Independent assessment and outcomes of 196 short-tapered stems short-term follow-up and review of the literature

Abstract

Background: Longer term outcome data are now becoming available for short-tapered femoral stems for cementless total hip arthroplasty. The shorter stem has a metaphyseal fit, loading the bone in this area, leading to physiological bone remodelling. It is also bone preserving, as it is 35 mm shorter. It may be easier to insert through a smaller incision and potentially reduce complication rates. We present a retrospective single surgeon case series of 196 patients (>53% follow-up over 5 years). All patients had the cementless 'Microplasty Taperloc' (Biomet). Primary outcome measures were femoral component revision rates. Secondary outcome measures included complications, patient-reported functional outcome scores (Oxford hip) and radiographic evidence of loosening. Methods: Patients were identified using electronic software. All were routinely followed up and assessed in clinic since implant introduction in 2009. Oxford hip scores were routinely obtained. A surgeon who had not carried out the procedure independently assessed radiographs. Results: One hundred ninety-six patients were identified. The revision rate was 0.5% due to an intraoperative periprosthetic fracture of the femur identified on post-operative radiograph. The complication rate was 2%, attributable to: subsidence of the prosthesis (one hip), post-operative dislocation (two hips), one of which required acetabular revision. Oxford hip scores increased on average from 21 to 45 (pre-to post-operatively). There were no signs of radiographic loosening. Conclusion: The results show that using the short-tapered stem is proving so far to be a reliable and safe alternative to its longer counterpart, with low complication rates in the short term.

The DePuy Proxima™ short stem for total hip arthroplasty – Excellent outcome at a minimum of 7 years

“…13 Available literature on short stems shows a heterogenous picture. Some stems have proven to be reliable in the short term, 14 while studies of others showed varied results. 15 Early studies of the Proxima stem have focused on surgical technique, 16 migration pattern and bony integration using radiostereometric analysis and/or dual energy X-ray absorptiometry (DXA).…”

Clinical and radiographic outcomes after total hip arthroplasty with the NANOS neck preserving hip stem: a 10 to 16-year follow-up study

“…It is increasingly accepted that preserving bone stock is essential in case of revision surgery and should potentially reduce complications such as loosening of the stem or periprosthetic fracture due to less bone resorption [ 46 ]. Furthermore, short-stem implants have proven to be a safe and efficient procedure that has demonstrated good primary stability and osteointegration and therefore a low risk of aseptic loosening despite their smaller surface area and implant-bone interface [ 12 , 28 , 47 , 48 ]. On the other hand, the surgical technique requires precision and experience to avoid misalignment, incorrect sizing of the stems and intraoperative fracture and is related with a steep learning curve [ 30 – 43 ].…”

Résultats de 119 tiges fémorales raccourcies Taperloc Microplasty™ à 61 mois de recul moyen

“…La Taperloc Microplasty™ (Zimmer-Biomet, Warsaw-Indiana, USA) fait partie des tiges raccourcies (3,5 cm de moins que la Taperloc™ standard) et a été développée par Lombardi à la fin des années 2000 [13]. Les études à court terme qui ont été publiées sur cette tige sont peu nombreuses et rapportent des résultats très satisfaisants [14][15][16][17]. Sauf erreur de notre part, nous n'avons pas retrouvé dans la littérature de résultats à plus de 5 ans de recul et sur des séries de plus de 100 cas.…”

“…Toutes les valeurs de p ont été comparées avec une valeur alpha de 0,05 pour rechercher une différence significative. Compte tenu du fait qu'il s'agissait d'une étude mono-centrique et mono-opérateur tous les dossiers étaient complets en pré et en postopératoire pour toutes les variables analysées.Le score de PMA est passé de 11 ± 2,3[5][6][7][8][9][10][11][12][13][14][15][16][17] en préopératoire à 17,8 ± 0,8 [12-18] au recul maximum (p=0,00001) avec un score douleur moyen de 5,9 ± 0,4. Il n'y avait pas de douleur de cuisse susceptible d'être en relation avec la tige.…”