Comparison of filling ratio, alignment, and stability between ABG<b>Ⅱ</b> short-stem and Corail long-stem in total hip arthroplasty for Dorr type C femur_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

BAO Xianchao , LI Mingyang , WU Limin , JIANG Shenghu ,  SHEN Bin

Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

SHEN Bin, Email: shenbin_1971@163.com

Keywords：

Dorr type C femur; total hip arthroplasty; short stem prosthesis; prosthesis filling ratio

DOI：

10.7507/1002-1892.202303123

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Objective Using the mono-energy reconstruction images and X-ray films to investigate whether the ABG Ⅱ short-stem could improve the filling ratio, stability, and alignment in the Dorr type C femur, compared with the Corail long-stem. Methods Among patients who were with Dorr type C femurs and treated with total hip arthroplasty between January 2006 and March 2012, 20 patients with a Corail long-stem (Corail group) and 20 patients with an ABG Ⅱ short-stem (ABG Ⅱ group) were randomly selected. The differences in gender, age, body mass index, and preoperative diagnoses between the two groups were not significant (P>0.05). The ABG Ⅱ group was with a mean follow-up of 142 months (range, 102-156 months), and the Corail group was with a mean follow-up of 107 months (range, 91-127 months). There was no significant difference in the Harris score and subjective satisfaction score between the two groups at last follow-up (P>0.05). At last follow-up, dual-energy CT scans with mono-energy image reconstruction were used to calculate the prosthetic filling ratio and to measure the alignment of the prosthesis in the coronal and sagittal positions. Stability assessment was performed based on X-ray films, and the subsidence distance was measured using EBRA-FCA software. Results X-ray film observation showed that the prostheses in the two groups were stable and no signs of loosening was found. The incidence of pedestal sign was significantly lower in the ABGⅡ group than in the Corail group (P<0.05), and the incidence of heterotopic ossification was significantly higher in the ABGⅡ group than in the Corail group (P<0.05). The subsidence distance of femoral stem in ABG Ⅱ group was significantly greater than that in Corail group (P<0.05), and the subsidence speed of femoral stem in ABG Ⅱ group was also greater than that in Corail group, but the difference was not significant (P>0.05). The overall prosthesis filling ratio was significantly higher in the ABG Ⅱ group than in the Corail group (P<0.05), while the coronal filling ratio at the lesser trochanter, 2 cm below the lesser trochanter, and 7 cm below the lesser trochanter were not significant (P>0.05). The results of prosthesis alignment showed that there was no significant difference in the sagittal alignment error value and the incidence of coronal and sagittal alignment error >3° between the two groups (P>0.05), while the coronal alignment error value in the ABG Ⅱ group was significantly greater than that in the Corail group (P<0.05). Conclusion Although the ABG Ⅱ short-stem avoids the distal-proximal mismatch of the Corail long-stem in the Dorr type C femur and thus achieves a higher filling ratio, it does not appear to achieve better alignment or stability.

Citation： BAO Xianchao, LI Mingyang, WU Limin, JIANG Shenghu, SHEN Bin. Comparison of filling ratio, alignment, and stability between ABGⅡ short-stem and Corail long-stem in total hip arthroplasty for Dorr type C femur. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(6): 641-646. doi: 10.7507/1002-1892.202303123 Copy

1.	Khanuja HS, Vakil JJ, Goddard MS, et al. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg (Am), 2011, 93(5): 500-509.
2.	Dorr LD, Faugere MC, Mackel AM, et al. Structural and cellular assessment of bone quality of proximal femur. Bone, 1993, 14(3): 231-242.
3.	Li M, Zeng Y, Wu Y, et al. Cementless femoral stems with lower canal fill ratio have similar mid-term to long-term outcomes to those with adequate fill ratio in Dorr type C femurs. Arch Orthop Trauma Surg, 2022, 142(6): 1265-1273.
4.	Molli RG, Lombardi AV, Berend KR, et al. A short tapered stem reduces intraoperative complications in primary total hip arthroplasty. Clin Orthop Relat Res, 2012, 470(2): 450-461.
5.	Kim YH, Park JW, Kim JS, et al. Long-term results and bone remodeling after THA with a short, metaphyseal-fitting anatomic cementless stem. Clin Orthop Relat Res, 2014, 472(3): 943-950.
6.	Chen HH, Morrey BF, An KN, et al. Bone remodeling characteristics of a short-stemmed total hip replacement. J Arthroplasty, 2009, 24(6): 945-950.
7.	Issa K, Stroh AD, Mont MA, et al. Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties. J Orthop Res, 2014, 32(9): 1214-1220.
8.	Herrera A, Mateo J, Lobo-Escolar A, et al. Long-term outcomes of a new model of anatomical hydroxyapatite-coated hip prosthesis. J Arthroplasty, 2013, 28(7): 1160-1166.
9.	Epinette JA, Asencio G, Essig J, et al. Clinical results, radiological findings and survival of a proximally hydroxyapatite-coated hip ABG Ⅱ stem at a minimum of ten years’ follow-up: results of a consecutive multicentre study of 1148 hips in 1053 patients. Bone Joint J, 2013, 95-B(12): 1610-1616.
10.	Wellenberg RHH, Hakvoort ET, Slump CH, et al. Metal artifact reduction techniques in musculoskeletal CT-imaging. Eur J Radiol, 2018, 107: 60-69.
11.	Pessis E, Campagna R, Sverzut JM, et al. Virtual monochromatic spectral imaging with fast kilovoltage switching: reduction of metal artifacts at CT. Radiographics, 2013, 33(2): 573-583.
12.	Nakaya R, Takao M, Hamada H, et al. Reproducibility of the Dorr classification and its quantitative indices on plain radiographs. Orthop Traumatol Surg Res, 2019, 105(1): 17-21.
13.	Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res, 1990, (257): 107-128.
14.	Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br), 1987, 69(1): 45-55.
15.	Biedermann R, Krismer M, Stöckl B, et al. Accuracy of EBRA-FCA in the measurement of migration of femoral components of total hip replacement. Einzel-Bild-Röntgen-Analyse-femoral component analysis. J Bone Joint Surg (Br), 1999, 81(2): 266-272.
16.	Krismer M, Biedermann R, Stöckl B, et al. The prediction of failure of the stem in THR by measurement of early migration using EBRA-FCA. Einzel-Bild-Roentgen-Analyse-femoral component analysis. J Bone Joint Surg (Br), 1999, 81(2): 273-280.
17.	Worlicek M, Weber M, Wörner M, et al. The final implant position of a commonly used collarless straight tapered stem design (Corail®) does not correlate with femoral neck resection height in cement-free total hip arthroplasty: a retrospective computed tomography analysis. J Orthop Traumatol, 2018, 19(1): 20. doi: 10.1186/s10195-018-0513-z.
18.	Ishii S, Homma Y, Baba T, et al. Does the canal fill ratio and femoral morphology of Asian females influence early radiographic outcomes of total hip arthroplasty with an uncemented proximally coated, tapered-wedge stem? J Arthroplasty, 2016, 31(7): 1524-1528.
19.	Rattanaprichavej P, Laoruengthana A, Chotanaphuti T, et al. Subsidence of hydroxyapatite-coated femoral stem in Dorr type C proximal femoral morphology. J Arthroplasty, 2019, 34(9): 2011-2015.
20.	Hwang KT, Kim YH, Kim YS, et al. Total hip arthroplasty using cementless grit-blasted femoral component: a minimum 10-year follow-up study. J Arthroplasty, 2012, 27(8): 1554-1561.
21.	Aldinger PR, Jung AW, Breusch SJ, et al. Survival of the cementless Spotorno stem in the second decade. Clin Orthop Relat Res, 2009, 467(9): 2297-2304.
22.	Streit MR, Innmann MM, Merle C, et al. Long-term (20- to 25-year) results of an uncemented tapered titanium femoral component and factors affecting survivorship. Clin Orthop Relat Res, 2013, 471(10): 3262-3269.
23.	Viceconti M, Pancanti A, Varini E, et al. On the biomechanical stability of cementless straight conical hip stems. Proc Inst Mech Eng H, 2006, 220(3): 473-480.
24.	Tarala M, Janssen D, Verdonschot N. Toward a method to simulate the process of bone ingrowth in cementless THA using finite element method. Med Eng Phys, 2013, 35(4): 543-548.
25.	Reina N, Salib CG, Perry KI, et al. Mild coronal stem malalignment does not negatively impact survivorship or clinical results in uncemented primary total hip arthroplasties with dual-tapered implants. J Arthroplasty, 2019, 34(6): 1127-1131.
26.	Teet JS, Skinner HB, Khoury L. The effect of the “mini” incision in total hip arthroplasty on component position. J Arthroplasty, 2006, 21(4): 503-507.
27.	Khalily C, Lester DK. Results of a tapered cementless femoral stem implanted in varus. J Arthroplasty, 2002, 17(4): 463-466.
28.	Stulberg SD, Patel RM. The short stem: promises and pitfalls. Bone Joint J, 2013, 95-B(11 Suppl A): 57-62.
29.	Whiteside LA, Easley JC. The effect of collar and distal stem fixation on micromotion of the femoral stem in uncemented total hip arthroplasty. Clin Orthop Relat Res, 1989, (239): 145-153.
30.	Young S, Michel MC, Selmi TAS, et al. The Corail^® Hip Stem//The Corail^® Hip System. Berlin: Springer, 2011: 53-88.
31.	Reitman RD, Emerson R, Higgins L, et al. Thirteen year results of total hip arthroplasty using a tapered titanium femoral component inserted without cement in patients with type C bone. J Arthroplasty, 2003, 18(7 Suppl 1): 116-121.
32.	Bonutti PM, Stroh AD, Issa K, et al. Proximally coated cementless bipolar hemiarthroplasty in Dorr type C bone. Orthopedics, 2014, 37(4): e345-e350.
33.	Tsubosaka M, Hayashi S, Hashimoto S, et al. Patients with a Dorr type C femoral bone require attention for using a Summit cementless stem: Results of total hip arthroplasty after a minimum follow-up period of 5 years after insertion of a Summit cementless stem. J Orthop Sci, 2018, 23(4): 671-675.
34.	Kelly SJ, Robbins CE, Bierbaum BE, et al. Use of a hydroxyapatite-coated stem in patients with Dorr Type C femoral bone. Clin Orthop Relat Res, 2007, 465: 112-116.
35.	Kim JT, Jeong HJ, Lee SJ, et al. Does proximally coated single-wedge cementless stem work well in Dorr type C femurs? Minimum 10-year followup. Indian J Orthop, 2019, 53(1): 94-101.
36.	Zhen P, Liu J, Li X, et al. Primary total hip arthroplasty using an uncemented Wagner SL stem in elderly patients with Dorr type C femoral bone. J Orthop Surg Res, 2019, 14(1): 377. doi: 10.1186/s13018-019-1421-5.

1. Khanuja HS, Vakil JJ, Goddard MS, et al. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg (Am), 2011, 93(5): 500-509.
2. Dorr LD, Faugere MC, Mackel AM, et al. Structural and cellular assessment of bone quality of proximal femur. Bone, 1993, 14(3): 231-242.
3. Li M, Zeng Y, Wu Y, et al. Cementless femoral stems with lower canal fill ratio have similar mid-term to long-term outcomes to those with adequate fill ratio in Dorr type C femurs. Arch Orthop Trauma Surg, 2022, 142(6): 1265-1273.
4. Molli RG, Lombardi AV, Berend KR, et al. A short tapered stem reduces intraoperative complications in primary total hip arthroplasty. Clin Orthop Relat Res, 2012, 470(2): 450-461.
5. Kim YH, Park JW, Kim JS, et al. Long-term results and bone remodeling after THA with a short, metaphyseal-fitting anatomic cementless stem. Clin Orthop Relat Res, 2014, 472(3): 943-950.
6. Chen HH, Morrey BF, An KN, et al. Bone remodeling characteristics of a short-stemmed total hip replacement. J Arthroplasty, 2009, 24(6): 945-950.
7. Issa K, Stroh AD, Mont MA, et al. Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties. J Orthop Res, 2014, 32(9): 1214-1220.
8. Herrera A, Mateo J, Lobo-Escolar A, et al. Long-term outcomes of a new model of anatomical hydroxyapatite-coated hip prosthesis. J Arthroplasty, 2013, 28(7): 1160-1166.
9. Epinette JA, Asencio G, Essig J, et al. Clinical results, radiological findings and survival of a proximally hydroxyapatite-coated hip ABG Ⅱ stem at a minimum of ten years’ follow-up: results of a consecutive multicentre study of 1148 hips in 1053 patients. Bone Joint J, 2013, 95-B(12): 1610-1616.
10. Wellenberg RHH, Hakvoort ET, Slump CH, et al. Metal artifact reduction techniques in musculoskeletal CT-imaging. Eur J Radiol, 2018, 107: 60-69.
11. Pessis E, Campagna R, Sverzut JM, et al. Virtual monochromatic spectral imaging with fast kilovoltage switching: reduction of metal artifacts at CT. Radiographics, 2013, 33(2): 573-583.
12. Nakaya R, Takao M, Hamada H, et al. Reproducibility of the Dorr classification and its quantitative indices on plain radiographs. Orthop Traumatol Surg Res, 2019, 105(1): 17-21.
13. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res, 1990, (257): 107-128.
14. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br), 1987, 69(1): 45-55.
15. Biedermann R, Krismer M, Stöckl B, et al. Accuracy of EBRA-FCA in the measurement of migration of femoral components of total hip replacement. Einzel-Bild-Röntgen-Analyse-femoral component analysis. J Bone Joint Surg (Br), 1999, 81(2): 266-272.
16. Krismer M, Biedermann R, Stöckl B, et al. The prediction of failure of the stem in THR by measurement of early migration using EBRA-FCA. Einzel-Bild-Roentgen-Analyse-femoral component analysis. J Bone Joint Surg (Br), 1999, 81(2): 273-280.
17. Worlicek M, Weber M, Wörner M, et al. The final implant position of a commonly used collarless straight tapered stem design (Corail®) does not correlate with femoral neck resection height in cement-free total hip arthroplasty: a retrospective computed tomography analysis. J Orthop Traumatol, 2018, 19(1): 20. doi: 10.1186/s10195-018-0513-z.
18. Ishii S, Homma Y, Baba T, et al. Does the canal fill ratio and femoral morphology of Asian females influence early radiographic outcomes of total hip arthroplasty with an uncemented proximally coated, tapered-wedge stem? J Arthroplasty, 2016, 31(7): 1524-1528.
19. Rattanaprichavej P, Laoruengthana A, Chotanaphuti T, et al. Subsidence of hydroxyapatite-coated femoral stem in Dorr type C proximal femoral morphology. J Arthroplasty, 2019, 34(9): 2011-2015.
20. Hwang KT, Kim YH, Kim YS, et al. Total hip arthroplasty using cementless grit-blasted femoral component: a minimum 10-year follow-up study. J Arthroplasty, 2012, 27(8): 1554-1561.
21. Aldinger PR, Jung AW, Breusch SJ, et al. Survival of the cementless Spotorno stem in the second decade. Clin Orthop Relat Res, 2009, 467(9): 2297-2304.
22. Streit MR, Innmann MM, Merle C, et al. Long-term (20- to 25-year) results of an uncemented tapered titanium femoral component and factors affecting survivorship. Clin Orthop Relat Res, 2013, 471(10): 3262-3269.
23. Viceconti M, Pancanti A, Varini E, et al. On the biomechanical stability of cementless straight conical hip stems. Proc Inst Mech Eng H, 2006, 220(3): 473-480.
24. Tarala M, Janssen D, Verdonschot N. Toward a method to simulate the process of bone ingrowth in cementless THA using finite element method. Med Eng Phys, 2013, 35(4): 543-548.
25. Reina N, Salib CG, Perry KI, et al. Mild coronal stem malalignment does not negatively impact survivorship or clinical results in uncemented primary total hip arthroplasties with dual-tapered implants. J Arthroplasty, 2019, 34(6): 1127-1131.
26. Teet JS, Skinner HB, Khoury L. The effect of the “mini” incision in total hip arthroplasty on component position. J Arthroplasty, 2006, 21(4): 503-507.
27. Khalily C, Lester DK. Results of a tapered cementless femoral stem implanted in varus. J Arthroplasty, 2002, 17(4): 463-466.
28. Stulberg SD, Patel RM. The short stem: promises and pitfalls. Bone Joint J, 2013, 95-B(11 Suppl A): 57-62.
29. Whiteside LA, Easley JC. The effect of collar and distal stem fixation on micromotion of the femoral stem in uncemented total hip arthroplasty. Clin Orthop Relat Res, 1989, (239): 145-153.
30. Young S, Michel MC, Selmi TAS, et al. The Corail^® Hip Stem//The Corail^® Hip System. Berlin: Springer, 2011: 53-88.
31. Reitman RD, Emerson R, Higgins L, et al. Thirteen year results of total hip arthroplasty using a tapered titanium femoral component inserted without cement in patients with type C bone. J Arthroplasty, 2003, 18(7 Suppl 1): 116-121.
32. Bonutti PM, Stroh AD, Issa K, et al. Proximally coated cementless bipolar hemiarthroplasty in Dorr type C bone. Orthopedics, 2014, 37(4): e345-e350.
33. Tsubosaka M, Hayashi S, Hashimoto S, et al. Patients with a Dorr type C femoral bone require attention for using a Summit cementless stem: Results of total hip arthroplasty after a minimum follow-up period of 5 years after insertion of a Summit cementless stem. J Orthop Sci, 2018, 23(4): 671-675.
34. Kelly SJ, Robbins CE, Bierbaum BE, et al. Use of a hydroxyapatite-coated stem in patients with Dorr Type C femoral bone. Clin Orthop Relat Res, 2007, 465: 112-116.
35. Kim JT, Jeong HJ, Lee SJ, et al. Does proximally coated single-wedge cementless stem work well in Dorr type C femurs? Minimum 10-year followup. Indian J Orthop, 2019, 53(1): 94-101.
36. Zhen P, Liu J, Li X, et al. Primary total hip arthroplasty using an uncemented Wagner SL stem in elderly patients with Dorr type C femoral bone. J Orthop Surg Res, 2019, 14(1): 377. doi: 10.1186/s13018-019-1421-5.

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Comparison of filling ratio, alignment, and stability between ABGⅡ short-stem and Corail long-stem in total hip arthroplasty for Dorr type C femur

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