The CORAIL® Hip System: A Practical Approach Based on 25 Years of Experience

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Int Orthop ;— Compared fixation and survival of lateralised vs standard cementless stems after two years 1—7. Orthop Traumatol Surg Res ;— Clin Orthop Relat Res ;— Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Structural and cellular assessment of bone quality of proximal femur.

Bone ;— Posterior longitudinal split osteotomy for femoral component extraction in revision total hip arthroplasty. J Arthroplasty ;— Berlin: Springer, Impact of a learning curve on the survivorship of cementless total hip arthroplasties. Bone Joint J ;B— The long-term clinical relevance of calcar atrophy caused by stress shielding in total hip arthroplasty: A year, prospective, randomized study. Does a collar improve the immediate stability of uncemented femoral hip stems in total hip arthroplasty?

Comparison of collared and collarless femoral components in primary uncemented total hip arthroplasty. Design modifications of the uncemented Furlong hip stem result in minor early subsidence but do not affect further stability.

The CORAIL Hip System: A Practical Approach Based on 25 Years of Experience

The E-value was calculated to define the minimum strength of association of the HR that an unmeasured confounder would need to have with both the treatment and the outcome to fully explain away the association between screw holes and cup revision on the measured covariates VanderWeele and Ding Ethics, funding, and potential conflicts of interest The study was approved by the Regional Ethics Committee in Gothenburg dnr No competing interests are declared.

Results Early revisions within 2 years after primary operation The survival rate with cup revision for aseptic loosening within 2 years was When including all reasons for cup revision, the survival rate for cups without screw holes was The crude HR for the risk of cup revision due to aseptic loosening of cups without screw holes compared with cups with screw holes was 0.

The crude HR for cup revision for any reason was 0. After adjustment for the covariates, cups without screw holes showed a lower risk for cup revision for any reason with an HR of 0. The influence of other patient- or prothesis-related factors on the revision rate is presented in Table 5 see Supplementary data. In out of 22, hips, cup revision, including exchange or extraction of the cup, the liner, or both, was performed within the first 2 years after the primary operation. Revisions within 10 years after primary operation The overall year survival rate for aseptic loosening was However, the risk for cup revision due to any reason was still lower for.

Cup revision for aseptic loosening Without screw holes The adjusted hazard ratio was calculated based on a Cox regression model with gender, age, surgical approach, type of stem fixation, cup coating, head size, head material, and cup design as covariates. Between the 2- and year follow-up, cup revisions were registered. The distribution of these revisions did not differ statistically significantly between patients who underwent unilateral or bilateral operations. Discussion We found similar risk both at 2 years and 10 years for revision because of aseptic loosening between cups with and without screw holes in patients with primary OA.

However, the risk for cup revision for any reason at both 2 and 10 years was higher when a cup with screw holes was used. Screw fixation of uncemented cups increases stability in simulated models Hsu et al. This theory might still hold true for patients with abnormal anatomy, fractures, revision settings, and cups without porous coating or trabecular surfaces.

Additional screw fixation of cups with a porous coating or trabecular surfaces has previously been investigated in small populations and did not reduce migration in radiostereometric analysis RSA studies Minten et al. A review of 5 articles with a total of more than 1, patients and a follow-up time of up to 5 years also did not show any difference in revision rate or osteolysis between cups with and without screw fixation Ni et al. Even in the present study with a substantially larger population and operations performed in more than 80 different hospitals, the cups without screw hole did not show a higher risk for early revision due to aseptic loosening.

In contrast, we found a higher risk for revision due to any reason for cups with screw holes. Using screws has some potential risks. Both prolonged operation time Pepe et al. Inserting screws in the acetabulum might even be a risk for damaging intrapelvic vessels Ohashi et al. A report from a smaller group of patients describe a higher risk for osteolysis around cups with screw holes Iorio et al.

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During the last 2 decades, the number of uncemented cups used per year in Sweden has substantially increased. In the last decade, cups designed without screw holes have been used more often in operations for primary OA than have cups with holes. Data from the current study show that this development did not increase the risk of aseptic loosening. In contrast, we found a higher HR for cup revision for any reason if the cup had screw holes, at both 2 and 10 years.

The main reason for both early and late revision was infection. A longer operation time when using screws might have caused a higher risk for infection, and there might also have been differences related to patient selection, which are not possible to adjust for in a register study. The E-value shows that unmeasured confounders need to increase the risk for revision by 2. Of the possible confounding factors available, female sex, the use of cemented stems, and HA coating of the cups reduced the risk for cup revision for any reason.

However, these 3 risk-reducing factors were overrepresented in the group of cups with screw holes. Nevertheless, cups with screw holes showed a higher risk for revision due to any reason both at 2 years and 10 years after operation. The second most common reason for revision in this study was dislocation. The larger the head size, the lower the risk for revision due to dislocation Hailer et al. In particular, 22 mm heads, which were used as standard size in the early days of modern hip arthroplasty to reduce wear Charn-. In cups with cross-linked PE liners, head sizes up to 36 mm do not seem to increase wear Howie et al.

Therefore, a head size of 28—36 mm, depending on the cup size, seems to be the optimal size when using metal or ceramic heads and a cross-linked PE liner. In this study, only head sizes 28, 32, and 36 mm were included. We did not find any difference in the risk for cup revision for any reason between these 3 head sizes.

However, a larger proportion of 28 mm heads was used in the group of cups with screw holes, and this might still have influenced the risk for revision. TMT cups have been reported to have a higher revision rate due to dislocation Hailer , Laaksonen et al. Our results are concurrent with these reports.

HA coating has been discussed in several other papers. There is still no consensus on how HA coating influences the risk for cup revision. Several studies have shown an increased revision rate for HA-coated cups Stilling et al. The main reason for the higher revision rate of cups with HA coating seems to be failure of the liner Lazarinis et al. Older cup designs have more often been used with HA coating and, at the same time, with standard but not crosslinked PE liners.

When adjusting for potential confounders, including the type of liner, in a larger register-based study, a similar risk of aseptic loosening was found for cups with or without HA coating Lazarinis et al. Unadjusted data from our study show a slight advantage for cups with HA coating, but when adjusting for several potential confounders, including cup design, there was no statistically significant difference in the risk for revision. The main limitation of this study is the lack of detailed patient- or surgeon-related information that might have influenced the decision to use screws.

Register data do not provide any information regarding the reason why a specific implant was chosen in the individual case. Perhaps surgeons chose cups with the possibility of augmentation with screws in more difficult cases. Excluding all diagnoses other than primary OA reduces the variety of some of these factors. A comparison of the included hospitals showed significant differences in the use of cups with screw holes. It is unlikely that these differences between hospitals can be explained fully by case mix.

Another limitation of our study is that only 2 of the cup designs, with unequal distribution between the groups, had a follow-up time of more than 10 years. Therefore, no reliable analysis was possible beyond 10 years of follow-up, and general conclusions about the long-term consequences of using cups with screw holes should be made with caution.

A new analysis of the registry data will be necessary when a sufficient number of cases with several different cup designs have been followed for more than 10—15 years to obtain robust long-term data. This subgroup decreases the variance within the groups and can increase the risk for type 1 errors. However, we did not find a statistically significant difference in HR for revision between.

The incidence of aseptic loosening was very low, making it statistically uncertain to adjust for a large number of potential confounders. The larger number of revisions for any reason gives better statistical strength. In conclusion, we found that the revision rate for modern and frequently used uncemented cups was very low, and cup revision due to aseptic loosening within 2 years was extremely rare. We could not show that the use of cups designed for additional fixation with screws had any advantages in standard patients.

In contrast, cups with screw holes increased the risk of cup revision for any reason. Notably, our study mainly embraces the first decade after the operation. Longer followup is needed to evaluate whether this conclusion remains valid during the second decade. VO: study design, data collection, statistical analysis, data analysis, manuscript writing. SM: statistical analysis, data analysis, manuscript writing. KN and SC: data analysis, manuscript writing. JK: study design, data collection, statistical analysis, data analysis, manuscript writing, study supervision.

Acta thanks Ross W Crawford for help with peer review of this study. Aspenberg P, van der Vis H. Fluid pressure may cause periprosthetic osteolysis: particles are not the only thing. Acta Orthop ; 69 1 : The optimum size of prosthetic heads in relation to the wear of plastic sockets in total replacement of the hip.

Medical Biol Eng ; 7 1 : Direct anterior approach total hip arthroplasty requires less supplemental acetabular screw fixation and fewer blood transfusions than posterior approach. Curr Orthop Pract ; 28 4 : Ideal femoral head size in total hip arthroplasty balances stability and volumetric wear. HSS J ; 8 3 : Less wear with aluminium-oxide heads than cobalt-chrome heads with ultra high molecular weight cemented polyethylene cups: a ten-year follow-up with radiostereometry. Int Orthop ; 36 3 : Hailer N.

Acta Orthop ; 89 3 : The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis: an analysis of 78, operations in the Swedish Hip Arthroplasty Register. The wear rate of highly crosslinked polyethylene in total hip replacement is not increased by large articulations: a randomized controlled trial.

J Bone Joint Surg Am ; 98 21 : The number of screws, bone quality, and friction coefficient affect acetabular cup stability. Med Eng Phys ; 29 10 : Cementless acetabular fixation with and without screws: analysis of stability and migration. J Arthroplasty ; 25 2 : Trabecular metal acetabular components in primary total hip arthroplasty: higher risk for revision compared with other uncemented cup designs in a collaborative register study including 93, hips.

Increased risk of revision of acetabular cups coated with hydroxyapatite. Acta Orthop ; 81 1 : Effects of hydroxyapatite coating of cups used in hip revision arthroplasty. Does hydroxyapatite coating of uncemented cups improve long-term survival? Osteoarthritis Cartilage ; No effect of additional screw fixation of a cementless, all-polyethylene press-fit socket on migration, wear, and clinical outcome: a 6.

Acta Orthop ; 87 4 : Press-fit cementless acetabular fixation with and without screws. Int Orthop Epub Aug Surgical anatomy of the pelvic vasculature, with particular reference to acetabular screw fixation in cementless total hip arthroplasty in Asian population: a cadaveric study. J Orthop Surg Hong Kong ; 25 1 : Stability of uncemented cups—long-term effect of screws, pegs and HA coating: a Year RSA follow-up of total hip arthroplasty.

J Arthroplasty ; 31 1 : Acetabular components with or without screws in total hip arthroplasty. World J Orthop ; 8 9 : Inferior survival of hydroxyapatite versus titanium-coated cups at 15 years. Sensitivity analysis in observational research: introducing the e-value.

Ann Intern Med ; 4 : Micromotion of cementless hemispherical acetabular components. Does press-fit need adjunctive screw fixation? Bone Joint J ; 77 3 : Background and purpose — In total hip replacements, stem design may affect the occurrence of periprosthetic femoral fracture. We studied risk factors for fractures around and distal to the 2 most used cemented femoral stems in Sweden.

The outcome was any kind of reoperation due to fracture around Vancouver type B or distal to the stem Vancouver type C , with use of age, sex, diagnosis at primary THR, and year of index operation as covariates in a Cox regression analysis. A separate analysis of the primary osteoarthritis patient group was done in order to evaluate eventual influence of the surgical approach lateral versus posterior on the risk for Vancouver type B fractures. The elderly, and patients with hip fracture or idiopathic femoral head necrosis, had a higher risk for both fracture types.

Inflammatory arthritis was a risk factor only for type C fractures. Type B fractures were more common in men, and type C in women. A lateral approach was associated with decreased risk for Type B fracture. Interpretation — Stem design influenced the risk for type B, but not for type C fracture.


The influence of surgical approach on the risk for periprosthetic femoral fracture should be studied further. However, most of the previous studies have focused on fractures treated with stem revision Thien et al. It is probable that the shape and the surface finish of the stem contribute to the risk for Vancouver type B fractures fractures around or close to a femoral stem Broden et al. Little research has been done to investigate whether the design of the stem can affect the risk for suffering a fracture distal to the stem Vancouver type C Lowenhielm et al.

The majority of hip arthroplasty registries report only primary procedures and revisions. Therefore, type C fractures, treated in principle with open reduction and internal fixation ORIF without revision, are not reported. A recent register study from Sweden Chatziagorou et al. These figures were, however, not related to the numbers at risk in each group. We are not aware of any study where the majority of type C fractures treated without revision were included.

Nothing is known regarding the influence of surgical approach on the risk for postoperative periprosthetic fracture around a total cemented hip prosthesis. Both the Exeter and the Lubinus stems are frequently used in Sweden. Between and , , Lubinus. Table 1. Stem lengths other than mm were excluded. Further excluFigure 1. Flow chart. Of the 73, originally included patients, 70, remained for analysis. Surgical treatment of fracture types excluded SPII and 53, Exeter stems were used in primary total hip for various reasons was labelled as reoperation due to causes replacements THR Karrholm et al.

Therefore, data linking was ment with osteosynthesis and without stem exchange. Cross-matching for the other types of reoperations mary THR, year of index operation, and surgical approach. The NPR holds information on all inpatient care We hypothesized that Lubinus stems might run an increased since , and all outpatient care since Both private risk of type C fractures because of the high resistance of this and public healthcare providers have had to report to the NPR stem to undergoing type B fractures ending up in a revision.

All medical records of reoperations due to fracture To include all types of surgical procedures of the operated were collected and scrutinized to detect all femoral fractures femur with relation to the hip prosthesis inserted, our primary in patients with a primary THR. The information provided in the case records was also used for fracture classification by outcome was any reoperation due to periprosthetic fracture. GC, according to the Vancouver classification system Brady et al.

A detailed description of the classification process, as well as its validation, is described in a previous publiPatients and methods cation Chatziagorou et al. Bilateral observations were All primary standard Lubinus SPII and Exeter Polished included as previous studies have indicated that this will not stems used in THRs between and , and reported cause significant problems related to dependency Ranstam et to the SHAR, were included. We studied reoperations for al.

To identify eventual , whichever came first. Reoperation was defined as any demographic differences between the Lubinus and the Exeter further surgical intervention related to the index hip arthro- group, a chi-squared test and Mann—Whitney test were used. All type A frac- ysis log rank test. We plotted survival curves for the covaritures fractures of the greater and lesser trochanter , conserva- ates included, and log—log plots to test that the Cox proportively treated periprosthetic fractures, and fractures occurring tional hazard model was fulfilled.

A Cox regression model during insertion of a primary stem intraoperative fractures was used to analyze the relative risk for reoperation due to were excluded. Adjustment for age, sex, type of stem, and diagnosis at spectively, for all primary and secondary arthroplasties. Stem the time of primary THR, as well as the year of index opera-. The distribution of the population into age groups was done according to the age at the time of the primary operation. The aim was to have as equally sized groups as possible. Diagnosis was separated into primary osteoarthritis OA , inflammatory arthritis, hip fracture, idiopathic femoral head necrosis, and various including sequel to childhood hip disease.

Censored were cases with cause of reoperation other than PPFF, excluded cases Table 1 , patients who died without any reoperation, or those who had not been reoperated until the end of The surgical approach lateral versus posterior , as a risk factor for Vancouver type B fracture, was studied in a subgroup analysis. Complete information on surgical approach was available in 43, Lubinus and in 22, Exeter cases with primary OA. Missing data were 9 cases for each stem Table 6.

In the other groups of diagnoses, up to Therefore, we chose to include only those patients operated due to primary OA and with a lateral or posterior incision. Ethics, funding, and potential conflicts of interest The study was approved by the Central Ethical Review Board in Gothenburg Entry number: , Date: There was no financial support for this research. The authors declare no conflict of interest. After the exclusions Figure 1 and Table 1 , there were 79, primary THRs 70, patients , with 2, first-time reoperations 2, patients left for analysis.

The mean follow-up time was 5. Vancouver type and risk factors The proportion of reoperations due to PPFF was higher in the Exeter than in the Lubinus group, as reflected in the survival analyses Table 2, Figure 2. The Exeter stem had a 3. There was no statistically significant difference between the 2 groups regarding the risk of type C fracture. Overall, women more frequently sustained fractures distally to the stem, whereas men had a higher risk for fracture around the stem, and a slightly higher risk for PPFF in general type B or C.

The risk for fracture increased with age, irrespective of whether age was studied as a continuous or a categorical variable. Patients aged 80 years and older had the highest risk for both type B and C fractures, compared with patients younger than 64 years Table 5. Cumulative survival unadjusted for periprosthetic femoral fracture. Mean survival at 10 years was Table 3. Table 4. Distribution of periprosthetic femoral fractures according to the Vancouver classification system. Table 5. Inflammatory arthritis, when compared with primary OA, did not affect the risk for fracture around a stem, but distal to it.

Patients with hip fracture or idiopathic femoral necrosis had approximately 3 times higher risk for type B fractures, and 4 times for type C Table 5. The later the year for the index operation, the more likely the patient would suffer a type B fracture. No corresponding time-related change in risk was observed as regards type C fractures. The subgroup analysis lateral versus posterior approach was done in 43, Lubinus SPII stems and 21, Exeter Polished stems, inserted. Table 6. Distribution of surgical approach among hips with primary OA. Exeter and 9 Lubinus stems with unknown approach were excluded.

Only patients operated with lateral or posterior approach were included in the separate regression analysis. Stems inserted with the posterior approach had a 1. Discussion Several previous studies have demonstrated an increased risk for periprosthetic fracture of the Exeter when compared with the Lubinus stem Lindahl et al. To our knowledge, this is the first study that distinguished between Vancouver type B and type C fractures, based on extensive research to include all reoperations.

Earlier studies have either looked at the overall risk for periprosthetic fracture Lindahl et al. Our main finding is that the Lubinus SPII did not have a higher risk for type C fractures, despite the fact that almost 3 out of 4 fractures around this stem were located distal to it see Table 4. The finding that the Exeter Polished stem had a higher risk for fracture type B and overall , confirms earlier publications Lindahl et al. The commonest fracture type in this material was, however, type C see Table 4.

This observation results from an almost complete registration of fractures treated with osteosynthesis only, and without any stem revision Chatziagorou et al. In Sweden, type B fractures are more common in uncemented stems, and type C fractures in cemented stems Chatziagorou et al. Its shape allows. Table 7. The anatomical shape of this stem probably facilitates an adequate cement mantle Broden et al. It does not bond to the cement and is designed to subside into the cement mantle as a wedge Palan et al. Both stems are well documented with excellent outcomes in the short and long term Murray et al.

It is postulated that the subsidence of the Exeter stem into the cement mantle will create an axial loading effect within the cement mantle, resulting in hoop stresses in the adjacent bone, which might increase the risk of sustaining a PPFF. As soon as a periprosthetic fracture occurs close to an Exeter stem, the stem is by definition loose Broden et al. The reason why forceclosed cemented stems have a higher risk for periprosthetic fractures has been reported previously Broden et al. The higher percentage of type C fractures within Lubinus SPII stems possibly has to do with the relative lower risk for fractures close to it type B.

Previous comparisons between the posterior and the lateral approach showed superior results for the former regarding the thickness of the cement mantle Hank et al.

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Femurs with a loose stem are more prone to suffer a periprosthetic fracture Lindahl et al. Thus, the posterior surgical approach should be beneficial regarding the risk for aseptic loosening and, hence, the risk for type B fractures around a loose stem. We are not aware of any publication where the surgical approach is studied as a risk factor for postoperative periprosthetic femoral fractures, secondary to a primary cemented THR.

Berend et al. A more recent study showed that patients older than 85 years, with hemiarthroplasty, had 2 times higher risk for postoperative PPFF if operated with a posterior approach, compared with those operated via a direct lateral approach Rogmark et al. Our finding, that use of a posterior approach is associated with a higher risk for PPFF, is difficult to explain.

A radiostereometric study Glyn-Jones et al. Gore et al. A Cochrane review Jolles and Bogoch also reported increased internal rotation of the hip joint in extension with use of the posterior approach, suggesting that implant loading might differ depending on the approach used. We studied risk factors in patients with cemented Lubinus or Exeter stems and only those suffering a postoperative PPFF on the same side, and without any history of previous reoperation. Therefore, a generalization of our results for the whole population of patients with THR would be unreliable.

High age, as well as the diagnosis of hip fracture or idiopathic femoral head necrosis, implied an increased risk for both type B and C fracture. Men had a higher risk for type B fractures, probably because of younger age with increased daily activity level Witte et al. Conversely, women, with more osteoporotic femoral bone and higher mean age at the time of primary THR, more frequently suffered type C fractures. The year of index operation influenced the risk for type B and not for type C fractures. This is probably the result of the increasing mean age at the index operation during the study period, from 71 years in to 72 years in Another reason could, theoretically, be a trend toward a decrease in.

The addition of the surgical approach in the subgroup analysis did not alter the relation of the other risk factors age, sex, stem type, and year of primary THR. Inflammatory arthritis did not have a higher risk for fractures around the stem when compared with primary OA. This finding is in line with a previous report Thien et al. On the other hand, femurs with inflammatory arthritis run a 6-times higher risk for distal femoral fractures. This is in accordance with a previous publication that reported a higher risk for osteoporotic fractures Yamamoto et al.

There are limitations to our study. The linkage between the SHAR and the NPR included only reoperations due to periprosthetic fracture and not all other reasons for reoperation aseptic loosening, infection, dislocation, other. These reoperations are recorded in the SHAR, but could be underreported, especially those performed owing to infection Lindgren et al. Therefore, the real number of all reoperations could be slightly higher than found by us.

Reoperations that took place before the PPFF were detected when the case records were scrutinized. All other reoperations not reported to the SHAR could most probably be expected to be equally distributed between the 2 groups studied. Another limitation, however, is that we did not include the presence of a total knee replacement TKR as a risk factor. Total hip replacements with an ipsilateral TKR have a higher risk for proximal femoral fracture Katz et al.

We do not, however, think that the relative number of patients with TKR differs between those who have been operated with a Lubinus and those who have received an Exeter stem. Hips with primary osteoarthritis and inflammatory arthritis had almost the same share in the 2 groups. It is also important to underline that the classification process was based on reading of medical records.

A better optimized way would be to define the fracture type based on information from both the medical records and the radiographs. In a previous validation of the classification process Chatziagorou et al. In addition, our analysis was based only on fractures classified as either B or C, without any further analyses of the sub-categories in the type B group. The methodological strength of this study was the relatively good data quality of a large volume of material, and its high external validity regarding PPFFs in the Swedish population.

The hip prostheses studied in our report have a long tradition in Sweden with excellent implant survival Junnila et al. The volume of our data was big enough to analyze only stems of the same length mm. A difference in stem length can potentially affect the risk of periprosthetic fracture and its classification into type B or C. We also excluded unce-. Furthermore, we investigated all kind of reoperations due to PPFF, and not only revisions, which is the contemporary standard in other arthroplasty registries. This, in addition to the cross-matching with the NPR, gave us the unique opportunity to study an almost complete data set of fractures treated surgically with other methods such as ORIF and without concomitant revision of the stem mostly type B1 and C fractures.

Overall, the Exeter stem had almost an 3. According to our findings and previous studies the difference in risk ratio will increase further with increasing age and in patients with secondary OA. Lindahl et al. We therefore think that our findings have clinical relevance and especially in the older population with a high incidence of osteoporosis. As regards type C fractures there was no difference.

The relative increased proportion of type C versus type B fractures in the Lubinus group might indicate that, after the insertion of a Lubinus stem, the distal femur will constitute the weakest part as long as the stem has not loosened. Our study suggested that the posterior approach may not be beneficial regarding the risk of PPFF in cemented THRs, but this observation needs to be studied further.

GC: Planning of the research, collection of the material, analysis of the material, manuscript. HL: Planning of the research, collection of the material, manuscript. JK: Planning of the research, analysis of the material, manuscript. Epidemiology of periprosthetic fracture of the femur in 32 primary total hip arthroplasties: a year experience.

Bone Joint J ; b 4 : Long-term outcome and risk factors of proximal femoral fracture in uncemented and cemented total hip arthroplasty in hips. J Arthroplasty ; 21 6 Suppl 2 : Classification of the hip. Orthop Clin North Am ; 30 2 : The reliability and validity of the Vancouver classification of femoral fractures after hip replacement. J Arthroplasty ; 15 1 : High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem.

Acta Orthop ; 86 2 : Migration of cemented stem and restrictor after total hip arthroplasty: a radiostereometry study of 25 patients with Lubinus SP II stem.

The Corail(r) Hip System: A Practical Approach Based on 25 Years of Experience

J Arthroplasty ; 20 2 : Incidence and demographics of surgically treated periprosthetic femoral fractures around a primary hip prosthesis. Hip Int ; Jul 1: doi: Risk factors for periprosthetic fractures of the hip: a survivorship analysis. Clin Orthop Relat Res ; 7 : The influence of surgical approach on cemented stem stability: an RSA study.

Clin Orthop Relat Res ; Anterolateral compared to posterior approach in total hip arthroplasty: differences in component positioning, hip strength, and hip motion. Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register. Anatomic stem design reduces risk of thin cement mantles in primary hip replacement. Arch Orthop Trauma Surg ; 1 : Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. Cochrane Database Syst Rev ; 3 : Cd Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty Register Association database.

Acta Orthop ; 87 6 : Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study. BMC Musculoskelet Disord ; The Swedish Hip Arthroplasty Register Annual Report Periprosthetic femoral fractures: classification and demographics of periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty ; 20 7 : The type of surgical approach influences the risk of revision in total hip arthroplasty: a study from the Swedish Hip Arthroplasty Register of 90, total hip replacements with 3 different cemented prostheses.

Acta Orthop ; 83 6 : Validation of reoperations due to infection in the Swedish Hip Arthroplasty Register. Fracture of the lower extremity after total hip replacement. Arch Orthop Trauma Surg ; 3 : McGraw P, Kumar A. Periprosthetic fractures of the femur after total knee arthroplasty. J Orthop Traumatol ; 11 3 : The risk of periprosthetic fracture after primary and revision total hip and knee replacement.

J Bone Joint Surg Br ; 93 1 : Ten-year RSA-measured migration of the Exeter femoral stem. The influence of cemented femoral stem choice on the incidence of revision for periprosthetic fracture after primary total hip arthroplasty: an analysis of national joint registry data. Bone Joint J ; B 10 : Excellent results with the cemented Lubinus SP II mm femoral stem at 10 years of follow-up: hips followed for 5—15 years.

Acta Orthop ; 85 3 : Statistical analysis of arthroplasty data, II: Guidelines. Acta Orthop ; 82 3 : European validation of the Vancouver classification of periprosthetic proximal femoral fractures.

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  4. J Bone Joint Surg Br ; 90 12 : Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients. Acta Orthop ; 85 1 : Migration measurement of the cemented Lubinus SP II hip stem: a year follow-up using radiostereometric analysis. Biomed Tech Berl ; 62 3 : J Arthroplasty ; 15 7 : Periprosthetic femoral fracture within two years after total hip replacement: analysis of , operations in the Nordic Arthroplasty Register Association database.

    Templating should be done with a medium neck so that the possibility to change to a short or a long neck still remains in order to adjust leg length. The pre-operative templating will indicate the level of neck resection. In Dorr Type A champagne flute femurs 26 Figure 1 proper metaphyseal fit may require a larger size than the femoral canal can accommodate distally.

    Narrow Canal Thick Cortices Figure 1. Femoral Neck Resection The angle of resection should be The neck resection guide should be used to determine the level of the femoral neck resection in conjunction with pre-operative templating. If the resection is too high, it may result in a varus positioned stem. Note: the osteotomy can be performed in one or two steps depending on the surgeon s preference.

    Proximal Cancellous Bone Compaction It is important to select a point of entry posterolaterally to the Piriformis Fossa to avoid varus positioning.

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    Use a curette or general instrument to indicate the direction of the canal. Use the bone tamp to compact the cancellous bone proximally. To prevent under-sizing or varus positioning, the greater trochanter may be prepared with an osteotome to allow better insertion of the broaches.

    Findbook > 商品簡介 > The Corail Hip Sysytem: A Practical Approach Based on 25 Years of Experience

    The broach should run parallel to the posterior cortex following the natural anatomy of the femur. Begin with the smallest broach attached to the broach handle and increase the size of broach sequentially until longitudinal and rotational stability is achieved, broaching should then be stopped. Careful preoperative planning is key to help selection of the final broach size. The version will be determined by the natural version of the femur. The calcar reaming should allow an optimised fit of the collar on the calcar. Note: Ensure all soft tissue is clear before performing calcar reaming.

    Femoral Component Insertion Important Note: The protective covers should be left on until the components are ready to be implanted. Before implanting a femoral head, the male taper on the femoral stem should be wiped clean of any blood, bone chips or other foreign materials. The HA coating should sit level with the milled femoral neck. With the final broach in situ, attach the appropriate trial neck and trial head.

    Reduce the hip and assess what adjustments, if any, are required to ensure stability through a full range of motion. Remove the trial head, neck trial and final broach. Do not irrigate or dry the femoral canal. This will help to preserve the compacted cancellous bone quality and encourage osteointegration of the stem. This will help avoid changing the version as a precautionary measure. You should not have more than a thumb s breadth between the resection line and the top of the HA coating on the stem. If the stem does not readily go down this far, the surgeon should broach again.

    If the HA level of the stem sinks below the resection line, the surgeon should consider a larger stem or using a collar. Then lightly tap the stem impactor to fully seat the stem. Note: The stem is 0. A final trial reduction is carried out to confirm joint stability and range of motion. Clean and dry the stem taper carefully to remove any particulate debris. Place the femoral head onto the taper and lightly tap it especially if a ceramic head is used using the head impactor. Ensure bearing surfaces are clean and finally reduce the hip. This stem must not be implanted in patient weighing more than 60kg lb.

    The maximum offset for the head is limited to 13mm. Pre-operative Planning X-ray templates are used during the pre-operative planning to define the femoral neck cutting plane, the degree of lateralisation and the positioning of the cup inside the native acetabular cavity. Pre-op templating Femoral Neck Resection Following exposure of the proximal femur, the first neck cut is made higher than the one planned, in order to remove the femoral head. The second neck cut will depend on the implant chosen during the pre-operative planning.

    If the implant chosen is the K6S, then the neck cut will be a 45 angle cut. If the implant chosen is the K6A, then the neck cut will be biplaner as identified. The chosen broach is inserted firmly down to the level of the cervical cutting plane. The trial stem is introduced to the prepared cavity. Joint mobility and stability tests can be carried out using trial heads. Implant K6S Implant K6A Femoral Head Impaction The stem is introduced by hand first and then impacted down to the level of either the hydroxyapatite coating in case of the K6S or at the level of the trochanteric bearing in case of the K6A.

    To implant the cemented option the following additional steps are required. Cement Restrictor - Trial Select the size of trial cement restrictor identified during pre-operative templating to fit the distal canal. Attach it to the cement restrictor inserter and insert the trial cement restrictor to the planned depth. Check that it is firmly seated in the canal.

    Corail stem wm

    Remove the trial cement restrictor. By using pulse lavage prior to setting the cement restrictor, the risks of creating fatty embolism will be reduced. Note: The size of the cement restrictor should be one size larger than the last trial restrictor inserted to the planned level. The planned level should be 1cm below the tip of the implant Implant Size Stem Length Crotch point to distal tip Restrictor Depth 8 95 mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm Table 1 Final Bone Preparation The bone can be dried by passing a swab down the femoral canal which helps to remove any remaining debris.

    Assess the viscosity of the cement. The cement is ready for insertion when it has taken on a dull, doughy appearance and does not adhere to the surgeon s glove. Start at the distal part of the femoral canal and inject the cement in a retrograde fashion, allowing the cement to push the nozzle gently back, until the canal is completely filled and the distal tip of the nozzle is clear of the canal.

    Note: Setting time may vary if the cement components or mixing equipment have not been fully equilibrated to 23 C before use. The cement must be pressurised to ensure good interdigitation of the cement into the trabecular bone. Continually inject cement during the period of pressurisation. Use the femoral preparation kit curettes to remove excess bone cement. Implant insertion can begin when the cement can be pressed together without sticking to itself. Select a stem of the same size as the final broach inserted.

    Introduce the implant using the curved stem inserter in line with the long axis of the femur in one slow movement. Its entry point should be lateral, close to the greater trochanter. During stem insertion maintain thumb pressure on the cement at the medial femoral neck. Insert the stem up to the resection level. If necessary, a few light taps on the stem inserter will bring the stem to the right level. Remove excess cement with a curette. Maintain pressure until the cement is completely polymerised. Femoral Head Impaction A final trial reduction is carried out to confirm joint stability and range of motion.

    Medium and long-term performance of uncemented primary femoral stems from the Norwegian arthroplasty register. Bone Joint Surg. Cells and Materials, ;5: Chatelet J-C. Survivorship in consecutive cases at 12 years. Survivorship patients. Femoral bone modelling in HA coated stems with 20 yrs follow-up. Orthopaedic Data Evaluation Panel. ODEP product ratings. Fessy MH and Bonnin M. Impingement: how to avoid the risk. The Corail Hip System. Natural history of osteointegration: look through the microscope. Acta Orthop. HA Coating.

    Acta Orthrop Belg. Intramedullary design: squaring the circle. A Randomized, Controlled Trial.