Thigh pain, subsidence and survival using a short cementless femoral stem with pure metaphyseal fixation at minimum 9-year follow-up

Cinotti, Gianluca; Rocca, Antonello Della; Sessa, Pasquale; Ripani, Francesca Romana; Giannicola, Giuseppe

doi:10.1016/j.otsr.2012.09.016

Cited by 59 publications

(50 citation statements)

References 30 publications

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“…It is unclear whether their patients were specifically queried regarding presence, location, and severity of thigh pain, which might explain the difference in findings. Only five of the studies of short stems reviewed (Table 2) reported any thigh pain at all [6,7,14,26,37]. Two studies reported thigh pain requiring revision surgery [7,14].…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 99%

“…Two studies reported thigh pain requiring revision surgery [7,14]. Cinotti et al reported that three of the five cases of thigh pain in their series appeared to be unrelated to the THA procedure [6]. Pipino et al [37] reported six cases of thigh pain but five of them resolved within 1 year.…”

Section: Discussionmentioning

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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“…We speculated that patients could obtain excellent clinical scores postoperatively in the early stage whatever prostheses were used. Cinotti et al [20] reported that the HHS averaged 43 points (range 19–50) preoperatively and 88 points (range 73–100) at a minimum follow-up of 9 years, and WOMAC increased from 47 points (range 35–56) before surgery to 76 points at the final follow-up. Patel et al [21] reported an average HHS of 88 for a cohort of ≥70 years and 93 for a cohort of ≤70 years at a minimum follow-up of 24 months (mean, 35 months; range, 24–60 months).…”

Section: Discussionmentioning

confidence: 99%

Short-stem prostheses in primary total hip arthroplasty

et al. 2016

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Background:Short-stem (SS) prostheses require less resection of the femoral neck, produce a more physiological load pattern in the proximal femur, reduce stress shielding, and aid bone conservation and are, therefore, beneficial for young patients. Conventional cementless implants in total hip arthroplasty (THA) have shown excellent clinical results; however, it is unclear whether SS prostheses can obtain the same clinical and radiological outcomes. We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate whether SS prostheses are superior to conventional implants after primary THA.Methods:We reviewed the literature published up to June 2016 from PubMed, Web of Science, and the Cochrane Library to find relevant RCTs comparing SSs and conventional stems in primary THA. Quality assessment was performed by 2 independent reviewers. The RevMan 5.3 software program of the Cochrane Collaboration was used to analyze the data. Random- or fixed-effect models were used to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) for each comparison.Results:Six RCTs involving 552 patients with 572 hips were identified. Strong evidence indicated that SS prostheses were more effective for reducing thigh pain than conventional implants (I 2 = 46%, P = 0.002; risk ratio [RR], 95% CI 0.15, 0.04–0.49). However, there were no significant differences between the 2 groups in Harris Hip Scores (I 2 = 0%, P = 0.84; SMD, 95% CI 0.02, −0.15–0.18), Western Ontario and McMaster Universities Osteoarthritis Index Scores (I 2 = 0%, P = 0.35; SMD, 95% CI 0.09, −0.10–0.27), femoral offset of stem (I 2 = 0%, P = 0.57; SMD, 95% CI 0.06, −0.16–0.29), and leg-length discrepancy (I 2 = 79%, P = 0.88; SMD, 95% CI 0.04, −0.44–0.51).Conclusion:SS prostheses achieve the same clinical and radiological outcomes as conventional implants, and were superior in terms of reducing thigh pain. But whether the postoperative thigh pain applied in 2nd-generation cementless prosthesis still needs further large-scale multicenter studies with longer follow-up to confirm.

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“…[9] The limited periprosthetic bone remodelling observed after a minimum of nine years follow-up suggests that this type of implant may improve mechanical stresses on host bone compared with standard stems requiring diaphyseal fixation. [10] There are still some controversial issues regarding total hip arthroplasty including cemented vs. cementless, short stem vs. long stem. [11] A systematic literature review was performed to provide an overview on the currently published survival results of short stems to allow comparison with the results of traditional hip stems.…”

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confidence: 99%