Shichman Ittai, Gemer Neta, Ashkenazi Itay, Sarfraz Anzar, Snir Nimrod, Schwarzkopf Ran, Rozell Joshua C, Warschawski Yaniv
Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
New York University Langone Medical Center, New York, USA.
Arch Orthop Trauma Surg. 2025 Apr 24;145(1):266. doi: 10.1007/s00402-025-05894-w.
Optimal femoral stem alignment and femoral canal fill have been associated with improved osteointegration in patients undergoing cementless total hip arthroplasty (THA). Direct anterior approach (DAA) has become more popular among new surgeons, and the ability to achieve appropriate stem alignment and canal fill due to limited surgical exposure may pose added risks. To mitigate these concerns, several modern tissue sparing stem designs have been designed. This study aimed to compare implant canal fill and alignment between two of the leading DAA-friendly femoral stems available.
This was a multi-center, retrospective study of patients who underwent DAA THA with either A (n = 149) or B stem (n = 85) between 2021 and 2023 and had a minimum one-year follow-up. Radiographic measures of proximal femoral morphology, including canal calcar ratio (CCR), Morphological Cortical Index (MCI), and Dorr Class (based on the CCR), as well as postoperative measures including femoral canal fill ratio (CFR), signs of osteointegration and stem alignment were analyzed and compared between stem types.
Proximal femoral morphology was similar between groups, as suggested by the CCR (p = 0.600), MCI (p = 0.489) and Dorr class distribution (p = 0.516). Patients who received stem A had improved CFR at the level of the lesser trochanter compared to patients who received stem B (0.73 vs. 0.70, respectively; p = 0.042), with similar CFR at the tip of the stem (0.76 vs. 0.77, p = 0.562). Similarly, there was a trend towards improving stem alignment for stem A patients (2.16 vs. 2.47, p = 0.082). Spot weld formation was significantly higher in stem A group (59.7% vs. 37.6%, P = 0.001).
For patients with similar femoral morphology undergoing DAA THA, the stem A group demonstrated superior anatomical fit in the metaphyseal region, as evidenced by CFR, spot weld formation and implant positioning. Further longer follow up research is needed to elucidate these findings and their correlation to clinical outcomes.
在接受非骨水泥型全髋关节置换术（THA）的患者中，最佳的股骨柄对线和股骨髓腔填充与改善骨整合相关。直接前路入路（DAA）在新外科医生中越来越受欢迎，由于手术暴露有限，实现适当的柄对线和髓腔填充的能力可能会带来额外风险。为了减轻这些担忧，已经设计了几种现代的保留组织的柄设计。本研究旨在比较两种领先的适合DAA的股骨柄之间的植入物髓腔填充和对线情况。
这是一项多中心回顾性研究，研究对象为2021年至2023年间接受DAA THA并使用A柄（n = 149）或B柄（n = 85）且至少随访一年的患者。分析并比较了两组患者股骨近端形态的影像学测量指标，包括股骨距比（CCR）、形态学皮质指数（MCI）和Dorr分级（基于CCR），以及术后测量指标，包括股骨髓腔填充率（CFR）、骨整合迹象和柄对线情况。
两组之间股骨近端形态相似，CCR（p = 0.600）、MCI（p = 0.489）和Dorr分级分布（p = 0.516）表明了这一点。与接受B柄的患者相比，接受A柄的患者在小转子水平的CFR有所改善（分别为0.73和0.70；p = 0.042），在柄尖处的CFR相似（0.76和0.77，p = 0.562）。同样，A柄患者的柄对线有改善的趋势（2.16对2.47，p = 0.082）。A柄组的点焊形成率明显更高（59.7%对37.6%，P = 0.001）。
对于接受DAA THA且股骨形态相似的患者，A柄组在干骺端区域表现出更好的解剖适应性，CFR、点焊形成和植入物定位证明了这一点。需要进一步进行更长时间的随访研究来阐明这些发现及其与临床结果的相关性。
