Vojnosanit Pregl 2017; 74(1): 51–53.

VOJNOSANITETSKI PREGLED Page 51

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DOI: 10.2298/VSP150514145M

First experiences with the Fitmore® hip stem – Early results of the 16-
month monitoring
Prvo iskustvo sa Fitmore® stemom kuka – rezultati 16-mesečnog posmatranja

Marko Mladenović, Ivan Micić, Predrag Stojiljković, Saša Milenković,

Desimir Mladenović

Clinic for Orthopaedic and Traumatology, Clinical Centar Niš, Niš, Serbia

Abstract Apstrakt

Background/Aim. Fitmore® hip stem belongs to the group of Uvod/Cilj. Fitmore® hip stem pripada grupi proteza kratkog
short stem prostheses with the metaphysar stabilization, with its stema sa metafiznom stabilizacijom, a svojim oblikom i for-
shape and form that protects the bone mass in the greater tro- mom štedi koštanu masu u regionu velikog trohantera i u
chanter region and the distal part of the femur. The aim of this distalnom delu femura. Cilj rada bio je da se prikažu rani
paper was to present the early postoperative results in patients operativni rezultati kod bolesnika sa ugrađenim Fitmore®
with implanted Fitmore® hip stem and point out some of the stemom kuka i da se ukaže na neke prednosti. Metode.
advantages. Methods. A series of 10 patients with implanted Prikazana je serija od 10 bolesnika kojima je ugrađen
Fitmore® hip stem, was included in this study. The average age Fitmore® stem kuka. Prosečna starost bolesnika, pet žena i
of the patients was 54.5 (48–65) years. There were 5 women and pet muškaraca, bila je 54.5 (48–65) godina. Ukupno vreme
5 men. The total monitoring time was 16 months. To rate the praćenja iznosilo je 16 meseci. Za ocenu stanja zgloba kuka
condition of the hip joint we used The Western Ontario and Mc koristili smo The Western Outario and Mc Master Universities
Master Universities Arthritis Index (WOMAC) score. We also Arthritis Index (WOMAC) skor. Pratili smo i stanje bola u
monitored the degree of hip pain, hip flexion, heterotopic ossi- butini, fleksiju kuka, heterotopne osifikacije i slegnuće stema
fication and indentation in the stem of the prosthesis. Results. proteze. Rezultati. Posle 12 meseci praćenja, 9 (90%)
After 12 months of monitoring 9 (90%) of the patients had no bolesnika nije imalo bolove u butini, a samo jedan (10%)
pain in the thigh region, and only 1 (10%) experienced mild imao je slabe bolove. Fleksija u kuku porasla je od 89° u
pain. The hip flexion rose from the average 89° to postoperative proseku, na 114° posle operacije. WOMAC skor takođe je
114°. WOMAC score rose as well, from 49 to 94 average porastao, od 49 na 94 poena u proseku. Nalegnuće stema
points. Indentation in the stem was registered 3 months after registrovano je posle tri meseca od operacije i to kod dva
the operation in 2 (20%) of the patients – in one of the patients (20%) bolesnika: kod jednog tri, a kod drugog 5 mm. Posle
the indentation was 3 mm and in the other patient 5 mm. After praćenja od 16 meseci rezultati su bili odlični. Period pra-
the 16-month monitoring, the results were excellent. The moni- ćenja bio je kratak i trebalo bi ga nastaviti i prikazati rezul-
toring period was short though it should be continued and the tate posle 5 i 10 godina. Zaključak. Rani rezultati primene
results should be presented after 5 and then after 10 years. Con- Fitmore® stema kuka pokazuju dobro urastanje stema uz
clusion. Early results of the implantation Fitmore stem showed odličan funkcionalni rezultat.
good bone ingrowth with excellent functional result.

Key words: Ključne reči:

arthroplasty, replacement, hip; orthopedic procedures; artroplastika kuka; ortopedske procedure;
postoperative period; recovery of function. postoperativni period; funkcija, povratak.

Introduction factors, all of these factors, individually or combined, can cause

a degenerative hip disease.
Osteoarthrosis is a very common chronic disease. It is de- Replacement of the natural hip joint with an artificial
tected in 60% of the population aged over 65, and hip osteo- one restores the function of the diseased joint and establishes
arthrosis is detected in 5% of the population aged over 55 1. a painless and satisfactory locomotion. There are a number
Etiology of coxarthrosis is complex and depends on multiple of cemented and uncemented prosthetic models used in

Correspondence to: Marko Mladenović, Clinic for Orthopaedic and Traumatology, Clinical Centar Niš, Dragiše Cvetkovića 21/1,
18 000 Niš, Serbia. E-mail: mladenovicdmarko@gmail.com
Page 52 VOJNOSANITETSKI PREGLED Vol. 74, No. 1

everyday practice. One of the models is Fitmore hip stem by ten hip endoprostheses of the Fitmore stem type were im-
Zimmer. planted.
This particular system has a short uncemented stem Total hip arthroplasty was performed in 5 female and 5
which with its shape and curve restores the anatomy of the male patients. The average age was 54.5 years (57.4 in male
proximal part of the femur and allows adjustment of the pro- and 50.4 in female patients). The average weight was 81 kg
sthetic offset, ie it offers the possibility of adjusting the dis- in male and 69 kg in female patients.
tance between the acetabulum and body of the stem. The The patients were monitored after 3, 6, 12 and 16
transection of the stem has a trapezoid form, which allows months following the operation.
the primary rotational stability. It belongs to the group of The main diagnosis was osteoartrosis – 7 (70%) pati-
short stem prostheses with metaphysar stabilization and the- ents, followed by avascular necrosis – 2 (20%) patients and
refore it spares the bone mass in the greater trochanter region rheumatoid arthritis – 1 (10%) patient.
and the distal part of the femur 2. With its curve, the stem of We used the intermediate calcar radius stem in 8 pati-
this prosthesis protects the lateral cortex of the femur, and di- ents, and in the remaining 2 a larger calcar radius stem A
rects its contact and the transmission of the mechanical for- family (Figure 1).
ces and loads in the hip, towards the small trochanter. The To rate the state of the hip joint, prior to and after the
greatest part of body weight is transferred through the medial operation, we used WOMAC score 5.
part of the prosthesis towards the small trochanter, to the It is critical with the use of the Fitmore® stem to use ra-
medial part of the resected femoral neck which has the shape diological templating to determine the appropriate stem

Fig. 1 – Implanted Fitmore® hip stem (larger calcar radius, A family).

of the letter U – this is calcar femoris. The surface of the cor- family preoperatively, as medial metaphyseal/diaphyseal
tical bone part of the resected femoral neck in the region of contact cannot be visualized intraoperatively. Templating is
the small trochanter, which is used for the transfer of weight, needed to assess the center of femoral head, leg length, off-
is about 1.29 cm 2, 3. set, level of femoral neck osteotomy and stem size. The neck
The short and curved prosthetic stem spares the distal osteotomy must be at an angle of 50° of the long axis of the
femur part, this maladjustment of the proximal and distal part shaft and also preservation of 5–10 mm of the lateral neck
is avoided, which is one of the reasons for the loosening of cortex.
the long prosthetic stem. Additionally, it spares the femur Subsidence was defined as vertical stem movement of
canal for the revision stem; it reduces the intraoperative ble- more than 5 mm according to Callaghan et al. 6.
eding and spares the soft tissue due to the reduced surgical Heterotopic ossification was classified according to
exposition 4. Fitmore® prosthesis has a narrower indication Brooker et al. 7.
area, ie it is used in younger patients, vital and good physical
shape with a small degree of osteoporosis. Results
The aim of this study was to present the early postope-
rative results in patients with the implanted Fitmor® hip stem Three months after the operation, in 5 (50%) patients
and point out some of its advantages. thigh pain disappeared, and in 9 (90%) after 12 months. Only
one (10%) patient had mild pain 12 months after the operati-
Methods on.
The range of motion (the degree of flexion) increased
In the period from December 25, 2013 to February 15, significantly from 79° (40°–120°) preoperatively to 114°
2014 in the Clinic for Orthopedic Surgery the Niš, Serbia, (95°–150°) at the time of the last monitoring (p < 0.001).

Mladenović M, et al. Vojnosanit Pregl 2017; 74(1): 51–53.

Vol. 74, No. 1 VOJNOSANITETSKI PREGLED Page 53

The mean duration of the surgical procedure was 75 varus of prosthetic stem from 4° to 8° as well as the fact that
(38–125) minutes and the mean length of hospitalization was Fitmore® stem has a small potential to take the varus positi-
9 (5–15) days. on. Additionally, sometimes a fracture of the long stem can
Radiological results after 16 months of monitoring were occur.
in 2 (20%) of the patients hipertrophy of the femoral cortex Loosening of the stem did not occur in our series, per-
at the height of the prosthetic stem was registered, but haps due to the short monitoring period, although other aut-
without clinical symptomatology. In 1 (10%) of the patient hors do not list it either. This phenomenon occurs in prosthe-
heterotrophic ossification gradus 1 according to Brooker et ses with long stem due to different factors 13.
al. 7 was registered, in 2 (20%) of the patients there was an The stem of the Fitmore® prosthesis can cause remode-
indentation in the stem up to 5 mm, registered 3 months after ling of periprosthetic bone structure. Pepke et al. 14 has found
the operation. that both Fitmore® and long stem prostheses have proximal
stability. Fitmore® stem also has rotational stability, so its
Discussion rigidity is higher, which is the reason why the remodeling
process of the bone is more prominent in this type of prost-
Total hip arthroplasty is one of the most successful ort- heses. Guske 2 as well, in his work reports cortical
hopedic procedures. The use of short stems is growing. With hypertrophy in 29% of the patients in the series of 100 pati-
short stems good and permanent fixation is achieved and cli- ents. In our series, this phenomenon was present in 2 (20%)
nical results are good. of the patients.
Joint Implant Surgery and Research Foundation (USA) has Indentation in the Fitmore® stem up to 5 mm was pre-
formed a classification system for the short stem uncemented sent three months after the operation. We had 2 (20%) pati-
prosthesis: head stabilized, neck stabilized, metaphyseal stabili- ents – in one the indentation in the stem was 3 mm, and in
zed and conventional (metaphyseal/diaphyseal) stabilized 8. Fi- the other 5 mm. In the series of 100 patients, Guske 2 repor-
tmore® hip stem by Zimmer that we used in our patients belongs ted indentation in 34% of the patients.
to the group of metaphyseal stabilized, and its characteristics are
the following: it spares the bone mass in the area of greater troc- Conclusion
hanter and diaphysis of the femur, crossection is trapezoid and
provides excellent stability, it has different curves in order to re- The early results of Fitmore® stem implantation showed
novate the hip joint anatomy and achieve a good offset of the good bone ingrowth with excellent functional result in our
femoral neck 4, 8, 9. patients. The number of published series of patients with im-
Radiological templating is mandatory to determine the planted Fitmore® hip stem is small, so as in our study of the
position of the prosthesis, its size, offset center of the rotati- early results of the implantation of Fitmore® stem in 10 pati-
on and leg length 10. ents. Further monitoring of the patients and reporting the re-
A long prosthetic stem can be implanted in the varus sults 5 and 10 years after the operation are needed. Monito-
position. Berend et al. 11, Khalily and Lester 12 mention the ring in our group of patients was 16 months.
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Mladenović M, et al. Vojnosanit Pregl 2017; 74(1): 51–53.