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Meltzer et al: Case factors for selection of femoral component type in canine hip arthroplasty using a modular system
Veterinary Surgery 2, 2022

🔍 Key Findings

  • Hybrid implants were used in older, heavier dogs with lower canal flare index (CFI) compared to cementless types.
  • CFI <1.8 was associated with higher risk of femoral fracture or stem subsidence with cementless implants.
  • Total complication rate was 14%, with catastrophic complications in only 1.5%—lower than reported in other studies.
  • No significant difference in complication rates across implant types (BFX, BFX-C, hybrid).
  • Femur fractures were rare (2.9%), lower than in prior studies, and successfully managed with cerclage/plate fixation.
  • Coxofemoral luxation was the most common complication (8 cases); all occurred within 62 days post-op, mostly resolved with revision.
  • Collared BFX stems did not significantly reduce complications, though they may limit stem subsidence.
  • An implant selection algorithm was proposed, using age ≥7 years, weight ≥45 kg, and CFI <1.8 to guide cemented vs. cementless stem use.

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← Articles

Meltzer et al: Case factors for selection of femoral component type in canine hip arthroplasty using a modular system
Veterinary Surgery 2, 2022

🔍 Key Findings

  • Hybrid implants were used in older, heavier dogs with lower canal flare index (CFI) compared to cementless types.
  • CFI <1.8 was associated with higher risk of femoral fracture or stem subsidence with cementless implants.
  • Total complication rate was 14%, with catastrophic complications in only 1.5%—lower than reported in other studies.
  • No significant difference in complication rates across implant types (BFX, BFX-C, hybrid).
  • Femur fractures were rare (2.9%), lower than in prior studies, and successfully managed with cerclage/plate fixation.
  • Coxofemoral luxation was the most common complication (8 cases); all occurred within 62 days post-op, mostly resolved with revision.
  • Collared BFX stems did not significantly reduce complications, though they may limit stem subsidence.
  • An implant selection algorithm was proposed, using age ≥7 years, weight ≥45 kg, and CFI <1.8 to guide cemented vs. cementless stem use.

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Multiple Choice Questions on this study

In Meltzer 2022 et al., on femoral implant selection, what was the most common major complication reported?

A. Femoral fissure
B. Stem subsidence
C. Osteomyelitis
D. Coxofemoral luxation
E. Femoral shaft fracture

Answer: Coxofemoral luxation

Explanation: Luxation was the most common complication, occurring in 8 of 135 THRs.
In Meltzer 2022 et al., on femoral implant selection, what was the role of canal flare index (CFI) in femoral component selection?

A. Higher CFI was associated with better cement interdigitation
B. Higher CFI predicted osteomyelitis
C. CFI was unrelated to stem type
D. Lower CFI was associated with femoral fractures and guided cemented stem selection
E. CFI > 2.5 was required for BFX use

Answer: Lower CFI was associated with femoral fractures and guided cemented stem selection

Explanation: CFI <1.8 was linked to increased risk of fracture and stem subsidence in cementless implants.
In Meltzer 2022 et al., on femoral implant selection, what was the frequency of catastrophic complications in dogs undergoing THR?

A. 8.6%
B. 5.1%
C. 1.5%
D. 0%
E. 3.2%

Answer: 1.5%

Explanation: Only two cases (1.5%) were catastrophic, both related to implant-associated infection.
In Meltzer 2022 et al., on femoral implant selection, which statement best describes the complication rate among dogs undergoing total hip replacement?

A. Complication rate was significantly higher in cementless BFX implants
B. Complication rate exceeded 25%
C. Total complication rate was 14% with no significant difference between implant types
D. All complications required revision surgery
E. Most complications occurred after 1 year

Answer: Total complication rate was 14% with no significant difference between implant types

Explanation: The study reported a 14% complication rate and no association between implant type and complication risk.
In Meltzer 2022 et al., on femoral implant selection, which factor most consistently predicted the use of a cemented femoral stem?

A. Increased femoral neck angle
B. Proximal femoral sclerosis
C. Age ≥ 7 years
D. Preexisting lameness
E. Bilateral hip dysplasia

Answer: Age ≥ 7 years

Explanation: Older dogs were more likely to receive cemented stems due to decreased bone quality and increased fracture risk.

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