Cementless Tapered Wedge Femoral Stems Decrease Subsidence in Obese Patients Compared to Traditional Fit-and-Fill Stems

Tanner W. Grant, Luke R. Lovro, David J. Licini, Lucian C. Warth, Mary Ziemba-Davis, R. Meneghini

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Femoral component stability and resistance to subsidence is critical for osseointegration and clinical success in cementless total hip arthroplasty. The purpose of this study was to radiographically evaluate the anatomic fit and subsidence of 2 different proximally tapered, porous-coated modern cementless femoral component designs. Methods: A retrospective cohort study of 126 consecutive cementless total hip arthroplasties was performed. Traditional fit-and-fill stems were implanted in the first 61 hips with the remaining 65 receiving morphometric tapered wedge stems. Preoperative bone morphology was radiographically assessed by the canal flare index. Canal fill in the coronal plane, subsidence, and the sagittal alignment of stems was measured digitally on immediate and 1-month postoperative radiographs. Results: Demographics and canal flare indices were similar between groups. The percentage of femoral canal fill was greater in the tapered wedge compared to the fit-and-fill stem (P = .001). There was significantly less subsidence in the tapered wedge design (0.3 mm) compared to the fit-and-fill design (1.1 mm) (P = .001). Subsidence significantly increased as body mass index (BMI) increased in the fit-and-fill stems, a finding not observed in the tapered wedge design (P = .013). Conclusion: An anatomically designed morphometric tapered wedge femoral stem demonstrated greater axial stability and decreased subsidence with increasing BMI than a traditional fit-and-fill stem. The resistance to subsidence, irrespective of BMI, is likely due to the inherent axial stability of a tapered wedge design and may be the optimal stem design for obese patients.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - Jan 28 2016

Fingerprint

Thigh
Hip
Body Mass Index
Arthroplasty
Osseointegration
Cohort Studies
Retrospective Studies
Demography
Bone and Bones
Fillcanal

Keywords

  • BMI
  • Canal fill
  • Fit-and-fill stems
  • Subsidence
  • Tapered wedge stems
  • Total hip arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Cementless Tapered Wedge Femoral Stems Decrease Subsidence in Obese Patients Compared to Traditional Fit-and-Fill Stems. / Grant, Tanner W.; Lovro, Luke R.; Licini, David J.; Warth, Lucian C.; Ziemba-Davis, Mary; Meneghini, R.

In: Journal of Arthroplasty, 28.01.2016.

Research output: Contribution to journalArticle

Grant, Tanner W. ; Lovro, Luke R. ; Licini, David J. ; Warth, Lucian C. ; Ziemba-Davis, Mary ; Meneghini, R. / Cementless Tapered Wedge Femoral Stems Decrease Subsidence in Obese Patients Compared to Traditional Fit-and-Fill Stems. In: Journal of Arthroplasty. 2016.
@article{ceaf7730fe3a40b898ec8cf9aa1cff50,
title = "Cementless Tapered Wedge Femoral Stems Decrease Subsidence in Obese Patients Compared to Traditional Fit-and-Fill Stems",
abstract = "Background: Femoral component stability and resistance to subsidence is critical for osseointegration and clinical success in cementless total hip arthroplasty. The purpose of this study was to radiographically evaluate the anatomic fit and subsidence of 2 different proximally tapered, porous-coated modern cementless femoral component designs. Methods: A retrospective cohort study of 126 consecutive cementless total hip arthroplasties was performed. Traditional fit-and-fill stems were implanted in the first 61 hips with the remaining 65 receiving morphometric tapered wedge stems. Preoperative bone morphology was radiographically assessed by the canal flare index. Canal fill in the coronal plane, subsidence, and the sagittal alignment of stems was measured digitally on immediate and 1-month postoperative radiographs. Results: Demographics and canal flare indices were similar between groups. The percentage of femoral canal fill was greater in the tapered wedge compared to the fit-and-fill stem (P = .001). There was significantly less subsidence in the tapered wedge design (0.3 mm) compared to the fit-and-fill design (1.1 mm) (P = .001). Subsidence significantly increased as body mass index (BMI) increased in the fit-and-fill stems, a finding not observed in the tapered wedge design (P = .013). Conclusion: An anatomically designed morphometric tapered wedge femoral stem demonstrated greater axial stability and decreased subsidence with increasing BMI than a traditional fit-and-fill stem. The resistance to subsidence, irrespective of BMI, is likely due to the inherent axial stability of a tapered wedge design and may be the optimal stem design for obese patients.",
keywords = "BMI, Canal fill, Fit-and-fill stems, Subsidence, Tapered wedge stems, Total hip arthroplasty",
author = "Grant, {Tanner W.} and Lovro, {Luke R.} and Licini, {David J.} and Warth, {Lucian C.} and Mary Ziemba-Davis and R. Meneghini",
year = "2016",
month = "1",
day = "28",
doi = "10.1016/j.arth.2016.09.023",
language = "English (US)",
journal = "Journal of Arthroplasty",
issn = "0883-5403",
publisher = "Churchill Livingstone",

}

TY - JOUR

T1 - Cementless Tapered Wedge Femoral Stems Decrease Subsidence in Obese Patients Compared to Traditional Fit-and-Fill Stems

AU - Grant, Tanner W.

AU - Lovro, Luke R.

AU - Licini, David J.

AU - Warth, Lucian C.

AU - Ziemba-Davis, Mary

AU - Meneghini, R.

PY - 2016/1/28

Y1 - 2016/1/28

N2 - Background: Femoral component stability and resistance to subsidence is critical for osseointegration and clinical success in cementless total hip arthroplasty. The purpose of this study was to radiographically evaluate the anatomic fit and subsidence of 2 different proximally tapered, porous-coated modern cementless femoral component designs. Methods: A retrospective cohort study of 126 consecutive cementless total hip arthroplasties was performed. Traditional fit-and-fill stems were implanted in the first 61 hips with the remaining 65 receiving morphometric tapered wedge stems. Preoperative bone morphology was radiographically assessed by the canal flare index. Canal fill in the coronal plane, subsidence, and the sagittal alignment of stems was measured digitally on immediate and 1-month postoperative radiographs. Results: Demographics and canal flare indices were similar between groups. The percentage of femoral canal fill was greater in the tapered wedge compared to the fit-and-fill stem (P = .001). There was significantly less subsidence in the tapered wedge design (0.3 mm) compared to the fit-and-fill design (1.1 mm) (P = .001). Subsidence significantly increased as body mass index (BMI) increased in the fit-and-fill stems, a finding not observed in the tapered wedge design (P = .013). Conclusion: An anatomically designed morphometric tapered wedge femoral stem demonstrated greater axial stability and decreased subsidence with increasing BMI than a traditional fit-and-fill stem. The resistance to subsidence, irrespective of BMI, is likely due to the inherent axial stability of a tapered wedge design and may be the optimal stem design for obese patients.

AB - Background: Femoral component stability and resistance to subsidence is critical for osseointegration and clinical success in cementless total hip arthroplasty. The purpose of this study was to radiographically evaluate the anatomic fit and subsidence of 2 different proximally tapered, porous-coated modern cementless femoral component designs. Methods: A retrospective cohort study of 126 consecutive cementless total hip arthroplasties was performed. Traditional fit-and-fill stems were implanted in the first 61 hips with the remaining 65 receiving morphometric tapered wedge stems. Preoperative bone morphology was radiographically assessed by the canal flare index. Canal fill in the coronal plane, subsidence, and the sagittal alignment of stems was measured digitally on immediate and 1-month postoperative radiographs. Results: Demographics and canal flare indices were similar between groups. The percentage of femoral canal fill was greater in the tapered wedge compared to the fit-and-fill stem (P = .001). There was significantly less subsidence in the tapered wedge design (0.3 mm) compared to the fit-and-fill design (1.1 mm) (P = .001). Subsidence significantly increased as body mass index (BMI) increased in the fit-and-fill stems, a finding not observed in the tapered wedge design (P = .013). Conclusion: An anatomically designed morphometric tapered wedge femoral stem demonstrated greater axial stability and decreased subsidence with increasing BMI than a traditional fit-and-fill stem. The resistance to subsidence, irrespective of BMI, is likely due to the inherent axial stability of a tapered wedge design and may be the optimal stem design for obese patients.

KW - BMI

KW - Canal fill

KW - Fit-and-fill stems

KW - Subsidence

KW - Tapered wedge stems

KW - Total hip arthroplasty

UR - http://www.scopus.com/inward/record.url?scp=85002815033&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85002815033&partnerID=8YFLogxK

U2 - 10.1016/j.arth.2016.09.023

DO - 10.1016/j.arth.2016.09.023

M3 - Article

JO - Journal of Arthroplasty

JF - Journal of Arthroplasty

SN - 0883-5403

ER -