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Variability in Femoral Preparation and Implantation Between Surgeons Using Manual and Powered Impaction in Total Hip Arthroplasty

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Variability in Femoral Preparation and Implantation Between Surgeons Using Manual and Powered Impaction in Total Hip Arthroplasty. / Konow, Tobias; Bätz, Johanna; Beverland, David; Board, Tim; Lampe, Frank; Püschel, Klaus; Morlock, Michael M.

In: Arthroplasty today, Vol. 14, 04.2022, p. 14-21.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Konow, T, Bätz, J, Beverland, D, Board, T, Lampe, F, Püschel, K & Morlock, MM 2022, 'Variability in Femoral Preparation and Implantation Between Surgeons Using Manual and Powered Impaction in Total Hip Arthroplasty', Arthroplasty today, vol. 14, pp. 14-21. https://doi.org/10.1016/j.artd.2021.10.005

APA

Konow, T., Bätz, J., Beverland, D., Board, T., Lampe, F., Püschel, K., & Morlock, M. M. (2022). Variability in Femoral Preparation and Implantation Between Surgeons Using Manual and Powered Impaction in Total Hip Arthroplasty. Arthroplasty today, 14, 14-21. https://doi.org/10.1016/j.artd.2021.10.005

Vancouver

Konow T, Bätz J, Beverland D, Board T, Lampe F, Püschel K et al. Variability in Femoral Preparation and Implantation Between Surgeons Using Manual and Powered Impaction in Total Hip Arthroplasty. Arthroplasty today. 2022 Apr;14:14-21. https://doi.org/10.1016/j.artd.2021.10.005

Bibtex

@article{54fc08e7ef5e4cbcb30213e07e336c69,
title = "Variability in Femoral Preparation and Implantation Between Surgeons Using Manual and Powered Impaction in Total Hip Arthroplasty",
abstract = "BACKGROUND: The influence of the surgical process on implant loosening and periprosthetic fractures (PPF) as major complications in uncemented total hip arthroplasty (THA) has rarely been studied because of the difficulty in quantification. Meanwhile, registry analyses have clearly shown a decrease in complications with increasing experience. The goal of this study was to determine the extent of variability in THA stem implantation between highly experienced surgeons with respect to implant size, position, press-fit, contact area, primary stability, and the effect of using a powered impaction tool.METHODS: Primary hip stems were implanted in 16 cadaveric femur pairs by three experienced surgeons using manual and powered impaction. Quantitative CTs were taken before and after each process step, and stem tilt, canal-fill-ratio, press-fit, and contact determined. Eleven femur pairs were additionally tested for primary stability under cyclic loading conditions.RESULTS: Manual impactions led to higher variations in press-fit and contact area between the surgeons than powered impactions. Stem tilt and implant sizing varied between surgeons but not between impaction methods. Larger stems exhibited less micromotion than smaller stems.CONCLUSIONS: Larger implants may increase PPF risk, while smaller implants reduce primary stability. The reduced variation for powered impactions indicates that appropriate measures may promote a more standardized process. The variations between these experienced surgeons may represent an acceptable range for this specific stem design. Variability in the implantation process warrants further investigations since certain deviations, for example, a stem tilt toward varus, might increase bone stresses and PPF risk.",
author = "Tobias Konow and Johanna B{\"a}tz and David Beverland and Tim Board and Frank Lampe and Klaus P{\"u}schel and Morlock, {Michael M}",
note = "{\textcopyright} 2021 The Authors.",
year = "2022",
month = apr,
doi = "10.1016/j.artd.2021.10.005",
language = "English",
volume = "14",
pages = "14--21",
journal = "Arthroplasty today",
issn = "2352-3441",
publisher = "Elsevier Inc.",

}

RIS

TY - JOUR

T1 - Variability in Femoral Preparation and Implantation Between Surgeons Using Manual and Powered Impaction in Total Hip Arthroplasty

AU - Konow, Tobias

AU - Bätz, Johanna

AU - Beverland, David

AU - Board, Tim

AU - Lampe, Frank

AU - Püschel, Klaus

AU - Morlock, Michael M

N1 - © 2021 The Authors.

PY - 2022/4

Y1 - 2022/4

N2 - BACKGROUND: The influence of the surgical process on implant loosening and periprosthetic fractures (PPF) as major complications in uncemented total hip arthroplasty (THA) has rarely been studied because of the difficulty in quantification. Meanwhile, registry analyses have clearly shown a decrease in complications with increasing experience. The goal of this study was to determine the extent of variability in THA stem implantation between highly experienced surgeons with respect to implant size, position, press-fit, contact area, primary stability, and the effect of using a powered impaction tool.METHODS: Primary hip stems were implanted in 16 cadaveric femur pairs by three experienced surgeons using manual and powered impaction. Quantitative CTs were taken before and after each process step, and stem tilt, canal-fill-ratio, press-fit, and contact determined. Eleven femur pairs were additionally tested for primary stability under cyclic loading conditions.RESULTS: Manual impactions led to higher variations in press-fit and contact area between the surgeons than powered impactions. Stem tilt and implant sizing varied between surgeons but not between impaction methods. Larger stems exhibited less micromotion than smaller stems.CONCLUSIONS: Larger implants may increase PPF risk, while smaller implants reduce primary stability. The reduced variation for powered impactions indicates that appropriate measures may promote a more standardized process. The variations between these experienced surgeons may represent an acceptable range for this specific stem design. Variability in the implantation process warrants further investigations since certain deviations, for example, a stem tilt toward varus, might increase bone stresses and PPF risk.

AB - BACKGROUND: The influence of the surgical process on implant loosening and periprosthetic fractures (PPF) as major complications in uncemented total hip arthroplasty (THA) has rarely been studied because of the difficulty in quantification. Meanwhile, registry analyses have clearly shown a decrease in complications with increasing experience. The goal of this study was to determine the extent of variability in THA stem implantation between highly experienced surgeons with respect to implant size, position, press-fit, contact area, primary stability, and the effect of using a powered impaction tool.METHODS: Primary hip stems were implanted in 16 cadaveric femur pairs by three experienced surgeons using manual and powered impaction. Quantitative CTs were taken before and after each process step, and stem tilt, canal-fill-ratio, press-fit, and contact determined. Eleven femur pairs were additionally tested for primary stability under cyclic loading conditions.RESULTS: Manual impactions led to higher variations in press-fit and contact area between the surgeons than powered impactions. Stem tilt and implant sizing varied between surgeons but not between impaction methods. Larger stems exhibited less micromotion than smaller stems.CONCLUSIONS: Larger implants may increase PPF risk, while smaller implants reduce primary stability. The reduced variation for powered impactions indicates that appropriate measures may promote a more standardized process. The variations between these experienced surgeons may represent an acceptable range for this specific stem design. Variability in the implantation process warrants further investigations since certain deviations, for example, a stem tilt toward varus, might increase bone stresses and PPF risk.

U2 - 10.1016/j.artd.2021.10.005

DO - 10.1016/j.artd.2021.10.005

M3 - SCORING: Journal article

C2 - 35106353

VL - 14

SP - 14

EP - 21

JO - Arthroplasty today

JF - Arthroplasty today

SN - 2352-3441

ER -