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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...
Autores principales: | , , , , |
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Formato: | Texto |
Lenguaje: | English |
Publicado: |
Springer Milan
2008
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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. |
format | Text |
id | pubmed-2656972 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2008 |
publisher | Springer Milan |
record_format | MEDLINE/PubMed |
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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