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      A new short uncemented, proximally fixed anatomic femoral implant with a prominent lateral flare: design rationals and study design of an international clinical trial

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          Abstract

          Background

          Anatomic short femoral prostheses with a prominent lateral flare have the potential to reduce stress-shielding in the femur through a more physiological stress distribution to the proximal femur. We present the design rationale of a new short uncemented, proximally fixed anatomic femoral implant and the study design of a prospective multi-centre trial to collect long-term patient outcome and radiographic follow up data.

          Methods

          A prospective surveillance study (trial registry NCT00208555) in four European centres (UK, Italy, Spain and Germany) with a follow up period of 15 years will be executed. The recruitment target is 200 subjects, patients between the ages of 18 and 70 admitted for primary cementless unilateral THA will be included. The primary objective is to evaluate the five-year survivorship of the new cementless short stem. The secondary objectives of this investigation are to evaluate the long term survivorship and the clinical performance of the implant, the impact on the subjects health related Quality of Life and the affect of the prosthesis on bone mineral density. Peri- and postoperative complications will be registered. Clinical and radiographic evaluation of prosthesis positioning will be done post-operatively and at 3, 6, 12, 24, 60, 120 and 180 months follow up.

          Discussion

          Shortening of the distal stem can maximise bone and soft tissue conservation. New stem types have been designed to improve the limitations of traditional implants in primary THA. A new, uncemented femoral short stem is introduced in this paper. A long-term follow up study has been designed to verify stable fixation and to research into the clinical outcome. The results of this trial will be presented as soon as they become available.

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          Most cited references41

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          The laws of bone architecture

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            A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial.

            Minimally invasive total hip arthroplasty has stirred substantial controversy with regard to whether it provides superior outcomes compared with total hip arthroplasty performed through longer incisions. The orthopaedic literature is deficient in well-designed scientific studies to support the clinical superiority of this approach. The objective of this study was to compare the results of a single mini-incision approach with those of a standard-incision total hip arthroplasty in the early postoperative period. Two hundred and nineteen patients (219 hips) admitted for unilateral total hip arthroplasty between December 2003 and June 2004 were randomized to undergo surgery through a short incision of
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              Prognosis of total hip replacement in Sweden. Follow-up of 92,675 operations performed 1978-1990.

              A prospective, national multi-center study of all reoperations after total hip replacement (THR) was started by the Swedish Orthopedic Association in 1979. The material comprises all THR performed in Sweden, presently more than 10,000 yearly or 130 THR per 100,000 inhabitants; uncemented implants have been used in less than 2 percent. The main reasons for revision have been aseptic loosening 79 percent, infection 10 percent, technical error 6 percent, and dislocation 2 percent. The cumulative rate of revision for deep infection has dropped from 0.9 percent to < 0.5 percent for implants inserted 1979 and 1983, respectively. With the Charnley prosthesis as the gold, standard the performance of other prostheses was analyzed. Improved cementation techniques and anti-infection measures have continuously reduced the revision risk. The register demonstrates that the average orthopedic surgeon cannot match the results achieved by experts. However, the vast majority of THR, worldwide, are not performed by experts. Quality-assurance in this sector of orthopedics demands a continuous analysis of the outcome of these operations.
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                Author and article information

                Journal
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central
                1471-2474
                2008
                4 November 2008
                : 9
                : 147
                Affiliations
                [1 ]Regensburg University Medical Center, Bad Abbach, Germany
                [2 ]Ospedale San Pietro Fatebenefratelli, Rome, Italy
                [3 ]University of Bristol, Bristol, UK
                [4 ]Hospital Arnau de Vilanova, Valencia, Spain
                [5 ]Hamburg University of Technology, Hamburg, Germany
                Article
                1471-2474-9-147
                10.1186/1471-2474-9-147
                2584636
                18983669
                0db9f640-e8da-4fad-86ca-4e7a7ace53ec
                Copyright © 2008 Renkawitz et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 April 2008
                : 4 November 2008
                Categories
                Study Protocol

                Orthopedics
                Orthopedics

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