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IntroductionFully hydroxyapatite-coated titanium alloy double-tapered stems have been successful implant designs for THA. The Novation Element Stem (Exactech, Gainesville, FL) is one of several of these implants following a modified Corail design philosophy. Although a great deal is known about the results of the Corail stem, little is known about the more recent Corail-inspired implants. The authors evaluated the clinical outcomes, radiographic findings and survival statistics of the collarless version of the Element Stem when used routinely in a diverse patient population.MethodsA retrospective review was performed for all primary THR cases from 2010 to 2018. Patient demographics and HHS/OHS/patient satisfaction scores were obtained. Radiographs were evaluated for stem subsidence, radiolucencies, and bone responses to the implant.ResultsOne hundred and fifty seven Element Stems were implanted with greater than 2 years of radiographic follow-up, while 105 Element Stems implanted during the study period had a survival of 5 years or more. Average HHS was 91.7 and average OHS was 44.0. 54 of 157 hips had radiolucencies, all of which included a proximal zonal radiolucency. Average subsidence was 3.33 mm; 18 hips had subsidence > 4 mm. There were 8 revisions for: aseptic loosening (4), trauma-related peri-prosthetic fractures, and early proximal–medial fractures. At 5 years, the all-cause survival rate is 92.4%, 96.2% based only on aseptic loosening and 98.1% based only on proximal medial fractures.ConclusionClinical outcomes using the collarless Novation Element Stem are good, but early proximal medial fracture is still a factor in patients with poor-quality bone. Proximal radiolucencies progressing to aseptic loosening post-operatively are also a concern. The 11.5% rate of subsidence is comparable to other fully HA-coated collarless stems. This study provides a thorough critical analysis of outcomes and midterm survival data of this dual tapered-wedge fully HA-coated collarless stem used routinely in a diverse patient population.

Purpose During total hip replacement (THR), prosthesis material is stiffer than the bone tissue, decreasing load transmission to the host tissue around the prosthesis. After a THR, the aim is to achieve stress distribution along the femur close to normal physiological stress distribution for all loads transferred across the hip joint. In this study, we analyzed the advantages of using a collared stem over collarless one with the finite element method (FEM), strain gauges (SGs), and the digital image correlation (DIC) system. Methods In the biomechanical tests, we implanted composite femurs and loaded them with the stance configuration in a universal testing machine (Instron). We compared the predicted strains with the strains recorded experimentally in the same regions of the femur. Results The results revealed that for collarless stems, a high level of stress concentration is observed in the distal region of the implant but not in the proximal region. The collared case presents a strain distribution closer to that of a healthy bone proximal zone that was almost two times better than in case of the collarless stem, whereas stresses in the distal part of the femur corresponded to a healthy state. Finally, the numerical results for the bone adaptation around the implant provided clear evidence that the collar design strongly influences the proximal resorption because of better load transmission. Conclusions According to both the numerical and experimental results, a collar that connects to the bone cut may decrease the proximal stress shielding effect and distal cortical hypertrophy.

ObjectiveWe examined longitudinal changes in bone mineral density (BMD) around the femur for 5 years after total hip arthroplasty (THA) using cemented collarless polished double-tapered stem implantation and investigated the influence of BMD changes on radiological remodeling of the femur.Materials and methodsSixty hips from 56 patients who underwent cemented THA with a collarless polished double-tapered stem were included. BMD was measured 2 weeks postoperatively (baseline), 3 months, 6 months, 1 year and annually thereafter until 5 years after surgery using dual-energy X-ray absorptiometry on the lumbar spine and proximal femur of the operated side according to the Gruen’s zone classification. We analyzed predictable factors for BMD preservation in the proximal femur and compared radiological remodeling of the femur and changes in BMD.ResultsBMD at 5 years in zone 7 decreased less than 10%, whereas BMD in zone 1 increased to over the baseline (+ 1.9%). Multiple linear regression analyses revealed that body weight was a predictor for positive BMD change in the proximal femur. The frequency of radiolucency of the femur was significantly lower in patients who exhibited an increase in BMD at 5 years compared with BMD at 2 weeks in zone 7.ConclusionBMD preservation of the proximal femur after cemented collarless polished double-tapered stem implantation was more effective in heavier patients. Furthermore, the frequency of radiolucency around the stem was significantly lower in patients who exceeded 100% of the baseline BMD in zone 7 at 5 years.

Aims: Metal-porcelain restoration on esthetic zones often results in an umbrella effect due to metal collar coping on the labiomarginal area. Therefore, metal collarless design on metal-porcelain restoration was indicated, yet it may influence the fracture resistance of the restoration. This study aimed to determine the effect of metal coping designs on the labiomarginal area against fracture resistance of metal-porcelain restoration. Materials and Methods: A total of 24 samples of metal-porcelain restorations from four designs were fabricated and cemented on 24 metal dies. The study was divided into four groups; Group A with metal collar design, Group B with modified metal collar design, Group C with metal collarless design, and Group D with modified metal collarless design. The measurement of fracture resistance was carried out using universal testing machine (Torsee UTM AMU-10, Tokyo, Japan) at a crosshead speed of 0.05 mm/minute. Loading point was applied at an angle of 45° until the porcelain layer fractured. Results: The mean value and standard deviation of fracture resistance are 2237.56 ± 183.83 N in Group A, 1934.34 ± 152.81 N in Group B, 2049.62 ± 162.58 N in Group C, and 2146.15 ± 210.75 N in Group D. Significant influence of fracture resistance on metal-porcelain restorations was found in all experimental groups (P < 0.05), and there were significant differences between Groups A and B and between Groups B and D (P < 0.05). Conclusion: Metal-porcelain restoration with modified metal collarless design can be an alternative restoration on esthetic zone with high fracture resistance and may be able to prevent umbrella effect on the labiomarginal area.

Esthetics with porcelain fused to metal restoration in the anterior region can be adversely affected due to the inadequate teeth preparations and design of the prosthesis. We presented here a case report where esthetics was compromised due to darkening of the interdental papilla and marginal gingival and overcontoured restorations in relation to porcelain fused to metal restorations. Good esthetic results were obtained by using basic principles of tooth preparation and using collarless metal ceramic restorations.

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