Definition and validation of a system for classifying the undersized Corail femoral stem in total hip arthroplasty
McConnell, Jamie S. Syed, Farhan Saunders, Paul Kattimani, Raviprasad Ugwuoke, Anthony Magra, Merzesh Young, Stephen
McConnell, Jamie S.
Syed, Farhan
Saunders, Paul
Kattimani, Raviprasad
Ugwuoke, Anthony
Magra, Merzesh
Young, Stephen
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Affiliation
Barnet and Chase Farm Hospitals NHS Trust, London; South Warwickshire University NHS Foundation Trust; Macclesfield District General Hospital; Countess of Chester Hospital; University Hospitals of Morecambe Bay NHS Foundation Trust
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Publication date
2022-11
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Abstract
Introduction: The uncemented total hip arthroplasty relies on a secure initial fixation of the femoral stem to achieve osseointegration. Undersizing of the femoral implant compromises this. Surgeons routinely review postoperative radiographs to assess appropriate sizing, but existing methods of assessment lack standardisation. We present a system of accurately and reliably classifying radiological undersizing, which will help us better understand the factors that might have led to undersizing.
Aim: To describe and evaluate a classification system for assessing radiological undersizing of the uncemented stem in hip arthroplasty.
Method: We conducted a retrospective review of 1,337 consecutive hip arthroplasties using the Corail stem. Two independent investigators reviewed post-operative radiographs and classified them as either appropriately sized or undersized. Undersized stems were sub-categorised into four subtypes: uniformly undersized, varus undersized, valgus undersized or 'cocktail-glass' undersized. Inter- and intra-observer agreement was determined. The accuracy of our classification system was validated by comparison with digital re-templating. We further assessed patient demographics and stem size in relation to sizing.
Results: 1 in 5 cases (19.75%) were deemed radiologically undersized. The commonest subtypes of undersizing were uniformly (47%) and varus (39%) undersized. When assessing sizing and subtype categorisation, inter-observer agreement was 89-92% and intra-observer agreement 86%. Classification decisions showed 92% and 97% accuracy for uniformly undersizing and varus undersizing respectively when validated against digital re-templating. Age, gender and smaller stem size were significantly associated with radiological undersizing. The Corail KLA model (125° neck) was found to have a higher incidence of stems undersized in varus.
Conclusions: This study describes and validates a classification system for the analysis of radiological undersizing.
Citation
McConnell JS, Syed FA, Saunders P, Kattimani R, Ugwuoke A, Magra M, Young SK. Definition and validation of a system for classifying the undersized Corail femoral stem in total hip arthroplasty. Hip Int. 2022 Nov;32(6):737-746. doi: 10.1177/1120700021996001. Epub 2021 Mar 15.
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Article