3 years ago

Femoral Stem Survivorship in Dorr Type A Femurs Following Total Hip Arthroplasty Using a Cementless Tapered Wedge Stem: A Matched Comparative Study with Type B Femurs

Chan-woo Park, Hyeon-jun Eun, Sung-hak Oh, Hyun-jun Kim, Seung-jae Lim, Youn-soo Park

Publication date: Available online 13 November 2018

Source: The Journal of Arthroplasty

Author(s): Chan-Woo Park, Hyeon-Jun Eun, Sung-Hak Oh, Hyun-Jun Kim, Seung-Jae Lim, Youn-Soo Park

Abstract
Background

There is a lack of understanding on relationship between the femoral geometry and outcomes of total hip arthroplasty (THA). We investigated clinical and radiographic outcomes of THA using a cementless tapered wedge stem in patients with Dorr type A proximal femoral morphology, and compared with those of type B femurs at a minimum follow-up of 5 years.

Methods

We analyzed 1089 hips (876 patients) that underwent THA using an identical cementless tapered wedge stem. We divided all femurs into 3 types (Dorr type A, B and C). Type A and B femurs were statistically matched with age, gender, body mass index and diagnosis by using propensity score matching. Clinical, radiographic results and stem survivorship were compared between the matched two groups.

Results

A total of 611 femurs (56%) were classified as type A, 427 (39%) as type B, and 51 (5%) as type C. More radiolucent lines around femoral stems were found in type A femurs (7.8%) than in type B femurs (2.5%) (P<0.001). Patients with radiolucency showed worse Harris hip score (86.2 points) compared to those without radiolucency (93.0 points) (P<0.001). The stem survivorship of type A femur (97.8%) was lower than that of type B femur (99.5%) (P=0.041). The reasons for femoral revision in type A femurs were periprosthetic fracture (67%), aseptic loosening (22%), and deep infection (11%).

Conclusions

This study showed a higher rate of complications following THAs using a cementless tapered wedge stem in Dorr type A femurs than those performed in type B femurs.

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