Stem Subsidence in Total Hip Arthroplasty: Retrospective Investigation of a Short Stem Using a Simple Measurement Approach

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2024 Dec 16

PMID 39680151

Authors

Nicolas Horst

Christoph Theil

Georg Gosheger

Tobias Kalisch

Burkhard Moellenbeck

Affiliations

Soon will be listed here.

Abstract

Background: Uncemented total hip arthroplasty (THA) is a successful treatment for advanced hip joint diseases. More recently, short stems became increasingly popular, but stem subsidence remains a concern. This study investigates early short stem subsidence in a large patient cohort using a simple measurement approach for everyday practice.

Methods: This retrospective, single center, single implant design study included 1000 patients with primary THA. Subsidence was evaluated using standardized weight-bearing radiographs taken 3-5 days and 2-3 weeks postoperatively with full weight-bearing (FWB). A novel Subsidence Index (SID) was introduced to quantify stem subsidence in a simple and reproducible manner. The SID is calculated by averaging four distinct linear measurements between defined anatomical landmarks on the femur and the implant, captured on standard radiographs without additional software.

Results: Out of all analyzed patients 6% (60/1000) had subsidence of more than 3 mm. The mean subsidence was 1.3 mm (range, 0 to 16.25 mm). There were 0.6% (6) who underwent stem revision for symptomatic subsidence. Men and obese patients had greater subsidence. However, patient age, BMI, stems without lateral bone contact and other demographic factors were not associated with subsidence.

Conclusion: Early subsidence is relatively frequent with this uncemented short stem, however revisions are rare. Patients with risk factors should be counseled regarding FWB and radiographic controls should be performed. The SID provides an easy, non-invasive and inexpensive tool for early subsidence assessment; however, its simplicity limits its accuracy. Further research is needed in comparison to more elaborate methods.

Citing Articles

High subsidence rate in primary total hip arthroplasty with a taper wedge stem featuring a three-dimensionally printed porous structure.

Ishikura H, Masuyama Y, Fujita S, Nishiwaki T Arch Orthop Trauma Surg. 2025; 145(1):188.

PMID: 40085230 DOI: 10.1007/s00402-025-05809-9.

References

Young N, Cheah D, Waddell J, Wright J . Patient characteristics that affect the outcome of total hip arthroplasty: a review. Can J Surg. 1998; 41(3):188-95. PMC: 3950159. View

Campbell D, Mercer G, Nilsson K, Wells V, Field J, Callary S . Early migration characteristics of a hydroxyapatite-coated femoral stem: an RSA study. Int Orthop. 2009; 35(4):483-8. PMC: 3066322. DOI: 10.1007/s00264-009-0913-z. View

Kutzner K, Ried E, Donner S, Bieger R, Pfeil J, Freitag T . Mid-term migration pattern of a calcar-guided short stem: A five-year EBRA-FCA-study. J Orthop Sci. 2020; 25(6):1015-1020. DOI: 10.1016/j.jos.2020.01.001. View

Budde S, Seehaus F, Schwarze M, Hurschler C, Floerkemeier T, Windhagen H . Analysis of migration of the Nanos® short-stem hip implant within two years after surgery. Int Orthop. 2015; 40(8):1607-1614. DOI: 10.1007/s00264-015-2999-9. View

Olsson S, JERNBERGER A, Tryggo D . Clinical and radiological long-term results after Charnley-Müller total hip replacement. A 5 to 10 year follow-up study with special reference to aseptic loosening. Acta Orthop Scand. 1981; 52(5):531-42. DOI: 10.3109/17453678108992143. View

Surin V, Sundholm K . Survival of patients and prostheses after total hip arthroplasty. Clin Orthop Relat Res. 1983; (177):148-53. View

Weber E, Flivik C, Sundberg M, Flivik G . Migration pattern of a short uncemented stem with or without collar: a randomised RSA-study with 2 years follow-up. Hip Int. 2019; 31(4):500-506. DOI: 10.1177/1120700019888471. View

Streit M, Haeussler D, Bruckner T, Proctor T, Innmann M, Merle C . Early Migration Predicts Aseptic Loosening of Cementless Femoral Stems: A Long-term Study. Clin Orthop Relat Res. 2016; 474(7):1697-706. PMC: 4887381. DOI: 10.1007/s11999-016-4857-5. View

Jacobs C, Christensen C . Progressive subsidence of a tapered, proximally coated femoral stem in total hip arthroplasty. Int Orthop. 2008; 33(4):917-22. PMC: 2898971. DOI: 10.1007/s00264-008-0583-2. View

10.

Rottinger H . [The MIS anterolateral approach for THA]. Orthopade. 2006; 35(7):708, 710-15. DOI: 10.1007/s00132-006-0962-6. View

11.

Shohat N, Fleischman A, Tarabichi M, Tan T, Parvizi J . Weighing in on Body Mass Index and Infection After Total Joint Arthroplasty: Is There Evidence for a Body Mass Index Threshold?. Clin Orthop Relat Res. 2019; 476(10):1964-1969. PMC: 6259862. DOI: 10.1007/s11999.0000000000000141. View

12.

Budde S, Schwarze M, Floerkemeier T, Plagge J, Wirries N, Windhagen H . Clinical and radiographic outcomes with the Nanos™ short-stem hip implant at 24 months: A prospective, single-center study. J Orthop. 2020; 20:326-331. PMC: 7330422. DOI: 10.1016/j.jor.2020.06.007. View

13.

Suksathien Y, Chuvanichanon P, Tippimanchai T, Sueajui J . Insufficient lateral stem contact is an influencing factor for significant subsidence in cementless short stem total hip arthroplasty. World J Orthop. 2022; 13(5):444-453. PMC: 9124996. DOI: 10.5312/wjo.v13.i5.444. View

14.

Karrholm J, Borssen B, Lowenhielm G, Snorrason F . Does early micromotion of femoral stem prostheses matter? 4-7-year stereoradiographic follow-up of 84 cemented prostheses. J Bone Joint Surg Br. 1994; 76(6):912-7. View

15.

Kutzner K, Kovacevic M, Freitag T, Fuchs A, Reichel H, Bieger R . Influence of patient-related characteristics on early migration in calcar-guided short-stem total hip arthroplasty: a 2-year migration analysis using EBRA-FCA. J Orthop Surg Res. 2016; 11:29. PMC: 4782512. DOI: 10.1186/s13018-016-0363-4. View

16.

Stihsen C, Radl R, Keshmiri A, Rehak P, Windhager R . Subsidence of a cementless femoral component influenced by body weight and body mass index. Int Orthop. 2011; 36(5):941-7. PMC: 3337099. DOI: 10.1007/s00264-011-1360-1. View

17.

CHANDLER H, Reineck F, Wixson R, McCarthy J . Total hip replacement in patients younger than thirty years old. A five-year follow-up study. J Bone Joint Surg Am. 1981; 63(9):1426-34. View

18.

Schmidutz F, Graf T, Mazoochian F, Fottner A, Bauer-Melnyk A, Jansson V . Migration analysis of a metaphyseal anchored short-stem hip prosthesis. Acta Orthop. 2012; 83(4):360-5. PMC: 3427626. DOI: 10.3109/17453674.2012.712891. View

19.

Freitag T, Fuchs M, Woelfle-Roos J, Reichel H, Bieger R . Mid-term migration analysis of a femoral short-stem prosthesis: a five-year EBRA-FCA-study. Hip Int. 2018; 29(2):128-133. DOI: 10.1177/1120700018772277. View

20.

Floerkemeier T, Budde S, Lewinski G, Windhagen H, Hurschler C, Schwarze M . Greater early migration of a short-stem total hip arthroplasty is not associated with an increased risk of osseointegration failure: 5th-year results from a prospective RSA study with 39 patients, a follow-up study. Acta Orthop. 2020; 91(3):266-271. PMC: 8023937. DOI: 10.1080/17453674.2020.1732749. View