Better early functional outcome after short stem total hip arthroplasty? A prospective blinded randomised controlled multicentre trial comparing the Collum Femoris Preserving stem with a Zweymuller straight cementless stem total hip replacement for the treatment of primary osteoarthritis of the hip

Abstract

ObjectivesPrimary aim was to compare the functional results at 3 months and 2 years between short and conventional cementless stem total hip arthroplasty (THA). Secondary aim was to determine the feasibility of a double-blind implant-related trial.DesignA prospective blinded randomised controlled multicentre trial in patients with osteoarthritis of the hip. All patients, research assistants, clinical assessors, investigators and data analysts were blinded to the type of prosthesis. Population: 150 patients between 18 and 70 years with osteoarthritis of the hip, 75 in the short stem and 75 in the conventional stem group. Mean age: 60 years (SD 7). Interventions: the Collum Femoris Preserving short stem versus the Zweymuller Alloclassic conventional stem.Main outcome measuresThe Dutch version of the Hip Disability and Osteoarthritis Outcome Score (HOOS). Secondary outcomes measures: Harris Hip Score, the Physical Component Scale of the SF12, the Timed Up and Go test, Pain and the EQ-5D. Feasibility outcomes: continued blinding, protocol adherence and follow-up success rate.ResultsNo significant difference between the two groups. Mean HOOS total score in the short stem group increased 32.7 points from 36.6 (95% CI 32.9 to 40.2) preoperatively to 69.3 (95% CI 66.4 to 72.1) at 3 months follow-up. Mean HOOS total score in the conventional straight stem group increased 36.3 points from 37.1 (95% CI 33.9 to 40.3) preoperatively to 73.4 (95% CI 70.3 to 76.4) at 3 months follow-up. 91.2% of patients remained blinded at 2 years follow-up. Both protocol adherence and follow-up success rate were 98%.ConclusionsFunctional result at 3 months and 2 years after short stem THA is not superior to conventional cementless THA. There were more perioperative and postoperative complications in the short stem group. Direct comparison of two hip implants in a double-blinded randomised controlled trial is feasible.Trial registration numberNTR1560.

A comparison of patient-reported outcome measures (PROMs) between short and conventional stem hip replacements: a systematic review and meta-analysis

“…McCalden et al 19 SMF Synergy Lateral Meyer et al 5 Fitmore CLS straight Lateral Salemyr et al 20 Proxima Bimetric Posterolateral Schilcher et al 21 Taperloc Microplasty Taperloc Posterior Sluimer et al 22 Omnifit-HA 1090 Omnifit-HA 1017 Posterolateral van Oldenrijk et al 23 CFP Zweymuller Lateral von Roth et al 24 Fitmore CLS Anterolateral S, short stem; C, conventional stem. 32 Retrospective Short Citation Multiple Posterolateral Shin et al 33 Prospective Metha Bicontact Posterolateral Tahim et al 34 Retrospective Microtaperloc Taperloc Posterior Tomazewski et al 35 Prospective Proxima ABG II Anterolateral + Posterolateral No data Yu et al 36 Retrospective Tri-locked stem Corail Posterolateral…”

Sleep improvement after hip arthroplasty: a study on short-stem prosthesis

“…However, the difference in the quality of life after shortstem and standard-stem hip arthroplasty has already been reviewed in several studies that suggest similar functional outcome with slight benefit for short stem prosthesis in younger patients due to faster post-operative recovery as well as less stress shielding [9,10,24,25]. A supplement reduction of thigh pain using short-stem hip arthroplasty might has an effect on sleep improvement, but existing studies show no significant difference compared with conventional standardstem hip arthroplasty [26].…”

“…The current gold standard for hip osteoarthrosis is a total hip replacement [8]. For younger patients with hip osteoarthrosis, the short-stem hip prosthesis is a new method that promises reduced surgical trauma as well as faster post-operative recovery compared with standard-stem prosthesis [9,10].…”

Intrasurgical Protein Layer on Titanium Arthroplasty Explants: From the Big Twelve to the Implant Proteome

“…Whereas polymethylmethacrylate fixation was the gold standard (“bone cement”) in the 1970s and 1980s, cementless fixation has become more and more popular in femoral stem fixation since the 1990s. Especially, titanium alloys are frequently applied and have shown superior clinical results compared to other biomaterials . However, still‐remaining challenges in arthroplasty are early implant failure due to insufficient osteointegration of the biomaterial and long‐term aseptic loosening caused by wear debris particles.…”