.58–1170.65). One-third (11/37) of the readmitted patients died, being sepsis non-related to the THA the most common cause of death. After adjusting for confounders, 90-day readmissions remained associated with mortality with an adjusted HR of 3.14 (CI95%: 1.05–9.36, p=0.04). Unplanned readmissions were an independent risk factor for future mortality, increasing 3 times the risk of a decease eventuality.
Femoral offset restoration is related to low rates of wear and dislocation. Replication of the native hip anatomy improves prosthesis survival, whereas increasing the femoral offset elevates the torque stresses, thus inducing a risk of suboptimal stem fixation. Although the Corail (DePuy Synthes, St Priest, France) uncemented stem has an excellent record of fixation, an unexpectedly number of aseptic loosenings has been noted in our institution. We sought to characterize the clinical parameters observed in a group of patients who have experienced metaphyseal aseptic loosenings with the collarless version of the Corail uncemented femoral component; describe the radiographic findings in this group of patients; expose the intraoperative findings in the cases that needed revision surgery and to calculate a possible frequency of this complication. We present a series of 15 metaphyseal debondings of the collarless version of the Corail uncemented stem in primary total hip arthroplasty. Eleven men and four woman with an average age of 60 years old (range: 42 to 81 years old) and a previous history of osteoarthritis presented with thigh pain and limping at an average of 33 months postoperative (range: 5 to 100 months). Seven cases presented a Dorr´s classification type A femur and 8 cases a type B femur. In 10 of the 15 cases a 36 mm ceramic on ceramic bearing surface was implanted and in 5 a 28 mm diameter ceramic on polyethylene pair. Radiographic assessment of the failures evidenced an increase in femoral offset of 6.2 mm in average (range: 0 to 17 mm). Nine of the 15 cases had a standard offset stem and 3 an extended offset stem. Leg length discrepancy was in average 2.4 mm (range: 0 to 8 mm). None of the failures presented a more than 2 mm subsidence. Alignment of these stems was in average 2.1 degrees of varus (range: 0 to 5 degrees). Six cases were revised to a long cemented or uncemented stem, 2 cases were lost and 7 cases are awaiting revision surgery. Although the incidence of this complication was low (15 failures in 855 cases in 10 years = 1.75%), we are concerned about the real magnitude of this problem, as this mode of failure was observed up to 8 years after implantation. Enhanced lateralization of the hip, independently of the type of stem, may have played a role in the infrequent early failures of this popular design. Routine use of “fine tunning” preoperative planning in order to avoid offset enhancement is strongly reccommended, as this was the only suspected factor that was present in almost all the failures we observed.
