Ten-year outcomes of cementless anatomical femoral implants after 3D computed tomography planning. Follow-up note - 27/08/19
, Emmanuel Debuyzer a, b, Kevin Benad a, b, Sophie Putman a, b, Adeline Pierache c, Julien Girard a, b, Gilles Pasquier a, b
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
Abstract |
Background |
Pre-operative 3D planning based on computed tomography (CT) imaging is used to optimise the restitution of normal hip anatomy during primary total hip arthroplasty (THA). Although CT planning has been proven effective and reproducible, its influence on long-term THA outcomes is unknown. In this 10-year follow-up study of patients managed with the same technique of CT-planned primary anatomical THA, the objectives were to assess femoral implant survival, long-term functional outcomes, 10-year outcomes of titanium modular femoral necks, and associations with the dislocation rate.
Hypothesis Pre-operative CT planning of primary THA ensures achievement of the NICE criterion of a lower than 5% femoral revision rate within 10 years.
Material and methods |
The study included 61 patients (61 hips) managed between 2004 and 2007 by CT-planned primary THA via the posterior approach, with an uncemented anatomical femoral component (SPS®, Symbios); when deemed necessary by the surgeon to restore normal anatomy, a titanium modular femoral neck was used (35/61 patients). After 10 years, 17 patients had died and 3 were lost to follow-up, leaving 41 patients with a mean age of 76 years (range, 60–91 years) for re-evaluation. Clinical outcomes were assessed by determining the Harris Hip Score (HHS) and the Postel-Merle d’Aubigné (PMA) score, which were compared to baseline values. Radiographs were evaluated using the AGORA Roentgenographic Assessment system (ARA).
Results |
The 10-year femoral component survival rate was 96% (95%CI, 88;99%). Revision was required in 4 patients, to treat delayed peri-prosthetic fractures (n=2) or to correct initial cup malposition (n=2). No changes occurred from 2010 to last follow-up in the mean HHS (90 [95%CI, 84;95] and 91 [95%CI, 77;96], respectively) or mean PMA score (16 [95%CI, 14;17] and 15.5 [95%CI, 14;16.5], respectively). The mean ARA score was 5.2 (range, 3–6) at last follow-up. No complications related to the use of modular femoral necks were recorded. Dislocation occurred in 2 patients, but in neither was the pre-operative plan followed during surgery.
Discussion |
The SPS® stem produced good 10-year clinical and radiographic outcomes. No patients experienced complications related to use of a titanium modular femoral neck. The restoration of anatomical hip geometry made possible by pre-operative CT planning provided sustained clinical improvements with a low complication rate.
Level of evidence |
IV, retrospective observational cohort study.
Le texte complet de cet article est disponible en PDF.Keywords : Total hip arthroplasty, Anatomical femoral implant, HIP, Pre-operative 3D planning, Computed tomography
Plan
Vol 105 - N° 5
P. 937-942 - septembre 2019 Retour au numéro
Article précédent
- Total hip arthroplasty with accolade/trident through the direct minimally invasive anterior approach without traction table: Learning curve and results after a minimum of 5 years
- Kersten Berndt, Stefan Rahm, Claudio Dora, Patrick O. Zingg
- Long-term comparative study of large-diameter metal-on-metal bearings: Resurfacing versus total arthroplasty with large-diameter Durom™ bearing
- Pierre-Emmanuel Ridon, Sophie Putman, Henri Migaud, Charles Berton, Gilles Pasquier, Julien Girard
Bienvenue sur EM-consulte, la référence des professionnels de santé.