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

Abstract

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.

Ceramic-on-metal bearing in short stem total hip arthroplasty: ions, functional and radiographic evaluation at mid-term follow-up

“…We detected an excellent fixation of the implant and optimal osseointegration confirmed by spot welds observed in 15 (75%) patients in zones 2 and 6 of Gruen and demonstrating a good distal fixation of the implant. 20 Similar evaluations have also been carried out for periacetabular bone and have shown osteolysis in 4 of 20 (20%) cups in 2 areas of Charnley-De Lee, while osseointegration also proved to be excellent in this case, when evaluated with the maximum score (5 points) in 19 patients and 4 points in 1 patient, following Hodgkinson's scale. 21,22 Calcar atrophy was detected in 5 patients (25%) and can be related to stem design.…”

“…6 Stress-shielding, spot-welds, cortical hypertrophy and femoral osteolysis were graded on the radiographs at final follow-up according to the classification of Engh et al 19 Short stem radiological outcome was assessed according to a modified Gruen zoning system, eliminating zones 3 and 5. 20 We also evaluated metal-back osseointegration according to Hodgkinson’s classification, dividing the interface between the bone and the metal-back into the 3 zones of Charnley-De Lee. 21,22 Periprosthetic heterotopic ossifications were evaluated by Brooker’s classification (from 1 to 4).…”

Could Short Stems THA Be a Good Bone-Saving Option Even in Obese Patients?

“…Stress-shielding, spot-welds, cortical hypertrophy and femoral osteolysis were graded on the radiographs at the final follow-up according to the classification of Engh, dividing the interface between the bone and the stem of the hip prosthesis into the seven zones of Gruen [ 14 , 15 ]. Short stem radiological outcome was assessed according to a modified Gruen zoning system, eliminating zone three and five [ 4 , 16 , 17 ]. We also evaluated the metal-back osseointegration according to the classification of Hodgkinson, dividing the interface between the bone and the metal-back into the three zones of Charnley–De Lee [ 18 , 19 ].…”

Mid-Term Outcomes of a Modern Zweymüller Monolithic Femoral Stem in Primary Total Hip Arthroplasty

“…In fact, the latter are known for having obtained excellent results in the medium-and long-term follow-up in practically any type of patient, from the youngest to the oldest. Furthermore, the optimal load distribution and the preservation of the bone stock have made the short stems a valid alternative to traditional designs [21].…”