Mid-Term Outcome of Total Hip Arthroplasty Using a Short Stem

Malhotra, Rajesh; Kumar, Vijay

doi:10.1177/1602400310

Cited by 9 publications

(9 citation statements)

References 30 publications

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“…Distal femoral cortical hypertrophy in short-stem THA is an issue often mentioned in the literature. 2,18,[27][28][29][30][31][32][33] The reported incidences are between 0-63% after a minimum 2 years follow-up. Our reported incidence of cortical hypertrophy at 5 years is higher, with 71% of the hips showing cortical hypertrophy with no significant progression over time.…”

Section: Discussionmentioning

confidence: 99%

An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem

et al. 2019

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Background: Although reported results on short stems sound very promising, the occurrence of distal femoral cortical hypertrophy is often observed. The aim of the present study was to report 5-year survival data of a commercially available trochanter sparing short stem and investigate the clinical impact of distal femoral cortical hypertrophy on the outcome. Methods: 123 total hip arthroplasties were performed on 120 patients from April 2008 to May 2010 (mean age 62, range 29–89 years; 71 hips from male patients, 58%). Clinical and radiological data were collected preoperative, at 6 weeks, 1, 2, 3, and 5 years postoperative to assess the outcome. Radiographs taken immediately postoperative as well as 1 and 5 years postoperative were used to identify and assess cortical hypertrophy. Results: 1 stem had to be revised due to aseptic loosening, resulting in a Kaplan-Meier survival analysis with endpoint for stem revision of 99.2% (95% Confidence Interval 94.1–99.9) at 5 years. 96 radiological and 95 clinical follow-ups were analysed 5 years postoperative. 68 (71%) hips showed distal femoral cortical hypertrophy after 5 years. The average Harris Hip Score and Oxford Hip Score improved 33 (standard deviation (SD) 15.1, range 2–70), 18 (SD 12.1, range -10–43) points, respectively. Overall 16% of the patients reported thigh pain, unrelated to the presence of cortical hypertrophy. Discussion: This short stem shows an excellent 5-year survival rate and good clinical outcome despite a high incidence of cortical hypertrophy. However, the question of the mechanism of load transfer arises.

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Section: Discussionmentioning

confidence: 99%

An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem

et al. 2019

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“…Biomechanical studies showed that these metaphyseal-fitting stems exhibit good fixation achieving durable bone ingrowth and good clinical performance providing a reliable long-term fixation. 10,11 Nowadays, there are many studies about short stems, but often with short-term follow-up and rarely with a direct comparison with conventional stems.…”

Section: Introductionmentioning

confidence: 99%

Stemless hip arthroplasty versus traditional implants: a comparative observational study at 30 months follow-up

et al. 2018

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The aim of this retrospective case-control study is to evaluate clinical and radiographic results of short stems compared with traditional hip prostheses. Methods: 46 short stems (SS) and 50 traditional stems (TS) were selected. All the stems were implanted by the same surgeon using posterior approach because of primary osteoarthritis, post-traumatic osteoarthritis and avascular necrosis. All the patients were compared clinically by Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF-12F/M) and radiographically (offset, CD angle, limb length discrepancy, cup inclination, subsidence, osseointegration, heterotopic ossification). Radiographic evaluations were carried out by 3 different blinded surgeons. A statistical analysis was performed (chi-square, t-test, Mann-Whitney). Results: At a mean follow-up of 30 months all the implanted stems were well-positioned and osseointegrated. In both groups there was a marked improvement in pain (p < 0.001) with a statistically significant advantage in the SS group for WOMAC (90.8 vs. 87.5; p = 0.02) and in part for HHS (93 vs. 91.7; p = 0.18). The radiographic evaluations, with high concordance correlation between the 3 blinded surgeons (ICC consistently >0.80), showed no significant differences in the restoration of the articular geometry, with a reduction of cortical hypertrophy (2% SS vs. 7% TS) and periprosthetic stress-shielding (p < 0.05) in the SS group. On the other hand, SS were more related to limb length discrepancy (61% vs. 33%; p < 0.05). No major complications were recorded in the 2 groups. Conclusion: Short stems were shown to be comparable or better than traditional implants at short-term follow-up.

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“…Tolerance to varus when positioning the femoral stem has been widely discussed. 8 Our experience has shown us that stems placed in less than 5° varus are totally acceptable, while a positioning greater than 5° can produce a progressive increase of the varus with femoral pain that requires revision of the stem. This is just what happened to us in one case.…”

Section: Discussionmentioning

confidence: 90%

Medium-term outcomes of short stems in total hip arthroplasty

Cano¹,

Molina²,

Puertolas³

2022

Journal of Orthopaedics, Trauma and Rehabilitation

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Background Prosthetic surgery has shown good short-term results with the use of short stems, results comparable with the experience of conventional stems. The aim of this study was to investigate and describe the characteristics and clinical course of patients operated on with the short stem GTS in the medium term. Methods Between November 2010 and September 2014, 152 primary hip prostheses were operated on in 142 patients with a mean follow-up of 95.49 months (range 75–120). We analyzed the intraoperative and postoperative complications and the reviews performed during the follow-up. Results One intraoperative complications occurred; case in which a femoral calcar fracture occurred and a screw was required during the operation. The clinical evaluation at the end of the follow-up, according to the Merle D’Aubigne Scale, showed the mean value was 17.3684 (SD 0,79472), with a survival at the end of the follow-up of 99.3% of the placed GTS stems. Conclusions GTS short stems have shown good results after more than 6 years of follow-up, with comparable results to conventional uncemented stems. Short-stem hip arthroplasty is an advanced way to preserve bone stock while protecting soft tissue

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Mid-Term Outcome of Total Hip Arthroplasty Using a Short Stem

Abstract: A short femoral stem design that transfers load proximally through a prominent lateral flare achieved good short-term outcome in younger patients. Nonetheless, the ease of removal and preservation of bone at the time of revision should guide the choice of the design of the short stem.

Cited by 9 publications

References 30 publications

An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem

An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem

Stemless hip arthroplasty versus traditional implants: a comparative observational study at 30 months follow-up

Medium-term outcomes of short stems in total hip arthroplasty

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