gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Intra and postoperative fractures and femoral shortened stem About a prospective series of 735 cases

Meeting Abstract

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  • presenting/speaker Jean Marc Puch - Clinique St George, Nice, France
  • Loys Descamps - Clinique St George, Nice, France
  • Guy Derhi - Clinique St Jean, Cagnes-sur-Mer, France

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN25-377

doi: 10.3205/17dkou051, urn:nbn:de:0183-17dkou0518

Veröffentlicht: 23. Oktober 2017

© 2017 Puch et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Today short stems are more and more used on total hip arthroplasty. Among these various short stems, there exists a class called « shortened stem ». The use of a femoral stem shortened, according to Lombardi, makes it possible to avoid the learning curve of the specific short stems and it reduces the intra and post operative fractures. This author recommends simply a oversizing of the implant compared to the standard model. Our objectives were to show that our shortened stem does not involve more intra and post operative fractures than the original standard stem and to check if oversizing were necessary.

Methods: It's a prospective and continue series from 05/2011 to 09/2015 including 735 implants for 700 patients. The femoral stem was cementless, covered completely with HAP and with a flange. 3 seniors surgeons and 2 centers, mean age 71,2 y (36 to 103), 59% women, oetiology was primary osteoarthritis in 83%, approach was posterior in 72%. All patients are followed clinically and radiologically regularly and all information is collected on a shared database.

We studied all intra and post operative fractures and compared the results with our standard stem( Targosr, Lépine groupe, 1299 cases , 07/2002 to 09/2011) and with the literature results about standard stems cementless and short stems.

Results and Conclusion: At the FU of 20 months (6-52), we found 7 femoral fractures including 5 intra operatives and 2 post operatives at 1 month post op. The rate of per op fractures is 0.95%. For our equivalent standard stems put by the same team, we found 0.53 %. One meta analysis by Ryan et al. about standard stems cementless show 2.1% for 50528 cases and the study of the literature of all type of short stems (16 publications) show 1,5% of intra and post operative fractures for 2782 cases and specially for the shortened stem a rate of 1,1% for 1273 cases. Our results are equivalent than shortened stems found on the literature and lower than the results of the conventional cementless stems. But we found more intra and post operative fractures than in our standard stem series. The analysis of the various fractures highlighted 2 reasons: a ancillary problem and an oversizing of the implant. If it's easy to regulate an ancillary problem, to find the best operative procedure is more difficult. However the study of the 3 principal procedures (« stop on the cortical », « bone conservative » and « round the corner ») showed that our shortened stem could be used in all the procedures on condition that respecting planning, to avoid oversizing and to use some time fluoroscopy.The use of a new femoral implant for a surgeon isn't really easy even if it is his usual stem but shortened.The learning curve is however reduced and the respect of the bone are in spite of very interesting. We don't agree with the oversizing preached by some authors which is to be avoided and doesn't correspond for us to a philosophy of respect of the bone.