A comparison of uncemented short versus standard stem length in total hip arthroplasty: results from the Dutch Arthroplasty Register

Abstract

Background and purpose: We aimed to compare revision rates between uncemented short and standard stems in total hip arthroplasties (THAs) and the corresponding patient-reported outcome measures (PROMs).Patients and methods: We included all short (C.F.P., Fitmore, GTS, Metha, Nanos, Optimys, Pulchra, and Taperloc Microplasty) and standard stems in uncemented THAs registered between 2009 and 2021 in the Dutch Arthroplasty Register. Kaplan–Meier survival and multivariable Cox regression analyses were performed with overall and femoral stem revision as endpoints.Results: Short stems were used in 3,352 and standard stems in 228,917 hips. 10-year overall revision rates (4.8%, 95% confidence interval [CI] 3.7–6.3 vs. 4.5%, CI 4.4–4.6) and femoral stem revision rates (3.0%, CI 2.2–4.2 vs. 2.3%, CI 2.2–2.4) were comparable for short- and standard-stem THAs. Today’s predominant short stems (Fitmore and Optimys) showed short-term revision rates similar to that of standard-stem THAs. Other, less frequently used short stems had higher 10-year overall (6.3%, CI 4.7–8.5) and femoral stem (4.5%, CI 3.1–6.3) revision rates. Multivariable Cox regression also showed a higher risk for overall (HR 1.7, CI 1.0–2.9) and femoral stem revision (HR 2.0, CI 1.1–3.5) using the latter short stems compared with standard stems. An exploratory analysis of PROMs showed no difference.Conclusion: There was no overall difference in revision rates but a tendency toward increased revision of short stems both for the whole THA and for the stem itself. The less frequently used short stems had increased revision risk. No difference in PROMs was shown.

Reply to the Letter to the editor from Grappiolo G et al. to the article ‘The History of the development of the regular straight stem in hip arthroplasty’

“…However, this higher risk can be explained by short stems that are hardly used in the Netherlands anymore, including Pulchra, Metha, Nanos, C.F.P., GTS, and Taperloc Microplasty. Our study showed a comparable risk for femoral stem revision for Fitmore, Optimys, and standard stems’ ( 9 ). The GTS stem did not perform poorly only in the Swiss arthroplasty registry.…”

No significant differences in 60‐day postoperative complication rates between conventional and shortened stems

“…A recent study on the Dutch Arthroplasty Register [39] analysed 228,917 cementless conventional stems and 3,352 cementless short stems and found no significant differences in 10‐year stem revision rates (2.3% vs 3.0%), although today’s predominant short stems (Fitmore and Optimys) had lower revision rates than other less frequently used short stems (4.5%). In addition, prior clinical studies comparing conventional versus short stems found no significant differences in subsidence (0% vs 0% [19, 22]; 1% vs 0% [16]; 0% vs 2%, p = 0.554 [36]) or misalignment (0% vs 0% [19]; 2% vs 4%, p = 0.313 [36]; 1% vs 5%, p = 0.111 [13]); however, these clinical studies were underpowered to detect significant differences across groups.…”

Short-stem hip arthroplasty in Australia and the Netherlands: a comparison of 12,680 cases between the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and the Dutch Arthroplasty Register (LROI)

“…At 10-year follow-up, the revision rate of all Australian uncemented THAs for primary osteoarthritis is 4.4% (CI 4.3-4.5) [1]. In the Netherlands, the performance of short-stem THAs is comparable to that of conventionalstem THAs, as the 10-year revision rate of conventional-stem THAs is 4.5% (CI 4.4-4.6) [2].…”

“…Revision within 1 and 5 years according to reason for revision differed slightly between shortstem THAs performed in Australia and in the Netherlands in this study. In Australia, peri-prosthetic fractures were a more common today's predominant short stems, including Fitmore and Optimys, have a similar risk of revision to conventional stems [2]. This is reflected by the comparable risks for revision of all short-stem THAs performed between 2015 and 2021 in Australia and the Netherlands.…”

“…In recent years, short-stem THAs have been increasingly performed in both Australia and the Netherlands, although currently representing less than 2% of all THAs in both countries [1,2]. Short-stemmed femoral components are designed to achieve metaphyseal fixation and to preserve proximal femoral bone stock to facilitate future revisions [3][4][5][6].…”