Outcome of Short Versus Conventional Stem for Total Hip Arthroplasty in the Femur with a High Cortical Index: a Five Year Follow-up Prospective Multicentre Comparative Study

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2019 Apr 26

PMID 31020342

Citations 14

Authors

Francesco Pogliacomi

Paolo Schiavi

Guido Grappiolo

Francesco Ceccarelli

Enrico Vaienti

Affiliations

Soon will be listed here.

Abstract

Background: The uncemented total hip arthroplasty (THA) has become the choice for many hip surgeons. Although conventional uncemented femoral components have a proven track record, there remain concerns about the rate of thigh pain, proximal stress shielding, and consequent loss of bone stock at revision surgery.

Methods: Inclusion criteria were the following: patients between 50 and 85 years old undergoing primary THA with implant of short (group 1) or conventional (group 2) femoral stem and with femoral shape type A, according to Dorr classification. Clinical follow-up was registered using OHS, HHS, and Womac scores. The radiographic scans were evaluated in order to compare component positioning and bone remodeling at five year follow-up.

Results: We included in the analysis 60 subjects in group 1 and 67 in group 2. No differences were registered between the groups comparing demographic and operative data. One case in group 1 (1.7%) and three cases in group 2 (4.5%) reported an intra-operative fracture. There was a significant improvement in the functional scores in both groups with no significant difference at final follow-up. The incidence of reported thigh pain at follow-up was 14.9% in group 2 and 3.3% in group 1 (p = 0.033). Radiographic analysis documented a difference in terms of stress shielding and thinning of medial and lateral cortex in favour of group 1. Moreover, patients of group 1 showed a higher varus angle at six month follow-up.

Conclusion: In patients with high cortical index, a short stem shows better clinical and radiological outcomes at five year follow-up.

Citing Articles

Long-term results of short stem total hip arthroplasty in patients with osteonecrosis of the femoral head.

Suksathien Y, Suarjui J, Tippimanchai T, Suksathien R, Lajuntuk B, Khamphaeng S Arch Orthop Trauma Surg. 2024; 145(1):9.

PMID: 39666077 DOI: 10.1007/s00402-024-05680-0.

Total Hip Replacement with a Fully Hydroxyapatite-Coated Shortened Stem: Five- to Thirteen-Year Follow-Up Results.

Marques Lopez F, Pares Alfonso I, Donaire Hoyas D, Ruiz Morales G, Pons M, Lizano Diez X J Clin Med. 2024; 13(9).

PMID: 38731186 PMC: 11084338. DOI: 10.3390/jcm13092657.

Evaluation of Outcome after Total Hip Arthroplasty for Femoral Neck Fracture: Which Factors Are Relevant for Better Results?.

Schiavi P, Pogliacomi F, Bergamaschi M, Ceccarelli F, Vaienti E J Clin Med. 2024; 13(7).

PMID: 38610614 PMC: 11012496. DOI: 10.3390/jcm13071849.

Dair approach in 7 infected total hip arthroplasties: our experience and current concepts of the literature.

Schiavi P, Pogliacomi F, Calderazzi F, Domenichini M, Ceccarelli F, Vaienti E Acta Biomed. 2022; 92(S3):e2021572.

PMID: 35604248 PMC: 9437696. DOI: 10.23750/abm.v92iS3.12603.

Clinical and radiological results of high offset tri-lock bone preservation stem in unilateral primary total hip arthroplasty at a minimum follow-up of 3 years.

Peng L, Ma J, Zeng Y, Wu Y, Si H, Shen B J Orthop Surg Res. 2021; 16(1):635.

PMID: 34689823 PMC: 8543806. DOI: 10.1186/s13018-021-02787-7.

References

McLaughlin J, Lee K . Total Hip Arthroplasty With an Uncemented Tapered Femoral Component in Patients Younger Than 50 Years of Age: A Minimum 20-Year Follow-Up Study. J Arthroplasty. 2016; 31(6):1275-1278. DOI: 10.1016/j.arth.2015.12.026. View

Khalily C, Lester D . Results of a tapered cementless femoral stem implanted in varus. J Arthroplasty. 2002; 17(4):463-6. DOI: 10.1054/arth.2002.32171. View

McCalden R, Korczak A, Somerville L, Yuan X, Naudie D . A randomised trial comparing a short and a standard-length metaphyseal engaging cementless femoral stem using radiostereometric analysis. Bone Joint J. 2015; 97-B(5):595-602. DOI: 10.1302/0301-620X.97B5.34994. View

Cho Y, Bae C, Yoon W, Chun Y, Rhyu K . High incidence of early subtrochanteric lateral cortical atrophy after hip arthroplasty using bone-conserving short stem. Int Orthop. 2017; 42(2):303-309. DOI: 10.1007/s00264-017-3544-9. View

von Roth P, Perka C, Mayr H, Preininger B, Ziebula F, Matziolis G . Reproducibility of femoral offset following short stem and straight stem total hip arthroplasty. Orthopedics. 2014; 37(7):e678-84. DOI: 10.3928/01477447-20140626-61. View

Min B, Song K, Bae K, Cho C, Kang C, Kim S . The effect of stem alignment on results of total hip arthroplasty with a cementless tapered-wedge femoral component. J Arthroplasty. 2008; 23(3):418-23. DOI: 10.1016/j.arth.2007.04.002. View

Engh Jr C, Young A, Engh Sr C, Hopper Jr R . Clinical consequences of stress shielding after porous-coated total hip arthroplasty. Clin Orthop Relat Res. 2003; (417):157-63. DOI: 10.1097/01.blo.0000096825.67494.e3. View

Engh C, Bobyn J . The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop Relat Res. 1988; (231):7-28. View

Leichtle U, Leasure J, Martini F, Leichtle C . Immediate changes of bone density caused by the implantation of a femoral stem--a DEXA study. Ulf.Leichtle@med.uni-tuebingen.de. Hip Int. 2011; 21(6):706-12. DOI: 10.5301/HIP.2011.8841. View

10.

Ghera S, Pavan L . The DePuy Proxima hip: a short stem for total hip arthroplasty. Early experience and technical considerations. Hip Int. 2009; 19(3):215-20. DOI: 10.1177/112070000901900305. View

11.

Gromov K, Bersang A, Nielsen C, Kallemose T, Husted H, Troelsen A . Risk factors for post-operative periprosthetic fractures following primary total hip arthroplasty with a proximally coated double-tapered cementless femoral component. Bone Joint J. 2017; 99-B(4):451-457. DOI: 10.1302/0301-620X.99B4.BJJ-2016-0266.R2. View

12.

Brown T, Larson B, Shen F, Moskal J . Thigh pain after cementless total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2002; 10(6):385-92. DOI: 10.5435/00124635-200211000-00002. View

13.

Huo S, Wang F, Dong L, Wei W, Zeng J, Huang H . Short-stem prostheses in primary total hip arthroplasty: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2016; 95(43):e5215. PMC: 5089112. DOI: 10.1097/MD.0000000000005215. View

14.

Lombardi Jr A, Berend K, Adams J . A short stem solution: through small portals. Orthopedics. 2009; 32(9). DOI: 10.3928/01477447-20090728-09. View

15.

Dorr L, Faugere M, Mackel A, Gruen T, Bognar B, Malluche H . Structural and cellular assessment of bone quality of proximal femur. Bone. 1993; 14(3):231-42. DOI: 10.1016/8756-3282(93)90146-2. View

16.

Ike H, Inaba Y, Kobayashi N, Hirata Y, Yukizawa Y, Aoki C . Comparison between mechanical stress and bone mineral density in the femur after total hip arthroplasty by using subject-specific finite element analyses. Comput Methods Biomech Biomed Engin. 2014; 18(10):1056-1065. DOI: 10.1080/10255842.2013.869320. View

17.

Jones C, Aqil A, Clarke S, Cobb J . Short uncemented stems allow greater femoral flexibility and may reduce peri-prosthetic fracture risk: a dry bone and cadaveric study. J Orthop Traumatol. 2015; 16(3):229-35. PMC: 4559535. DOI: 10.1007/s10195-015-0343-1. View

18.

Banerjee S, Pivec R, Issa K, Harwin S, Mont M, Khanuja H . Outcomes of short stems in total hip arthroplasty. Orthopedics. 2013; 36(9):700-7. DOI: 10.3928/01477447-20130821-06. View

19.

Bjorklund L . The Bone and Joint Decade 2000-2010. Inaugural meeting 17 and 18 April 1998, Lund, Sweden. Acta Orthop Scand Suppl. 1998; 281:67-80. View

20.

Albanese C, Rendine M, de Palma F, Impagliazzo A, Falez F, Postacchini F . Bone remodelling in THA: A comparative DXA scan study between conventional implants and a new stemless femoral component. A preliminary report. Hip Int. 2009; 16 Suppl 3:9-15. DOI: 10.1177/112070000601603S03. View