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

Jonathon Lindner; Jonathan Napier; Anthony Feher; Heather S Haeberle; Linsen T Samuel; Michael A Mont; Ronald Delanois; Arthur L Malkani

doi:10.21037/atm.2019.08.124

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

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

Authors

Jonathon Lindner¹, Jonathan Napier², Anthony Feher³, Heather S Haeberle⁴, Linsen T Samuel⁵, Michael A Mont⁶, Ronald Delanois⁷, Arthur L Malkani⁸

Affiliations

¹ Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA.
² Department of Emergency Medicine, University of Kentucky, Lexington, KY, USA.
³ Franciscan Health Total Joint Reconstruction, Carmel, IN, USA.
⁴ Baylor College of Medicine, Houston, TX, USA.
⁵ Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
⁶ Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA.
⁷ Rubin Institute for Advanced Orthopedics, Owings Mills, MD, USA.
⁸ Adult Reconstruction Program, University of Louisville, Louisville, KY, USA.

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.