A Comparative Retrospective Study to Identify the Smallest Primary Cementless Femoral Prosthesis Available in Thailand Using Digital Templating Method
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Abstract
Background: Cementless femoral stems are commonly used in hip arthroplasty; however, caution is advised for patients with narrow femoral canals. Currently, there is no published study on the smallest cementless stem available in Thailand, and such information would be valuable for preoperative planning.
Objective: To identify the smallest cementless stem that can be implanted in Thai patients with narrow femoral canals, particularly in those with Dorr type A femurs.
Material and methods: A comparative analytic study was conducted on patients who underwent hip arthroplasty using the smallest size (size 1) Avenir cementless stem at Lampang Hospital between January 2015 and March 2023. Preoperative radiographs of the normal contralateral hip were calibrated and magnification adjusted. Digital templating was then performed using 10 different stem templates, and the optimal stem size was recorded. The percentage of patients in whom the fourth smallest stem size, or the third and fourth smallest sizes could be inserted was compared among the 10 stem types using the exact probability test.
Results: The study included hip radiographs from 71 patients, with a mean age of 60.1 ± 10.8 years (range 25–89), of whom 54 (76.1%) were female. Femoral morphology was classified as Dorr type A in 45 cases (63.4%) and type B in 26 cases (36.6%). The Accolade II stem could be inserted as the fourth smallest size in 57 cases (80.3%), a rate significantly higher than that of other stems (p<0.001). No significant differences were found among the Tri-Lock, Synergy, M/L taper, and Polar stems (p>0.05). The third and fourth smallest sizes could be inserted in all cases (100%) using the Accolade II stem and in 69 cases (97.2%) with the Polar stem (p=0.496), both demonstrating significantly higher insertion capabilities than other stems (p<0.05). The Tri-Lock stem could be inserted in 58 cases (81.7%), which was not significantly different from the Synergy stem (56 cases, 78.9%, p=0.833) but was significantly higher than the M/L taper stem (34 cases, 47.9%, p<0.001). Analysis of the 45 patients with Dorr type A femurs yielded similar results.
Conclusion: The Accolade II stem is the smallest cementless stem available in Thailand, followed by the Polar stem. The Tri-Lock and Synergy stems ranked third and were considered equally comparable.
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บทความที่ส่งมาลงพิมพ์ต้องไม่เคยพิมพ์หรือกำลังได้รับการพิจารณาตีพิมพ์ในวารสารอื่น เนื้อหาในบทความต้องเป็นผลงานของผู้นิพนธ์เอง ไม่ได้ลอกเลียนหรือตัดทอนจากบทความอื่น โดยไม่ได้รับอนุญาตหรือไม่ได้อ้างอิงอย่างเหมาะสม การแก้ไขหรือให้ข้อมูลเพิ่มเติมแก่กองบรรณาธิการ จะต้องเสร็จสิ้นเป็นที่เรียบร้อยก่อนจะได้รับพิจารณาตีพิมพ์ และบทความที่ตีพิมพ์แล้วเป็นสมบัติ ของลำปางเวชสาร
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