Abstract:
BACKGROUND:Exchangeable neck stems, defined as those with a dual taper (that is, a modular junction between the femoral head and the femoral neck and an additional junction between the neck and the stem body), were introduced in THA to improve restoration of joint biomechanics (restoring anteversion, offset, and limb length) and reduce the risk of dislocation. However exchangeable necks have been reported to result in adverse effects such as stem fractures and acute local tissue reaction. Whether they result in a net improvement to or impairment of reconstructive survivorship remains controversial. QUESTIONS/PURPOSES:(1) To compare the prosthetic survivorship and all-cause revision risk of exchangeable femoral neck THAs versus fixed neck THAs, taking known prosthetic revision risk factors into account; and (2) to compare the cause-specific revision risk of exchangeable femoral neck THAs versus fixed neck THAs, adjusting for known prosthetic risk factors. METHODS:Using French national health-insurance databases, we identified all French patients older than 40 years who underwent primary THA from 2009 through 2012. To ensure accuracy of the data, we considered only beneficiaries of the general insurance scheme (approximately 77% of the population). Characteristics of the prosthesis and the patients receiving an exchangeable femoral neck THA were compared with those receiving a fixed femoral neck THA (defined as femoral stem with only the head being exchangeable). Revision was the event of interest. Followup started on the date the THA was performed, until the patient experienced revision, died, was lost to followup, or until the followup period ended (December 31, 2014), whichever came first. Competing risk THA survivorship was calculated and compared (purpose 1), as were cause-specific Cox regression models (purpose 2). The study cohort included 324,108 individuals with a mean age of 77 years. A total of 24% underwent THA for acute trauma, and 3% of the group received an exchangeable neck THA. During the median 45-month followup (mean, 42 months; minimum, 1 day; maximum, 6 years), 11,968 individuals underwent prosthetic revision. RESULTS:The cumulative revision incidence was 6.5% (95% CI, 5.8%-7.3%) for exchangeable neck THAs versus 4.7% (95% CI, 4.6%-4.8%) for fixed neck THAs (p < 0.001). After controlling for potential confounding variables including age, sex, comorbidities, indication for THA, cementation, bearing surface, and the characteristics of the center where the implantation was performed, we found that the exchangeable femoral neck THA was associated with an increased hazard ratio (HR) of revision of 1.26 (95% CI, 1.14-1.38; p < 0.001) compared with the fixed neck THA. When dealing with cause-specific revision, exchangeable neck THAs had a higher incidence of revision for implant failure or periprosthetic fracture, and for mechanical complications; adjusted HRs were, respectively, 1.68 (95% CI, 1.24-2.27; p < 0.001) and 1.27 (95% CI, 1.13-1.43; p < 0.001), for exchangeable neck THAs compared with fixed ones. CONCLUSIONS:Exchangeable neck THAs had poorer survivorship independent of other prosthetic revision risk factors. Accordingly, expected anatomic and functional benefits should be carefully assessed before choosing this design. LEVEL OF EVIDENCE:Level III, therapeutic study.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Colas S,Allalou A,Poichotte A,Piriou P,Dray-Spira R,Zureik Mdoi
10.1007/s11999-017-5260-6subject
Has Abstractpub_date
2017-08-01 00:00:00pages
2046-2059issue
8eissn
0009-921Xissn
1528-1132pii
10.1007/s11999-017-5260-6journal_volume
475pub_type
杂志文章abstract::Experience with cementless fixation over the last six years indicates that the technique offers greater opportunities for bone conservation. Thus, when cement is used, and especially if it is forced into the skeleton under pressure, the amount of bone incorporated into the implant is considerable. Conversely, if no ce...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract:BACKGROUND:Pasteurized autograft is regarded as a biologic reconstructive option for managing bone defects after tumor resection; however, reports on long-term outcomes from large patient series are scarce. Contrary to previous favorable reports, we have observed many patients with failures, in particular as the durati...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999.0000000000000100
更新日期:2018-09-01 00:00:00
abstract:UNLABELLED:Although acute management of pelvic fractures and their long-term functional outcome have been widely documented, important information regarding malunion and nonunion of these fractures is sparse. Despite their relative rarity, malunions and nonunions cause disabling symptoms and have major socioeconomic im...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1007/s11999-009-0712-2
更新日期:2009-08-01 00:00:00
abstract::A case of an osteoid osteoma occurring in the cervical spine and presenting as scapular and arm pain has been described. Correct diagnosis was delayed for 2 years. Plain radiographs may fail to demonstrate a lesion in the spine. Radiographic evaluation, when osteoid osteoma is a possibility, should include bone scanni...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1977-11-01 00:00:00
abstract::A new spinal implant has been designed and biomechanical testing completed, intended for application to "short-segment" spinal defects such as disc degeneration, fracture, spondylolisthesis, or tumor. Major improvements over currently available devices include: only 2-3 vertebrae are spanned, not 5-7 as with Harringto...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1986-02-01 00:00:00
abstract::Three hundred three patients undergoing total hip replacement were enrolled in a prospective, randomized, double-blind clinical study of heterotopic bone formation. All the procedures were primary arthroplasties done for osteoarthritis using an anterolateral approach. Patients with spondyloarthropathy, previous surger...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1995-05-01 00:00:00
abstract::Achondroplastic patients having lengthening surgery of the lower limbs were preoperatively evaluated from psychologic, functional, vascular, and endocrinometabolic points of view. Long-term research is required to determine effects of surgical correction of achondroplasia from both psychologic and various physical poi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1990-01-01 00:00:00
abstract::The authors studied 10 consecutive patients with closed femoral shaft or supracondylar fractures who were nonambulatory and who were treated by reamed retrograde intramedullary nailing via an intercondylar notch approach. The study consisted of five women and five men with an average age of 60.7 years (range, 40-89 ye...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200004000-00026
更新日期:2000-04-01 00:00:00
abstract:BACKGROUND:The innate immune system can recall previous immunologic challenges and thus respond more effectively to subsequent unrelated challenges, a phenomenon called trained immunity. Training the innate immune system before surgery might be a potential option to prevent bone and joint infection. QUESTIONS/PURPOSES...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000001461
更新日期:2020-11-01 00:00:00
abstract::The results of revision total hip arthroplasty, with or without sepsis, are compared in a review of the recent literature. In 661 total hip revisions without sepsis, there is an overall 54% excellent/good/satisfactory rate and a 12% infection rate. Of 1063 total hip revisions in the presence of or after sepsis, there ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-10-01 00:00:00
abstract::For reappraisal of total hip arthroplasty (THA) in the treatment of nontraumatic osteonecrosis (ON) of the femoral head, 29 hips in 23 patients with ON were surveyed in a comparison with 63 osteoarthritic (OA) hips treated in the same manner during the same period; the hips were selected according to the same criteria...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1989-07-01 00:00:00
abstract::Recent technologic advances in bone mineral densitometry have resulted in increasingly precise and accurate methods of estimating bone mineral density. Dual-photon absorptiometry has been made obsolete by the introduction of dual-energy radiography, a development that is likely to result in more widespread use of dens...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1991-10-01 00:00:00
abstract::Bisphosphonate treatment has been shown to decrease endosteal bone formation and increase periosteal bone apposition in the rat tibial diaphysis. This study tested the hypothesis that the increase in periosteal apposition is a compensatory attempt to maintain skeletal mass appropriate for the mechanical load. Twenty-f...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:Rotating-hinge total knee prostheses may be used for the treatment of global instability about the knee. The designs of previous generations were associated with suboptimal outcomes. QUESTIONS/PURPOSES:We evaluated the clinical and radiographic outcomes of salvage knee reconstructions using modern-generatio...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-009-1226-7
更新日期:2010-05-01 00:00:00
abstract::To combat the most common and most serious cause of mechanical failure of total hip arthroplastics, namely loosening, a method of improving the insertion of methacrylate is presented, called the cement fixation system. Using the cement gun with the keying hole seal, the methacrylate is pressure injected into the keyin...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-04-01 00:00:00
abstract::Seven cases of fractures of the humerus from arm wrestling included 2 types of fractures. Two were spiral fractures of the humeral shaft with large butterfly fragments at the junction of the middle and distal one third caused by a violent uncoordinated muscular action. Five were fractures of the medial epicondyle of t...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1980-03-01 00:00:00
abstract::Eighteen hips in 15 children showed persistent roentgenographic evidence of congenital acetabular residual dysplasia at four- to eight-year follow-up evaluations. The mean follow-up period was 5.8 years. These hips were subsequently evaluated by magnetic resonance (MR) imaging. MR imaging studies revealed thick unossi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-04-01 00:00:00
abstract::The effectiveness of physeal distraction in stimulating bone growth in animals was investigated by force applied to the distal femoral growth plate of immature rabbits. The system was continuously monitored to detect physeal separation. A distraction of 0.25 mm every 12 hours led to physeal separation in five animals....
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-06-01 00:00:00
abstract::Osteopetrosis is an inherited skeletal condition characterized by increased bone radiodensity. There are three clinical groups: infantile-malignant autosomal recessive, fatal within the first few years of life (in the absence of effective therapy); intermediate autosomal recessive, appears during the first decade of l...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1993-09-01 00:00:00
abstract:BACKGROUND:Revision of the infected hip arthroplasty with major bone loss is difficult. Attempts to restore bone stock with structural allograft are controversial. QUESTIONS/PURPOSES:We assessed the (1) reinfection rate; (2) rerevision rate; (3) radiographic graft union, resorption, and implant migration; (4) Harris h...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-010-1673-1
更新日期:2011-04-01 00:00:00
abstract::A retrospective study during a 3-year interval revealed that four of 112 patients had intertrochanteric fractures that were irreducible by the usual closed manipulation and traction techniques at the time of surgery. Each of these patients' preoperative radiographs showed a fracture line that bisected the lesser troch...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199706000-00027
更新日期:1997-06-01 00:00:00
abstract::The impact of preoperative gait analysis on the orthopaedic care of 97 patients (101 gait analyses) at the authors' institution was evaluated. For the 70 patients for whom a specific treatment plan had been outlined before the preoperative gait study, the treatment plan was altered in 62 (89%) after the gait analysis ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200003000-00023
更新日期:2000-03-01 00:00:00
abstract::Gene therapy has much to offer in the treatment of conditions in which it is necessary to increase the formation of bone. Nonunions, segmental defects, and aseptic loosening are examples of conditions where the local expression of genes that inhibit osteolysis and promote osteogenesis might be helpful. Studies in whic...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200010001-00016
更新日期:2000-10-01 00:00:00
abstract::The Exeter stem and impacted, morselized allograft bone and cement were used in the revisions of 18 consecutive femoral components (17 patients). The primary arthroplasty had been done because of osteoarthritis. All of the femoral components were revised for the first time because of aseptic loosening. The migration p...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200108000-00018
更新日期:2001-08-01 00:00:00
abstract::The injured cervical spine may be completely examined without patient movement by positioning the X-ray tube relative to the injured patient. The prevertebral soft tissue in the cervical area is extremely important in the evaluation of injury, and a thickness of 5 mm or more at the level of the anterior inferior bord...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-197506000-00003
更新日期:1975-01-01 00:00:00
abstract::Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works wel...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-009-0930-7
更新日期:2009-10-01 00:00:00
abstract::Various guidelines have been proposed regarding which portions of a surgical gown may be considered sterile. Unfortunately, the validity of these recommendations has not been definitively established. We therefore evaluated gown sterility after major spinal surgery to assess the legitimacy of these guidelines. We used...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-008-0341-1
更新日期:2009-03-01 00:00:00
abstract::Wear was analyzed on 21 metal on metal hip replacements, including McKee-Farrar, Müller, and Ring, that were retrieved from patients after as many as 25 years. Light and scanning electron microscopy indicated that early wear included substantial third body abrasion, possibly from particles generated while scratches fr...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199608001-00013
更新日期:1996-08-01 00:00:00
abstract:BACKGROUND:Degenerative rotator cuff tears are increasing with the aging population, and healing is not uniform after surgery. Rotator cuffs may show improved healing when biologic factors are added during surgery. QUESTIONS/PURPOSES:We asked: (1) What cellular processes are involved in normal bone-to-tendon healing? ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1007/s11999-010-1323-7
更新日期:2010-06-01 00:00:00
abstract::Seventy-five uncemented porous-coated total hip prostheses were implanted in 64 patients. The results were reviewed after a mean follow-up period of 47 months (range, 40-64 months). The mean preoperative rating was fair, and the mean postoperative rating was excellent. There were six dislocations. Ten patients had mil...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-08-01 00:00:00