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Effect of stem sizing and position on short-term complications with canine press fit cementless total hip arthroplasty


Townsend, Sarah; Kim, Stanley E; Pozzi, Antonio (2017). Effect of stem sizing and position on short-term complications with canine press fit cementless total hip arthroplasty. Veterinary Surgery, 46(6):803-811.

Abstract

OBJECTIVE: To determine the influence of stem sizing and positioning with early subsidence and stem complications with cementless (BFX) total hip arthroplasty (THA).
STUDY DESIGN: Retrospective case series.
ANIMALS: Fifty-five dogs; 58 THAs.
METHODS: Eighty cobalt-chromium BFX THAs were reviewed, 58 met inclusion criteria. Implant size, positioning, and major complications within 12 months of surgery were recorded. Femoral canal flare (FCF), canal fill, stem angle, and subsidence at 3 months were measured from postoperative radiographs. Appropriateness of final stem size was assessed with digital templates. Odds ratios for associations were calculated.
RESULTS: Mean ± SD coronal canal fill (Fillcor ) was 75% ± 6, FCF was 2.0 ± 0.3, and subsidence was 1.7 mm ± 2.6. Stem angulation ranged from 7° varus to 6° valgus, and 7° cranial to 3° caudal. Appropriately sized stems (n = 45) had a mean Fillcor of 78%. Major stem complications occurred in 12% of THAs. Femora with subsidence > 3 mm were 45.3 times more likely to develop postoperative stem complications (P = .02). Stems with varus angulation ≥ 5° were 12.5 times more likely to sustain intraoperative fissures (P = .03). Stems considered undersized based on postoperative digital templating were 5.6 times more likely to develop stem complications (P = .04) and 5.7 times more likely to subside > 3 mm (P = .03).
CONCLUSION: Varus stem angulation should be avoided to prevent fissures. Canal fill is a poor indicator of optimal stem size and the current recommendation of >85% is unnecessarily high. Postoperative templating may be useful for assessing appropriateness of stem size.

Abstract

OBJECTIVE: To determine the influence of stem sizing and positioning with early subsidence and stem complications with cementless (BFX) total hip arthroplasty (THA).
STUDY DESIGN: Retrospective case series.
ANIMALS: Fifty-five dogs; 58 THAs.
METHODS: Eighty cobalt-chromium BFX THAs were reviewed, 58 met inclusion criteria. Implant size, positioning, and major complications within 12 months of surgery were recorded. Femoral canal flare (FCF), canal fill, stem angle, and subsidence at 3 months were measured from postoperative radiographs. Appropriateness of final stem size was assessed with digital templates. Odds ratios for associations were calculated.
RESULTS: Mean ± SD coronal canal fill (Fillcor ) was 75% ± 6, FCF was 2.0 ± 0.3, and subsidence was 1.7 mm ± 2.6. Stem angulation ranged from 7° varus to 6° valgus, and 7° cranial to 3° caudal. Appropriately sized stems (n = 45) had a mean Fillcor of 78%. Major stem complications occurred in 12% of THAs. Femora with subsidence > 3 mm were 45.3 times more likely to develop postoperative stem complications (P = .02). Stems with varus angulation ≥ 5° were 12.5 times more likely to sustain intraoperative fissures (P = .03). Stems considered undersized based on postoperative digital templating were 5.6 times more likely to develop stem complications (P = .04) and 5.7 times more likely to subside > 3 mm (P = .03).
CONCLUSION: Varus stem angulation should be avoided to prevent fissures. Canal fill is a poor indicator of optimal stem size and the current recommendation of >85% is unnecessarily high. Postoperative templating may be useful for assessing appropriateness of stem size.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:05 Vetsuisse Faculty > Veterinary Clinic > Department of Small Animals
Dewey Decimal Classification:570 Life sciences; biology
630 Agriculture
Language:English
Date:29 April 2017
Deposited On:26 Jan 2018 10:01
Last Modified:29 Apr 2018 00:00
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:0161-3499
Additional Information:This is the peer reviewed version of the following article: Townsend S, Kim SE, Pozzi A. Effect of stem sizing and position on short-term complications with canine press fit cementless total hip arthroplasty. Veterinary Surgery. 2017;46:803-811, which has been published in final form at https://doi.org/10.1111/vsu.12666. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-820227.html#terms)
OA Status:Green
Publisher DOI:https://doi.org/10.1111/vsu.12666
PubMed ID:28460422

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