Use of short stems in revision of standard femoral stem: A case report

Evola, Francesco Roberto; Evola, Giuseppe; Sessa, Giuseppe

doi:10.5312/wjo.v11.i11.528

Cited by 3 publications

(9 citation statements)

References 18 publications

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“…Evola et al recently published a case report of one patient with stem breakage in the distal part. Intraoperatively, the distal apex of the implant could not be removed easily [7]. In this situation, to avoid a transfemoral approach, extensive operative time associated with increased blood loss and marked soft-tissue damage, a Fitmore short stem (Zimmer; Winterthur, Switzerland) was used.…”

Section: Discussionmentioning

confidence: 99%

“…The 2‑year follow-up resulted in a good clinical outcome with stable implant position. They concluded that short-stem designs can help surgeons to treat specific revision procedures in patients with poor general health conditions to avoid a surgical invasiveness due to transfemoral approaches and long-stemmed revision implants [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Applying a short stem as a revision implant could potentially reduce the peri- Universities Osteoarthritis Index operative secondary surgical risks, for example by avoiding femoral osteotomy and a transfemoral approach, which is often necessary for the removal of parts of the implant, remaining cement and sclerotic bone formation from the medullary canal [7]. Thus, there may be certain assorted indications, for which downsizing the femoral component in failed conventional THA is potentially advantageous.…”

Section: Introductionmentioning

confidence: 99%

“…Applying a short stem as a revision implant could potentially reduce the perioperative secondary surgical risks, for example by avoiding femoral osteotomy and a transfemoral approach, which is often necessary for the removal of parts of the implant, remaining cement and sclerotic bone formation from the medullary canal [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, there may be certain assorted indications, for which downsizing the femoral component in failed conventional THA is potentially advantageous. To our best knowledge, only one case report of revision surgery of conventional hip arthroplasty using a cementless short stem has been published so far [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Downsizing in total hip arthroplasty. A short stem as a revision implant

et al. 2021

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Background Short stems have constantly gained popularity in primary total hip arthroplasty (THA) over the last decade. Although cementless short stems are not primarily designed to be used as revision implants, there may be certain indications for which downsizing the femoral component in failed conventional THA is potentially advantageous. Methods In this single center retrospective case series, six patients who underwent revision using a calcar-guided short stem after failed THA are presented. The mean follow-up was 3.32 years (SD 0.63 years). The health status was evaluated by the EQ-5D-5L score. Patient reported outcome measurements (PROM) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain and satisfaction were assessed using a visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignment and signs of aseptic loosening. Complications were documented. Results At last follow-up the mean EQ-5D-5L index was 0.851 (SD 0.098). Clinical outcome was excellent (HHS ≥ 90) in 4 patients and moderate (HHS 71 and 79) in 2 patients. The mean WOMAC score was 9.20% (SD 12.61%). Pain and satisfaction on VAS were 1.00 (SD 1.15) and 9.17 (SD 0.37), respectively. No major complications occurred. To date, no further revision surgery was needed. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fractures were obvious. Conclusion The present case series indicates that in failed conventional THA downsizing may be considered a treatment option, using short stem THA in selected cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Downsizing in total hip arthroplasty. A short stem as a revision implant

et al. 2021

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Cementless Primary Stems in Revision Hip Arthroplasty: A Narrative Review

Castagnini,

Pardo,

Lucchini

et al. 2024

JCM

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Cementless primary stems in revision hip arthroplasties may be conservative options to preserve bone stock and provide adequate reconstruction of the hip biomechanics. However, there is still little evidence about indications, limitations, and outcomes. This narrative review showed that conventional standard stems were adopted in different revision settings, up to Paprosky IIIA grade bone defects. In cases of acceptable metaphyseal bone stock, when a scratch fit of at least 4 cm can be achieved, a conventional cementless stem may be an adequate solution. Mid-term clinical and radiographic outcomes and survival rates were similar to long revision stems, whereas complications, surgical time, and costs were lower among conventional stems. However, unsuitable contexts for conventional stems included canal diameters larger than 18 mm and failed revision stems with cortical weakening. Even short stems can be considered in revisions, in order to preserve bone stock and stay proximal to femoral remodeling zones and bone/cement plugs. Short stems were successfully adopted up to Paprosky IIIA bone defects, achieving mid-term survival rates not inferior to long revision stems. Ageing, osteoporosis, and intraoperative femoral fractures were the main negative prognostic factors. In very select cases, a downsizing technique (from longer to shorter stems) may be adopted to simplify the procedure and reduce complications.

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Use of Short Stems in Revision Total Hip Arthroplasty: A Retrospective Observational Study of 31 Patients

Mauch,

Brecht,

Clauss

et al. 2023

Medicina

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Background and Objectives: Implantation of a short femoral stem in revision total hip arthroplasty (rTHA) could reduce the perioperative time, soft tissue damage, and preserve the bone stock of the proximal femur. The objective of this study was to describe the clinical and radiographic outcomes after the use of short stems in rTHA with a follow-up of 1 to 5 years. Materials and Methods: This retrospective, single center, and observational study analyzed the data of 31 patients (12 female, 19 male) with a median (interquartile range) age of 68.2 years (61.2–78.4) and BMI of 26.7 kg/m2 (24.6–29.4) who received an uncemented short femoral stem in rTHA between 2015 and 2020. Clinical outcomes were extracted from medical reports and assessed using the modified Harris Hip Score (mHHS), the numerical rating scale (NRS) for pain and satisfaction, and the UCLA Physical Activity Score. Radiographs were analyzed for stem subsidence, fixation, and bone parameters. The Wilcoxon test was used for pre–post rTHA differences (p < 0.05); clinical relevance was interpreted based on effect sizes according to Cohen’s d. Results: All the clinical outcome measures improved significantly (p ≤ 0.001) at follow-up compared to preoperative status, with large effect sizes (Cohen’s d) ranging from 2.8 to 1.7. At the last follow-up, the median (interquartile) mHHS was 80.9 (58.6–93.5). Stem fixation was stable in all cases. Complications included stem subsidence of 3 mm (n = 1) and 10 mm (n = 1), heterotopic ossification Brooker stage III (n = 2), intraoperative femur perforation (n = 1), periprosthetic fracture Vancouver type A (n = 1), and dislocation (n = 2). Conclusions: The good clinical results in our selective study population of patients with mild to moderate bone deficiency, supported by large effect sizes, together with a complication rate within the normal range, support the consideration of short stems as a surgical option after a thorough preoperative analysis.

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Use of short stems in revision of standard femoral stem: A case report

Cited by 3 publications

References 18 publications

Downsizing in total hip arthroplasty. A short stem as a revision implant

Downsizing in total hip arthroplasty. A short stem as a revision implant

Cementless Primary Stems in Revision Hip Arthroplasty: A Narrative Review

Use of Short Stems in Revision Total Hip Arthroplasty: A Retrospective Observational Study of 31 Patients

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