Outcomes of Short Stems in Total Hip Arthroplasty

Banerjee, Samik; Pivec, Robert; Issa, Kimona; Harwin, Steven F.; Mont, Michael A.; Khanuja, Harpal S.

doi:10.3928/01477447-20130821-06

Cited by 76 publications

(56 citation statements)

References 43 publications

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“…In addition, shorter broach-only stems can provide easier insertion, especially through smaller direct anterior approaches [18,27,36,45]. Earlier studies have shown that short stems have similar risks of revision as well as comparable fixation and clinical outcomes to conventional length stems [2,40,49].…”

Section: Introductionmentioning

confidence: 99%

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Two- to 4-Year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern

Amendola

Goetz

Liu

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Short stem cementless femoral components were developed to aid insertion through smaller incisions, preserve metaphyseal bone, and potentially decrease or limit the incidence of thigh pain. Despite some clinical success, the senior author (DDG) believed a higher percentage of his patients who had received a cementless short stem design were experiencing thigh pain, which, coupled with concerns about bone ingrowth fixation, motivated the review of this case series.Questions/purposes (1) What is the proportion of patients treated with a short stem cementless THA femoral component that develop thigh pain and what are the hip scores of this population? (2) What are the radiographic results, specifically with respect to bone ingrowth fixation and stress shielding, of this design? (3) Are there particular patient or procedural factors that are associated with thigh pain with this short stem design? Methods Two hundred sixty-one primary THAs were performed in 238 patients by one surgeon between November 2010 and August 2012. During this time period, all patients undergoing primary THA by this surgeon received the same cementless short titanium taper stem. Seven patients (eight hips) died and five patients (five hips) were lost to followup, leaving 226 patients (248 hips) with a mean followup of 3 years (range, 2-5 years). Patients rated their thigh pain during activity or rest at final followup on a 10-point visual analog scale. Harris hip scores (HHS) were obtained at every clinic appointment. Thigh pain was evaluated at the final followup or by contacting the patient by phone. Radiographs were evaluated for boneimplant fixation, bone remodeling, and osteolysis. An attempt was made to correlate thigh pain with patient demographics, implant specifications, or radiographic findings. Results Seventy-six percent of hips (180 of 238) had no thigh pain, 16% of hips (37 of 238) had mild thigh pain, and 9% (21 of 238) had moderate or severe thigh pain. Preoperatively, mean HHS was 47 (SD, 16) and at last followup, mean HHS was 88 (SD, 13). There were two femoral revisions, one for severe thigh pain and the other for infection. All but two components demonstrated bone ingrowth fixation (99%). Femoral stress shielding was mild in 64% of hips (135 of 212), moderate in 0.5% (one of 212), and severe in no hips. There is an inverse linear

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Section: Introductionmentioning

confidence: 99%

“…(2) What are the radiographic results, specifically with respect to bone ingrowth fixation and stress shielding, of this design? (3) Are there particular patient or procedural factors that are associated with thigh pain with this short stem design?…”

Section: Introductionmentioning

confidence: 99%

Two- to 4-Year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern

Amendola

Goetz

Liu

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…It differs from other neck-preserving prostheses in that its resection level runs through the middle of the femoral head rather than the head-neck junction. This design sought to overcome the problems of other short-stemmed hip implants, especially proximal femoral neck stress-shielding [7,18,23,30,35,36,38,45]. In this study we set out to assess the performance of BMHR at mid-term followup.…”

Section: Discussionmentioning

confidence: 99%

“…It differs from other neck-preserving prostheses in that its resection level runs through the middle of the femoral head rather than the head-neck junction. Allowing the load to go through the conically shaped headneck junction would theoretically prevent stress shielding in the femoral neck [15,35,36], a complication reported in other neck-preserving hip implants [7,18,23,30,38,45].…”

Section: Introductionmentioning

confidence: 99%

Frequent Femoral Neck Osteolysis With Birmingham Mid-head Resection Resurfacing Arthroplasty in Young Patients

Asaad

Hart

Khoo

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Mid-head resection total hip resurfacing arthroplasty was promoted as an alternative to traditional total hip resurfacing for patients with poor femoral head bone quality or abnormal femoral head morphology, because those patients are at high risk of failure with traditional total hip resurfacing. It is a large-headed metal-onmetal device that uses a short, bone-conserving stem. Good performance of the implant has been reported at short-term followup, but no information on the implant performance in the mid-or long-term is available. Questions/purposes In this study, we report (1) on the mid-term implant survivorship and hip scores in a single nondesigner surgeon series. Because of the occurrence of femoral neck osteolysis and pseudotumor in a subgroup of patients, we also investigated the following: (2) Were there any preoperative parameters that are associated with osteolysis? (3) Could we differentiate the osteolysis group from the others on the basis of implant component sizes, positions, and radiologic parameters? (4) Could we differentiate the osteolysis group from the others on the basis of metal ion levels? Methods Between 2006 and 2011, one surgeon performed a total of 49 Birmingham Mid-head Resection total hip resurfacing arthroplasties in 47 patients. The general indications for this procedure were young patients who were considered suitable for hip resurfacing arthroplasty but had avascular necrosis, large cysts, or severe deformity of the femoral head. Clinical followup including Oxford Hip Score (OHS) and UCLA hip scores were available preoperatively and at a mean of 6 years (range, 3-8 years) on all patients (100%), radiographic followup on 45 of 47 (96%), MRIs on 18 (38%), and metal ion levels on 37 (79%). Mean age at surgery was 50 years. Spearman's correlation was used to test the association between femoral neck osteolysis and preoperative parameters, implant component sizes and positions, and blood metal ion levels. Results We found 100% survival. Patients' median OHS was 46 of 48 (range, 35-48) and UCLA 8 of 10 (range, 4-10). However, 16% of the hips (seven of 45) demonstrated osteolysis in the femoral neck. Of the preoperative parameters, the osteolysis was associated with low weight (r = À0.337, p = 0.031) and to a lesser degree with female sex (r = 0.275, p = 0.067). Radiologically, the osteolysis was strongly associated with the presence of a

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“…All current designs of short stems demonstrated excellent survival rate, ranging from 98% to 100%, in both short and midterm [6,8,13,14]. Although the current designs showed good survival in the short term, they can be associated with malalignment, incorrect stem sizing, and intraoperative fractures.…”

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confidence: 99%

Short Stem In Primary Total Hip Arthroplasty

Loppini¹

2016

MOJOR

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Outcomes of Short Stems in Total Hip Arthroplasty

Cited by 76 publications

References 43 publications

Two- to 4-Year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern

Two- to 4-Year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern

Frequent Femoral Neck Osteolysis With Birmingham Mid-head Resection Resurfacing Arthroplasty in Young Patients

Short Stem In Primary Total Hip Arthroplasty

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