Are there limits for a cementless short hip stem?

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1 Are there limits for a cementless short hip stem? Results after 2 year follow up Dr. Sabine Mai Consulting Surgeon Vitos Orthopädische Klinik Kassel Germany Akademisches Lehrkrankenhaus der Universität TITEL DER Marburg PRÄSENTATION XX.XX.2009 Ärztlicher Direktor: Prof. W. Siebert

2 Multicenter Study starting right from the beginning 2010 including learning curve Bürgerspital Solothurn 85 Hopital de Zone de Nyon 64 Orthopädische Klinik Kassel 279 Park-Krankenhaus Leipzig 235 St. Josefs-Hospital Wiesbaden 221 All together 884

3 Optimys Femoral neck partly preserving

4 BMI related 2 year Results (Multicenterstudy optimys ) Class BMI N 884 Age (24-91) Gender f / m (50 / 50) 1 < 25 normal weight over weight / / 61 3 > 30 obese / 45

5 Optimys - Obesity Diagnosis Class 1 Class 2 Class 3 Osteoarthritis Secondary Arthritis Necrosis Dysplasia Duration median Class 1 Class 2 Class

6 Complications Optimys-obesity Intraop Complications Class 1 Class 2 Class 3 None 94,3 96,7 94,5 Fissure of femur 0,8 0,5 1,2 Trochanter avulsion 1,2 0,3 0,4 Postop Complications Class 1 Class 2 Class 3 None 96,4 94,8 92,8 Haematoma /seroma 1,2 3,4 4,4 Wound healing problem 0 0,3 1,6 Nerve palsy 0,8 1,3 0 Thrombosis, embolism 0 0,5 0,8

7 Optimys-obesity Adverse events, Revisions Complication Class 1 1,6 Class 2 2,3 Class 3 4 Periprosthetic fracture femur Aseptic loosening stem Deep infection 0 1 early 3 late (9-12 mo) 1 superficial 1 late (8 mo)

8 Radiological evaluation Optimys-obesity Class 1 Class 2 Class 3 Subsidence 1,9 2,7 1,8 Hypertrophy painless Lucent lines Zone 1 and/or 7 3,3 4,5 5,5 0,5 2,7 1,

9 rest VAS pain Optimys-obesity load

10 Harris Hip Score VAS Satisfaction Optimys-obesity

11 Age related 2 year Results (Multicenterstudy optimys ) Class N 403 Age Mean (range) Gender f / m young 261 < / 58 elderly 139 > / 45

12 Diagnosis young Optimys-age elderly Osteoarthritis Secondary Arthritis Necrosis 9 4 Dysplasia 15 0,7 Inflammatory arthritis 1,5 1,4

13 Complications Optimys-age Intraop Complications young elderly None Fissure of femur 1,1 1,4 Trochanter avulsion 0,4 0,7 Acetabulum perforation 1,9 5 Postop Complications young elderly None Haematoma /seroma 3,1 3,6 Wound healing problem 0,4 0,7 Nerve palsy 0,8 1,4

14 Adverse events Optimys-age Complication Young (cases) Elderly (cases) Periprosthetic fracture stem 1 3 Aseptic loosening 3 0 Infection 4 late deep infections (8-12 months) 1 superficial infection

15 Radiological evaluation Optimys-age Subsidence 6-12 weeks young (-7 mm) 12 Elderly (-3 mm) 8 Slight painless Hypertrophy Gruen zone 3 and 5 no difference between classes Slight lucent line Gruen zone 1 and 7 no difference between classes

16 Harris Hip Score Optimys-age similar results Pain at rest Load pain satisfaction

17 Literature: Obesity and standard THA Higher Risk for Woundhealing problems, infections Malplacement (esp. cup) Dislocation Aseptic loosening Revisions Systemic complications Obesity and total joint arthroplasty, a literature based review. Bryan D. Springer et al.; The journal of arthroplasty 2013; 28: Obesity in THA does it really matter? A meta analysis. Haverkamp D. et al.; Acta Orthop 2011; 82 (4): Age and Obesity are risk factors for adverse events after THA. Huddleston J.I. et al.; Clin Orthop Relat Res 2012; 470:

18 Revision rate age related Dg: primary OA, conventional stem Intraoperative fractures Register Orthopädische Klinik Kassel Spartakus Spotorno Type Twinsys Corail Type Optimys shortstem 4 0,8 0, cases 614 cases 300 cases Australian Registry: 1. September December 2013

19 Conclusion Young obese patients seem to have a higher risk of aseptic loosening. The short stem optimys seems to be safe with obese and elderly patients. Follow up will be continued.

20 Dokumentastadt Schloss Wilhelmshöhe Kassel Himmelsstürmer Herkules u. Löwenburg

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