Keywords:
Musculoskeletal joint, Nuclear medicine, Anatomy, SPECT-CT, MR, Plain radiographic studies, Decision analysis, Outcomes analysis, Technical aspects, Arthritides, Biological effects, Outcomes
Authors:
D. Dalili, T. M. Bansal, M. J. Bankes, M. George, Z. Shah, A. Isaac; London/UK
DOI:
10.1594/essr2017/P-0309
Conclusion
The concept of an extensive hydroxyapatite (HA) coating for the fixation of a specifically tapered femoral stem (Corail®) was introduced 25 years ago.
The aim was to achieve durable biological fixation while preserving normal periprosthetic bone activity.
The value of uncemented fixation using HA-coated implants is widely accepted amongst scholars.
The Corail® system offers validated superior osteointegration around the femoral stem when compared to other systems,
partially due to the lack of medullary reaming required prior to placement of the femoral stem component.
On histological evaluation,
there is absence of the expected fibrous-interface between the native bone and the prosthesis with relatively silent radiographic findings on peri-operative and short term follow up radiographs.
Transient “Femoral Blaze” phenomenon can therefore be observed in patients following Total Hip replacement with extensive HA coated stems (like Corail®) in patients returning to early high levels of activity.
In our cohort the incidence was 3.54 % of our total patient population and as high as 42.9 % (12/28) of all patients with symptoms of hip or thigh pain following Corail® cementless THR over 9 years of follow up.
In our series,
the clinical symptoms and scintigraphy findings resolved on follow up and modification of the levels of activity within 6 months.
Knowledge of these characteristic transient findings,
should alert the team to exclude infection or loosening in the first instance,
thereafter monitoring the patient with serial imaging,
rehabilitation and clinical follow up.
This could reduce the incidence of excessive interventions and encourage patients to continue with their rehabilitation and return to normal levels of physical activity.