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Perspectives on metaphyseal conservative stems

Total hip replacement is showing, during the last decades, a progressive evolution toward principles of reduced bone and soft tissue aggression. These principles have become the basis of a new philosophy, tissue sparing surgery. Regarding hip implants, new conservative components have been proposed...

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Detalles Bibliográficos
Autores principales: Falez, F., Casella, F., Panegrossi, G., Favetti, F., Barresi, C.
Formato: Texto
Lenguaje:English
Publicado: Springer Milan 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656972/
https://www.ncbi.nlm.nih.gov/pubmed/19384482
http://dx.doi.org/10.1007/s10195-008-0105-4
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author Falez, F.
Casella, F.
Panegrossi, G.
Favetti, F.
Barresi, C.
author_facet Falez, F.
Casella, F.
Panegrossi, G.
Favetti, F.
Barresi, C.
author_sort Falez, F.
collection PubMed
description Total hip replacement is showing, during the last decades, a progressive evolution toward principles of reduced bone and soft tissue aggression. These principles have become the basis of a new philosophy, tissue sparing surgery. Regarding hip implants, new conservative components have been proposed and developed as an alternative to conventional stems. Technical and biomechanical characteristics of metaphyseal bone-stock-preserving stems are analyzed on the basis of the available literature and our personal experience. Mayo, Nanos and Metha stems represent, under certain aspects, a design evolution starting from shared concepts: reduced femoral violation, non-anatomic geometry, proximal calcar loading and lateral alignment. However, consistent differences are level of neck preservation, cross-sectional geometry and surface finishing. The Mayo component is the most time-tested component and, in our hands, it showed an excellent survivorship at the mid-term follow-up, with an extremely reduced incidence of aseptic loosening (partially reduced by the association with last generation acetabular couplings). For 160 implants followed for a mean of 4.7 years, survivorship was 97.5% with 4 failed implants: one fracture with unstable stem, 1 septic loosening and 2 aseptic mobilizations. DEXA analysis, performed on 15 cases, showed a good calcar loading and stimulation, but there was significant lateral load transfer to R3–R4 zones, giving to the distal part of the stem a function not simply limited to alignment. Metaphyseal conservative stems demonstrated a wide applicability with an essential surgical technique. Moreover, they offer the options of a “conservative revision” with a conventional primary component in case of failure and a “conservative revision” for failed resurfacing implants.
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spelling pubmed-26569722009-03-25 Perspectives on metaphyseal conservative stems Falez, F. Casella, F. Panegrossi, G. Favetti, F. Barresi, C. J Orthop Traumatol Tissue-Sparing Surgery Section Total hip replacement is showing, during the last decades, a progressive evolution toward principles of reduced bone and soft tissue aggression. These principles have become the basis of a new philosophy, tissue sparing surgery. Regarding hip implants, new conservative components have been proposed and developed as an alternative to conventional stems. Technical and biomechanical characteristics of metaphyseal bone-stock-preserving stems are analyzed on the basis of the available literature and our personal experience. Mayo, Nanos and Metha stems represent, under certain aspects, a design evolution starting from shared concepts: reduced femoral violation, non-anatomic geometry, proximal calcar loading and lateral alignment. However, consistent differences are level of neck preservation, cross-sectional geometry and surface finishing. The Mayo component is the most time-tested component and, in our hands, it showed an excellent survivorship at the mid-term follow-up, with an extremely reduced incidence of aseptic loosening (partially reduced by the association with last generation acetabular couplings). For 160 implants followed for a mean of 4.7 years, survivorship was 97.5% with 4 failed implants: one fracture with unstable stem, 1 septic loosening and 2 aseptic mobilizations. DEXA analysis, performed on 15 cases, showed a good calcar loading and stimulation, but there was significant lateral load transfer to R3–R4 zones, giving to the distal part of the stem a function not simply limited to alignment. Metaphyseal conservative stems demonstrated a wide applicability with an essential surgical technique. Moreover, they offer the options of a “conservative revision” with a conventional primary component in case of failure and a “conservative revision” for failed resurfacing implants. Springer Milan 2008-03-13 2008-03 /pmc/articles/PMC2656972/ /pubmed/19384482 http://dx.doi.org/10.1007/s10195-008-0105-4 Text en © Springer-Verlag Italia 2008
spellingShingle Tissue-Sparing Surgery Section
Falez, F.
Casella, F.
Panegrossi, G.
Favetti, F.
Barresi, C.
Perspectives on metaphyseal conservative stems
title Perspectives on metaphyseal conservative stems
title_full Perspectives on metaphyseal conservative stems
title_fullStr Perspectives on metaphyseal conservative stems
title_full_unstemmed Perspectives on metaphyseal conservative stems
title_short Perspectives on metaphyseal conservative stems
title_sort perspectives on metaphyseal conservative stems
topic Tissue-Sparing Surgery Section
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656972/
https://www.ncbi.nlm.nih.gov/pubmed/19384482
http://dx.doi.org/10.1007/s10195-008-0105-4
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