Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty

Abstract

Background In the last decade, the increase in the use of the direct anterior approach to the hip has contributed to the diffusion of the use of short stems in orthopedic surgery. The aim of the study is to verify the medium-term clinical and radiographic results of a cementless anatomic short stem in the anterior approach to the hip. We also want to verify whether the use of the standard operating room table or the leg positioner can affect the incidence of pre- and postoperative complications. Materials and methods All total hip arthroplasty patients with a 1-year minimum follow-up who were operated using the MiniMAX stem between January 2010 and December 2019 were included in this study. Clinical evaluation included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC) Score, and Short Form-36 (SF-36) questionnaires. Bone resorption and remodeling, radiolucency, osteolysis, and cortical hypertrophy were analyzed in the postoperative radiograph and were related to the final follow-up radiographic results. Complications due to the use of the standard operating room table or the leg positioner were evaluated. Results A total of 227 patients (238 hips) were included in the study. Average age at time of surgery was 62 years (range 38–77 years). Mean follow-up time was 67.7 months (range 12–120 months). Kaplan–Meier survivorship analysis after 10 years revealed 98.2% survival rate with revision for loosening as endpoint. The mean preoperative and postoperative HHS were 38.35 and 94.2, respectively. The mean preoperative and postoperative WOMAC Scores were 82.4 and 16.8, respectively. SF-36 physical and mental scores averaged 36.8 and 42.4, respectively, before surgery and 72.4 and 76.2, respectively, at final follow-up. The radiographic change around the stem showed bone hypertrophy in 55 cases (23%) at zone 3. In total, 183 surgeries were performed via the direct anterior approach (DAA) on a standard operating room table, and 44 surgeries were performed on the AMIS mobile leg positioner. Comparison between the two patient groups did not reveal significant differences. Conclusion In conclusion, a short, anatomic, cementless femoral stem provided stable metaphyseal fixation in younger patients. Our clinical and radiographic results support the use of this short stem in the direct anterior approach. Level of evidence IV.

Tri-Lock Bone Preservation Stem Versus Conventional Corail Stem in Primary Total Hip Arthroplasty via Direct Anterior Approach: A Short-Term, Retrospective, Comparative Study

“…Proximal femoral exposure is a major factor affecting surgical incision, operative time, and intraoperative bleeding [31][32][33]. The superior perioperative indices with Tri-Lock BPS vs Corail stems in the current study may be attributable to the short and curved design of Tri-Lock BPS.…”

Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review

“…Our rate of intraoperative fracture increases to 2% including minor complications (intraoperative cerclages due to calcar incomplete fractures). Our results encourage us to continue our experience with short stems, both with the use of the standard table and the traction table[ 8 ]. Surprisingly, however, Greco et al [ 42 ] report an opposite experience.…”

“…The increase in popularity of DDA is due to the advantages such as less surgical trauma, minimal dissection of soft tissues, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation. However, the literature reports a higher rate of perioperative DAA complications than other approaches[ 4 - 8 ] like periprosthetic fracture, prosthesis loosening and nerve injury, but the reported complication rates vary widely in the published literature both in the incidence rate and in the type of complication[ 9 - 13 ]. There is not yet consensus concerning the best approach for total hip arthroplasty (THA) and debates are ongoing[ 14 ].…”

Successful reconstruction of natural femoral anteversion using a short femoral stem in total hip arthroplasty surgery

“…[22][23][24] Therefore, this study aimed to examine the "MiniMAX" prosthesis (Medacta International, Castel San Pietro, Switzerland), which is a new-generation, short, anatomical femoral stem. 25 We also investigated patients' satisfaction 6 months postsurgery using the Harris Hip Score (HHS) and the Oxford Hip Score (OHS) to assess function, quality of life, and pain.…”