Wayne G. Paprosky
PARK CITY, Utah — According to a presenter who started using tapered wedge hip stems with femoral fixation 10 years ago and called himself a late adopter of these designs, data on these stems convinced him of their efficacy and they became a “game changer” for his practice due to the rotational stability they provided for patients’ hips.
At the Joint Arthroplasty Mountain Meeting, Wayne G. Paprosky, MD, said, “[The] bottom line is basically the same principle. You have to decide if you want a little extra fixation distally in the corundumized form or roughened surface, but that’s where we are today.”
Paprosky noted the single wedge, double wedge and taper round versions of these stems constitute a “conservative” approach, and taper wedge stems are now the most widely used.
“It’s a square peg in a round hole distally. You certainly get excellent [anteroposterior] AP stability. It is remarkable how stable these are,” he said.
Regarding the surgical technique, Paprosky said the broaching is simple.
“When the pitch changes and the broach stops, it is probably the right size. If you keep hitting it, it might break the femur,” he said. He noted that about 10% of the narrow canals he encounters in male patients need reaming, but not aggressive reaming.
Researchers of one study, he said, had about a 5% failure rate due to unreamed canals.
Other than the fact that tapered wedge stems are not appropriate in all patients, such as patients with a Dorr C or a violated hip, “I think it’s a go-to stem in all Dorr A and B bone, whether it’s single or double wedge, but I prefer the single wedge,” he said. – by Susan M. Rapp
Paprosky WG. The tapered wedge stem has become the gold standard for cementless femoral fixation. Presented at: Joint Arthroplasty Mountain Meeting; Feb. 10-13, 2019; Park City, Utah.
Disclosure: Paprosky reports he receives IP royalties from Innomed; stock or stock options from Intellijoint; is on the editorial or governing board of Journal of Arthroplasty; receives IP royalties from Stryker; receives publishing royalties, financial or material support from Wolters Kluwer Health - Lippincott Williams & Wilkins; and receives IP royalties and is a paid consultant for Zimmer Biomet.