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High incidence of early subtrochanteric lateral cortical atrophy after hip arthroplasty using bone-conserving short stem

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Abstract

Purpose

Load transfer to the bone is believed to be more physiological around the short stem in total hip arthroplasty (THA). However, we found unusual bony remodeling around the shortened tapered stem. This study was performed to investigate the extent and frequency of this phenomenon and to find the possible risk factors of it.

Methods

Among 121 consecutive THA using the same short stem, 80 THAs were enrolled. Radiographic measurements were made using anteroposterior (AP) radiographs taken immediately and at two years after surgery. The thickness of the lateral cortex at the level of the distal end of the coated surface and at 10, 20, 30, and 40 mm proximal to it were measured.

Results

Significant atrophy was noted in all regions (P < 0.001 each). In 46 cases, this presented as an intra-cortical osteolytic line (IOL). Sixty-one cases showed either an IOL or atrophy >10%. The risk of a mean reduction >20% was related to an increased operating time (odds ratio [OR] = 0.981; 0.966 < 95% confidence interval [CI] < 0.996) and lower body mass index (BMI) (OR = 1.216; 1.043 < 95% CI < 1.417). Periprosthetic fracture through the lateral cortex occurred in one case.

Conclusion

Even with THA using a shortened stem, high incidence of proximal stress shielding was noted in the form of lateral cortical atrophy, especially for the patient with low BMI.

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kyung Hee University Hospital, 23 Kyung Hee Dae-ro, Dongdaemoon-ku, Seoul, 02447, South Korea

    Yoon Je Cho

  2. Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-ku, Seoul, 05278, South Korea

    Chan Il Bae, Wan Keun Yoon, Young Soo Chun & Kee Hyung Rhyu

Authors
  1. Yoon Je Cho
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  2. Chan Il Bae
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  3. Wan Keun Yoon
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  4. Young Soo Chun
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  5. Kee Hyung Rhyu
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Corresponding author

Correspondence to Kee Hyung Rhyu.

Additional information

This study was approved by Institutional Review Board of corresponding author’s institutes

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Cho, Y.J., Bae, C.I., Yoon, W.K. et al. High incidence of early subtrochanteric lateral cortical atrophy after hip arthroplasty using bone-conserving short stem. International Orthopaedics (SICOT) 42, 303–309 (2018). https://doi.org/10.1007/s00264-017-3544-9

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  • DOI: https://doi.org/10.1007/s00264-017-3544-9

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