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. 2023 Aug 30;11(10):349.
doi: 10.21037/atm.2019.08.124. Epub 2019 Sep 23.

Cementless tapered wedge stems in patients undergoing primary total hip arthroplasty with Dorr C bone-are complication risks increased?

Jonathon Lindner  1 , Jonathan Napier  2 , Anthony Feher  3 , Heather S Haeberle  4 , Linsen T Samuel  5 , Michael A Mont  6 , Ronald Delanois  7 , Arthur L Malkani  8
Affiliations

Cementless tapered wedge stems in patients undergoing primary total hip arthroplasty with Dorr C bone-are complication risks increased?

Jonathon Lindner et al. Ann Transl Med. .

Abstract

Background: The use of cementless femoral stems in patients undergoing primary total hip arthroplasty (THA) with Dorr C bone remains controversial for fear of fracture or subsidence. Purpose of this multicenter study was to compare clinical outcomes and complications of THA using a tapered femoral prosthesis in patients with Dorr C bone versus Dorr A/B bone.

Methods: A total of 1,030 patients underwent primary THA with a tapered wedge femoral stem at a minimum one year follow up. Forty-eight patients with Dorr C bone (mean age 68.7 years) were compared with a matched cohort of patients with Dorr A/B bone (mean age 69.9 years). Mean follow-up was approximately 4 years in both cohorts. There were no differences in sex, age, body mass index (BMI), Harris Hip Score (HHS), complications, and radiographic outcomes including subsidence and aseptic loosening were evaluated.

Results: Postoperative HHSs were a mean of 82 points in the Dorr C cohort compared to 84 points in the Door A/B cohort (P=0.2653). There was no significant difference in complication or revision rates for any reason (P=0.23). Mean subsidence for the Dorr C and Dorr A/B was 1.4 and 1.2 mm, respectively (P=0.5164), and there was no aseptic loosening of the femoral component found in either group.

Conclusions: Current generation tapered wedge cementless femoral stems provide stable fixation for patients with Dorr C bone quality without increased complications with respect to fracture or subsidence and can be considered an alternative to cemented stems in patients with compromised bone quality.

Keywords: Dorr C bone; Primary total hip arthroplasty (primary THA); clinical outcomes; complications; radiographic outcomes; tapered wedge cementless femoral stem.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm.2019.08.124/coif). RD declares the following outside of the submitted work: Baltimore City Medical Society: board or committee member; Flexion Therapeutics: research support; Orthofix, Inc.: research support; Stryker: research support; tissue Gene: research support; United Orthopedics: research support. MAM declares the following outside of the submitted work: AAOS: board or committee member; American Association of Hip and Knee Surgeons: board or committee member; Cymedica: paid consultant; DJ Orthopaedics: paid consultant; research support; Flexion Therapeutics: paid consultant; Johnson & Johnson: paid consultant; research support; Journal of Arthroplasty: editorial or governing board; Journal of Knee Surgery: editorial or governing board; Knee Society: board or committee member; Medicus Works LLC: publishing royalties, financial or material support; Microport: IP royalties; National Institutes of Health (NIAMS & NICHD): research support; Ongoing Care Solutions: paid consultant; research support; Orthopedics: editorial or governing board; Orthosensor: paid consultant; research support; Pacira: paid consultant; Peerwell: paid consultant; stock or stock options; Performance Dynamics: paid consultant; Pfizer: paid consultant; Skye Biologics: paid consultant; Stryker: IP royalties; paid consultant; research support; Surgical Techniques International: editorial or governing board; TissueGene: paid consultant; research support; Up-to-Date: publishing royalties, financial or material support; USMI: stock or stock options; Wolters Kluwer Health-Lippincott Williams & Wilkins: publishing royalties, financial or material support. ALM declares the following outside of the submitted work: AAOS: board or committee member; Journal of Arthroplasty: editorial or governing board; Stryker: IP royalties; paid consultant; paid presenter or speaker; research support. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Preoperative X-rays of a 67-year-old patient with a history of osteoporosis, previous retained hardware and severe left hip osteoarthritis.
Figure 2
Figure 2
Postoperative X-rays of a 67-year-old patient demonstrating a stable, well-fixed tapered wedge Accolade II implant.
See this image and copyright information in PMC

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