Does Lack of Initial Collar-Calcar Contact Influence Performance of Collared Cementless Femoral Stems?

Autor: Travis R. Weiner, BS, Catelyn A. Woelfle, BA, Winnie Xu, BA, Duke G. Yim, MD, Roshan P. Shah, MD, H. John Cooper, MD
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Arthroplasty Today, Vol 27, Iss , Pp 101432- (2024)
Druh dokumentu: article
ISSN: 2352-3441
DOI: 10.1016/j.artd.2024.101432
Popis: Background: Initial stability of cementless stems is important to minimize the risk of subsidence, pain, and periprosthetic fracture after total hip arthroplasty (THA). Collared stems improve initial component stability when contacting the femoral calcar. Direct contact is not always achieved, and collared stem performance has not been studied in this context. We hypothesized that collared stems achieving direct contact would demonstrate reduced subsidence. Methods: A single-surgeon retrospective study of 482 consecutive primary THAs implanted between February 2020 and May 2023 using collared cementless stems was performed. The 2 cohorts included stems with initial collar-calcar contact vs stems without. Subsidence was evaluated by comparing intraoperative fluoroscopy to postoperative 8-week radiographs. Binary logistic regression identified independent risk factors for subsidence. Chi-square tests were used for categorical variables and t-tests for continuous variables. Results: Of stems, 63.9% achieved initial collar-calcar contact, while 36.1% did not. The rate (1.3% vs 19.0%; P < .001) and magnitude (0.02 mm, range 0-3 mm vs 0.35 mm, range 0-3 mm; P < .001) of subsidence were significantly higher among stems without initial contact. Stems without initial collar-calcar contact (P < .001) and male gender (P = .007) were independent risk factors for subsidence. Two patients with initial contact had nondisplaced calcar cracks and
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