Comparison of the 5-Year Outcomes Between Standard and Short Fit-and-Fill Stems in Japanese Populations

Kato, Suguru; Nozawa, Masahiko; Kim, Sungon; Sakamoto, Yuko; Ochi, Hironori; Ishijima, Muneaki

doi:10.1016/j.artd.2022.03.023

Cited by 2 publications

(5 citation statements)

References 22 publications

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“…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. Based on this data, the present study performed an a priori sample size calculation to determine the number of patients that would be needed in each group to provide a significant difference in subsidence and misalignment.…”

Section: Discussionmentioning

confidence: 96%

“…In contrast, radiographic outcomes were not widely evaluated; three systematic reviews reported contradictory findings regarding bone mineral density [23, 43, 44], while one systematic review reported no significant differences in femoral offset and limb length discrepancy [12]. A number of comparative clinical studies have reported radiographic outcomes of conventional versus short stems, with cohorts varying between 25–132 per group [13, 16, 19–22, 36, 37, 42], which may be underpowered to detect significant differences across groups, considering the small incidence of subsidence (0–2%) and misalignment (0–5%) [13, 16, 19, 22, 36]. In terms of subsidence, Kato et al [16] reported only one case ≥ 2 mm in the conventional group and Shin et al [36] reported only one case ≥ 2 mm in the short group, while Lacko et al [22] and Kim et al [19] reported no cases ≥ 2 mm and ≥ 3 mm respectively in either group.…”

Section: Introductionmentioning

confidence: 99%

“…A number of comparative clinical studies have reported radiographic outcomes of conventional versus short stems, with cohorts varying between 25–132 per group [13, 16, 19–22, 36, 37, 42], which may be underpowered to detect significant differences across groups, considering the small incidence of subsidence (0–2%) and misalignment (0–5%) [13, 16, 19, 22, 36]. In terms of subsidence, Kato et al [16] reported only one case ≥ 2 mm in the conventional group and Shin et al [36] reported only one case ≥ 2 mm in the short group, while Lacko et al [22] and Kim et al [19] reported no cases ≥ 2 mm and ≥ 3 mm respectively in either group. In terms of misalignment, Kim et al [19] reported no cases ≥ 5° in either group, while Shin et al [36] reported 2 versus 1 case ≥ 5° in the short and conventional groups respectively ( p = 0.554).…”

Section: Introductionmentioning

confidence: 99%

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

Girardot,

Guy,

Bonin

2023

J. exp. orthop.

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Purpose To compare 60-day complication rates, radiographic outcomes, and clinical outcomes following primary THA with conventional versus shortened stems, in a large cohort study. Methods The authors reviewed a consecutive series of 800 primary THAs, of which 781 met the inclusion/exclusion criteria: 395 received a conventional stem and 386 received a shortened stem. Intraoperative and postoperative complications were noted. Radiographic and clinical assessments were performed preoperatively and 60 days after surgery. Results Compared to conventional stems, shortened stems had significantly less intraoperative complications (2.8% vs 0.3%, p = 0.006), but no significant differences in complications that did not require reoperation (1.0% vs 1.3%, p = 0.620), complications that required reoperation without stem revision (2.0% vs 1.0%, p = 0.384), and complications that required stem revision (0.5% vs 0.5%, p = 1.000). Four hips (two from each group) required stem revision and were thus excluded from 60-day assessment. There were no significant differences between groups in subsidence ≥ 3 mm (1.0% vs 0.5%, p = 0.686), alignment (90.3%vs 86.7%, p = 0.192), net change in offset (within 3 mm, 32.3% vs 30.5%, p = 0.097), and limb length discrepancy (3.0 ± 2.6 mm vs 2.9 ± 2.4 mm, p = 0.695). Compared to conventional stems, shortened stems had significantly better preoperative mHHS (56.5 ± 18.5 vs 64.5 ± 13.5, p < 0.001), and significantly lower net improvement in mHHS (29.9 ± 17.1 vs 24.4 ± 15.0, p < 0.001), but no significant differences in postoperative mHHS (87.3 ± 11.9 vs 89.4 ± 9.6, p = 0.109). Conclusions There were no significant differences between conventional and shortened stems in terms of postoperative complication rates, radiographic outcomes, and postoperative mHHS. However, patients implanted with shortened stems had less intraoperative complications, but lower net improvement in mHHS. Level of Evidence Level IV, Retrospective comparative cohort study

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Girardot,

Guy,

Bonin

2023

J. exp. orthop.

View full text Add to dashboard Cite

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“…The grade of SS caused by fit-and-fill stems implanted in the control group were reported previously using Engh’s classification. Kato reported that Synergy stems were shown grade 2 of SS appeared 66% and grade 3 and 4 of SS appeared 22% at 5-year follow-up [ 39 ]. Nishino also reported that Synergy stems had grade 2 of SS appeared 38% and grade 3 and 4 of SS appeared 46% at 10- to 12-year follow-up [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…We did not evaluate bone mineral density of femurs. SS was evaluated using Engh’s classification and Gruen zone for comparison with previous studies using radiographic analyses of control stems implanted in this study [ 39 – 41 ]. Third, different surgeons performed the surgeries in the TNS and control groups at different timing.…”

Section: Discussionmentioning

confidence: 99%

TiNbSn stems with gradient changes of Young’s modulus and stiffness reduce stress shielding compared to the standard fit-and-fill stems

et al. 2023

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Background The difference between Young’s moduli of the femur and the stem causes stress shielding (SS). TiNbSn (TNS) stem has a low Young’s modulus and strength with gradient functional properties during the change in elastic modulus with heat treatment. The aim of this study was to investigate the inhibitory effect of TNS stems on SS and their clinical outcomes compared to conventional stems. Methods This study was a clinical trial. Primary THA was performed using a TNS stem from April 2016 to September 2017 for patients in the TNS group. Unilateral THA was performed using a Ti6Al4V alloy stem from January 2007 to February 2011 for patients in the control group. The TNS and Ti6Al4V stems were matched in shape. Radiographs were obtained at the 1- and 3-year follow-ups. Two surgeons independently checked the SS grade and appearance of cortical hypertrophy (CH). The Japanese Orthopaedic Association (JOA) scores before and 1 year after surgery were assessed as clinical scores. Results None of the patients in the TNS group had grade 3 or 4 SS. In contrast, in the control group, 24% and 40% of patients had grade 3 and 4 SS at the 1- and 3-year follow-ups, respectively. The SS grade was lower in the TNS group than in the control group at the 1- and 3-year follow-ups (p < 0.001). The frequencies of CH in both groups were no significant difference at the 1- and 3-year follow-ups. The JOA scores of the TNS group significantly improved at 1 year after surgery and were comparable to control group. Conclusion The TNS stem reduced SS at 1 and 3 years after THA compared to the proximal-engaging cementless stem, although the shapes of the stems matched. The TNS stem could reduce SS, stem loosening, and periprosthetic fractures. Trial registration: Current Controlled Trials. ISRCTN21241251. https://www.isrctn.com/search?q=21241251. The date of registration was October 26, 2021. Retrospectively registered.

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Comparison of the 5-Year Outcomes Between Standard and Short Fit-and-Fill Stems in Japanese Populations

Cited by 2 publications

References 22 publications

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

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

TiNbSn stems with gradient changes of Young’s modulus and stiffness reduce stress shielding compared to the standard fit-and-fill stems

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