Fully hydroxyapatite-coated collared femoral stems in direct anterior versus direct lateral hip arthroplastyFully hydroxyapatite-coated collared femoral stems in direct anterior versus direct lateral hip arthroplasty

Fully hydroxyapatite-coated collared femoral stems in direct anterior versus direct lateral hip arthroplastyFully hydroxyapatite-coated collared femoral stems in direct anterior versus direct lateral hip arthroplasty

Can J Surg 2021;64(2):E205-E210 | PDF

Sebastian Heaven, MBBCh, MSc; Maxwell Perelgut, BMSc, MESc; Edward Vasarhelyi, MD; James Howard, MD; Matthew Teeter, PhD; Brent Lanting, MD

Abstract

Background: Total hip arthroplasty (THA) via the direct anterior approach has increased in popularity in the last decade, with research supporting enhanced early recovery; however, some investigators have reported increased early revision rates in direct anterior THA. We examined outcomes from a single institution’s experience with a fully hydroxyapatite-coated collared femoral stem implanted via the anterior or the lateral approach.

Methods: Patients who had received fully hydroxyapatite-coated collared femoral stems as part of THA surgery performed by 1 of 3 surgeons between January 2012 and September 2017 were identified from our institutional database. We examined revision rates for the 2 approaches and compared them between the 2 groups. We also analyzed outcomes on plain film radiographs obtained immediately postoperatively and at 1 and 2 years.

Results: A total of 695 patients received a fully hydroxyapatite-coated collared stem during the study period. Total hip arthroplasty was performed via the direct anterior approach in 281/778 hips (36.1%) and via the direct lateral approach in 497 (63.9%). Nineteen patients (2.5%) underwent subsequent revision surgery; there was no statistically significant difference in the revision rate between the anterior and lateral approaches (2.5% v. 2.4%, p = 0.95). The mean subsidence of the stem at 1 year was 1.68 mm (standard deviation 11.7 mm). No statistically significant differences were observed between the cohorts for any of the radiographic measurements at either follow-up time.

Conclusion: We found no significant difference in revision rates between the direct anterior and direct lateral approach. Stem subsidence levels were in keeping with expected values, and no major changes in stem position occurred during the first postoperative year. Surgical approach did not appear to substantially affect biomechanical stem behaviour.

Résumé

Contexte : L’arthroplastie totale de la hanche (ATH) par voie antérieure directe a gagné en popularité dans les 10 dernières années, la recherche ayant montré qu’elle favorisait un rétablissement rapide; certains chercheurs ont toutefois signalé qu’elle était associée à un taux accru d’opérations de révision précoces. Nous avons étudié les issues de l’installation d’une tige fémorale à collier entièrement recouverte d’hydroxyapatite par voie antérieure ou latérale dans un établissement.

Méthodes : Nous avons interrogé la base de données de notre établissement pour y recenser les patients ayant subi, entre janvier 2012 et septembre 2017, une ATH au cours de laquelle 1 de 3 chirurgiens a installé une tige fémorale à collier entièrement recouverte d’hydroxyapatite. Nous avons ensuite examiné le taux d’opérations de révision pour les 2 approches étudiées, et avons comparé les issues des 2 groupes. Nous avons également analysé les clichés radiographiques pris immédiatement après l’intervention, de même de ceux pris aux suivis à 1 et à 2 ans.

Résultats : Durant la période à l’étude, 695 patients se sont fait installer une tige fémorale à collier entièrement recouverte d’hydroxyapatite. Sur 778 hanches, 281 (36,1 %) avaient subi une ATH par voie antérieure directe, et 497 (63,9 %), une ATH par voie latérale directe. Dix-neuf patients (2,5 %) ont dû subséquemment subir une opération de révision; aucune différence statistiquement significative n’a été observée entre le groupe voie antérieure et le groupe voie latérale en ce qui a trait au taux de révision (2,5 % c. 2,4 %; p = 0,95). L’affaissement moyen de la tige au suivi à 1 an était de 1,68 mm (écart type 11,7 mm). Les mesures radiographiques des 2 groupes ne présentaient pas de différences statistiquement significatives, quel que soit le moment du suivi.

Conclusion : Nous n’avons constaté aucune différence significative dans le taux de révision entre les 2 groupes. L’affaissement observé était dans les valeurs attendues, et la position de la tige n’avait pas changé de façon importante au cours de la première année. La voie chirurgicale utilisée ne semblait pas influencer considérablement le comportement biomécanique de la tige.


Accepted May 12, 2020

Affiliations: From the Department of Orthopaedics, London Health Sciences Centre, London, Ont. (Heaven, Vasarhelyi, Howard, Lanting); the School of Biomedical Engineering, Western University, London, Ont. (Perelgut); and the Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Teeter).

Competing interests: Edward Vasarhelyi reports consultant fees from DePuy Synthes, Zimmer Biomet and Hip Innovation Technology, and institutional research support from DePuy Synthes, Smith & Nephew, Stryker and Zimmer Biomet. James Howard reports grants from Stryker and DePuy Synthes, personal fees from Stryker, DePuy Synthes, Smith & Nephew and Intellijoint Surgical, and institutional research support from Stryker, DePuy Synthes, Smith & Nephew, Zimmer Biomet, and Microport. He holds stock in PersaFix Technologies. Matthew Teeter is on the boards of the International Society for Technology in Arthroplasty and the Canadian RSA Network, and holds stock in IdealFit Spacer Technologies and Solo Spine. Brent Lanting reports consultant, principal investigator and institutional support from DePuy Synthes, Stryker and Smith & Nephew, and institutional support from Zimmer Biomet. No other competing interests were declared.

Contributors: S. Heaven, E. Vasarhelyi, J. Howard, M. Teeter and B. Lanting designed the study. S. Heaven, M. Perelgut and E. Vasarhelyi acquired the data, which S. Heaven, M. Perelgut, E. Vasarhelyi, J. Howard and B. Lanting analyzed. S. Heaven wrote the manuscript, which M. Perelgut, E. Vasarhelyi, J. Howard, M. Teeter and B. Lanting critically revised. All authors gave final approval of the article to be published.

Content licence: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BYNC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Funding: No funding was received for this work.

DOI: 10.1503/cjs.000920

Correspondence to: S. Heaven, Department of Orthopaedics, London Health Sciences Centre, 339 Windermere Rd, London ON N6A 5A5, sebheaven@gmail.com