Abstract
Introduction
The EcoFit® total hip endoprosthesis has recently been approved for clinical use in the USA as a substantially equivalent implant to the Taperloc® Hip System, but no report has directly compared their long-term results so far. The primary aim of the presented single-hospital EcoFit® cohort analysis was to determine femoral stem survival rates at 5/10 years of follow-up in comparison to eight Taperloc® studies published within the last decade (2011–2021). The secondary aim was to find out whether femoral stem survival depended on the patients’ age, gender and the operating surgeon.
Materials and Methods
The retrospective surgeon-stratified observational cohort study included 680 consecutive patients with primary EcoFit® femoral stem implanted at the same operating theatre block of a single tertiary hospital between April 2009 and December 2015. Survival analyses after 6–12 years of follow-up were performed with the Kaplan–Meier method and the Cox regression.
Results
The cumulative proportion of revision-free surviving EcoFit® femoral stems 5/10 years after the primary implantation was 96/94%, respectively, and the cumulative proportion of unremoved stems was 99/98%, respectively. The EcoFit® stem revision rate of 0.46 per 100 components-years was not significantly different from most Taperloc® cohorts. Higher age increased the risk of subsequent EcoFit® femoral stem revision (hazard ratio 1.039, p = 0.048) while the impact of gender and the operating surgeon was not statistically significant.
Conclusions
The study presents the first surgeon-stratified cohort analysis of the EcoFit®-Implantcast femoral stem from a single hospital with 5851 component years of observation. Long-term EcoFit® survival rates are comparable to the Taperloc® hip system. Caution is warranted when using such flat cementless single-wedge stems in the elderly population.
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Data availability
The data that support the findings of this study are available on request from the corresponding author BM.
References
Toossi, N., Adeli, B., Timperley, A. J., Haddad, F. S., Maltenfort, M., & Parvizi, J. (2013). Acetabular components in total hip arthroplasty: is there evidence that cementless fixation is better? Journal of Bone and Joint Surgery - American Volume, 95(2), 168–174. https://doi.org/10.2106/JBJS.K.01652
Murray, D. W. (2013). Cemented femoral fixation: the North Atlantic divide? The Bone and Joint Journal, 95-B(11 Supp A), 51–52. https://doi.org/10.1302/0301-620X.95B11.32976
Feyen, H., & Shimmin, A. J. (2014). Is the length of the femoral component important in primary total hip replacement? The Bone and Joint Journal, 96-B(4), 442–448. https://doi.org/10.1302/0301-620X.96B4.33036
Khanuja, H. S., Banerjee, S., Jain, D., Pivec, R., & Mont, M. A. (2014). Short bone-conserving stems in cementless hip arthroplasty. Journal of Bone and Joint Surgery - American Volume, 96(20), 1742–1752. https://doi.org/10.2106/JBJS.M.00780
Giardina, F., Castagnini, F., Stea, S., Bordini, B., Montalti, M., & Toni, A. (2018). Short stems versus conventional stems in cementless total hip arthroplasty: a long-term registry study. Journal of Arthroplasty, 33(6), 1794–1799. https://doi.org/10.1016/j.arth.2018.01.005
Goyal, N., & Engh, C. A. (2013). Cementless femoral stems: is there an optimum? Semin Arthroplasty, 24(2), 61–67. https://doi.org/10.1053/j.sart.2013.07.011
Food and Drug Administration. EcoFit® hip system. [Internet]. Silver Spring: Food and Drug Administration; ©2020 [cited 31 Dec 2021]. Available at: https://fda.report/PMN/K163577
Food and Drug Administration. FDA approval on EcoFit® hip endoprostheis. [Internet]. Food and Drug Administration; ©2020 [cited 31 Dec 2021]. Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf18/K180263.pdf
Grimberg, A., Jansson, V., Melsheimer, O., & Steinbruck, A. (2019). German arthroplasty registry 2019 annual report (pp. 52–87). Germany: EPRD.
Australian Orthopaedic Association National Joint Replacement Registry (2020) Hip, knee & shoulder arthroplasty; 2020 annual report. Adelaide; AOA
Parvizi, J., Sharkey, P. F., Hozack, W. J., Orzoco, F., Bissett, G. A., & Rothman, R. H. (2004). Prospective matched-pair analysis of hydroxyapatite-coated and uncoated femoral stems in total hip arthroplasty. A concise follow-up of a previous report. The Journal of Bone and Joint Surgery - American Volume, 86(4), 783–786. https://doi.org/10.2106/00004623-200404000-00017
Purtill, J. J., Rothman, R. H., Hozack, W. J., & Sharkey, P. F. (2001). Total hip arthroplasty using two different cementless tapered stems. Clinical Orthopaedics and Related Research, 393, 121–127. https://doi.org/10.1097/00003086-200112000-00014
Keisu, K. S., Orozco, F., Sharkey, P. F., Hozack, W. J., & Rothman, R. H. (2001). Primary cementless total hip arthroplasty in octogenarians: two to eleven-year follow-up. The Journal of Bone and Joint Surgery - American Volume, 83(3), 359–363. https://doi.org/10.2106/00004623-200103000-00007
Rothman, R. H., Hozack, W. J., Ranawat, A., & Moriarty, L. (1996). Hydroxyapatite-coated femoral stems. A matched-pair analysis of coated and uncoated implants. The Journal of Bone and Joint Surgery - American Volume, 78(3), 319–324. https://doi.org/10.2106/00004623-199603000-00001
McLaughlin, J. R., & Lee, K. R. (2006). The outcome of total hip replacement in obese and non-obese patients at 10- to 18-years. The Journal of Bone Joint Surgery - British Voume, 88(10), 1286–1292. https://doi.org/10.1302/0301-620X.88B10.17660
McLaughlin, J. R., & Lee, K. R. (2008). Total hip arthroplasty with an uncemented tapered femoral component. Journal of Bone and Joint Surgery - American Volume, 90(6), 1290–1296. https://doi.org/10.2106/JBJS.G.00771
Mallory, T. H., Lombardi, A. V., Leith, J. R., Fujita, H., Hartman, J. F., Capps, S. G., Kefauver, C. A., Adams, J. B., & Vorys, G. C. (2002). Why a taper? The Journal of Bone and Joint Surgery - American Volume, 84-A(Suppl 2), 81–90. https://doi.org/10.2106/00004623-200200002-00010
Labek, G., Frischhut, S., Schlichtherle, R., Williams, A., & Thaler, M. (2011). Outcome of the cementless Taperloc stem: a comprehensive literature review including arthroplasty register data. Acta Orthopaedica, 82(2), 143–148. https://doi.org/10.3109/17453674.2011.570668
Nebergall, A. K., Rolfson, O., Rubash, H. E., Malchau, H., Troelsen, A., & Greene, M. E. (2016). Stable fixation of a cementless, proximally coated, double wedged, double tapered femoral stem in total hip arthroplasty: a 5-year radiostereometric analysis. Journal of Arthroplasty, 31(6), 1267–1274. https://doi.org/10.1016/j.arth.2015.11.036
McLaughlin, J. R., & Lee, K. R. (2016). Total hip arthroplasty with an uncemented tapered femoral component in patients younger than 50 years of age: a minimum 20-year follow-up study. Journal of Arthroplasty, 31(6), 1275–1278. https://doi.org/10.1016/j.arth.2015.12.026
McLaughlin, J. R., & Lee, K. R. (2016). Long-term results of uncemented total hip arthroplasty with the Taperloc femoral component in patients with Dorr type C proximal femoral morphology. The Bone and Joint Journal, 98-B(5), 595–600. https://doi.org/10.1302/0301-620X.98B5.35816
Drobniewski, M., Borowski, A., Krasińska, M., Sibiński, M., & Synder, M. (2016). Results of total cementless hip joint arthroplasty with Taperloc stem. Ortopedia Traumatologia Rehabilitacja, 18(4), 317–325. https://doi.org/10.5604/15093492.1220823
Inacio, M. C., Lorimer, M., Davidson, D. C., De Steiger, R. N., Lewis, P. L., & Graves, S. E. (2018). What is the risk of revision surgery in hydroxyapatite-coated femoral hip stems? Findings from a large national registry. Clinical Orthopaedics and Related Research, 476(12), 2353–2366. https://doi.org/10.1097/CORR.0000000000000513
Nieuwenhuijse, M. J., Vehmeijer, S. B. W., Mathijsen, N. M. C., & Keizer, S. B. (2020). Fixation of the short global tissue-sparing hip stem. The Bone and Joint Journal, 102(6), 699–708. https://doi.org/10.1302/0301-620X.102B6.BJJ-2019-1026.R2
McLaughlin, J. R., Lee, K. R., & Johnson, M. A. (2021). Second-generation uncemented total hip arthroplasty: a minimum 20-year follow-up. Bone and Joint Open, 2(1), 33–39. https://doi.org/10.1302/2633-1462.21.BJO-2020-0157.R1
Valdoltra Orthopaedic Hospital. The National Arthroplasty Registry of Slovenia [Internet]. Ankaran: ©2014 [cited 31 Dec 2021]. Available at: https://www.ob-valdoltra.si/sl/international
Labek, G., Kovac, S., Levasic, V., Janda, W., & Zagra, L. (2012). The outcome of the cementless tapered SL-Plus stem: an analysis of arthroplasty register data. International Orthopaedics, 36(6), 1149–1154. https://doi.org/10.1007/s00264-011-1421-5
Rohe, S., Brodt, S., Windisch, C., Matziolis, G., & Böhle, S. (2021). Patient safety during endoprosthetic training: does the training of surgeons in primary hip arthroplasty at certified endoprosthesis centres lead to increased complications? Orthopade. https://doi.org/10.1007/s00132-021-04110-y
Tanzer, M., Graves, S. E., Peng, A., & Shimmin, A. J. (2018). Is cemented or cementless femoral stem fixation more durable in patients older than 75 years of age? A comparison of the best-performing stems. Clinical Orthopaedics and Related Research, 476(7), 1428–1437. https://doi.org/10.1097/CORR.0000000000001213
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All authors contributed to the study conception and design. Surgical work was performed by VA and BM. Material preparation, data collection and analysis were performed by SR, VA and BM. The first draft of the manuscript was written by SR and BM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Ethical standard statement
The study protocol was reviewed and approved by the National Medical Ethics Committee of the Republic of Slovenia on October 27, 2015, case No. 0120-443/2015-2. All procedures performed in studies involving human participants were in accordance with the institutional and national ethical standards and with the revised Helsinki Declaration 2013 and comparable ethical standards.
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The National Medical Ethics Committee of the Republic of Slovenia approved the study on October 27, 2015, case No. 0120-443/2015-2 and concluded that informed consent was not required for anonymized retrospective observational studies of archived medical data.
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Roškar, S., Antolič, V. & Mavčič, B. Implant Survival of 680 Consecutive EcoFit® Flat Single-Wedge Cementless Femoral Stems is Equivalent to the Taperloc® Total Hip Arthroplasty Series. JOIO 56, 1969–1977 (2022). https://doi.org/10.1007/s43465-022-00733-1
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DOI: https://doi.org/10.1007/s43465-022-00733-1