Bone-preserving total hip arthroplasty in avascular necrosis of the hip—a matched-pairs analysis

  • David Merschin
  • Richard Häne
  • Mersedeh Tohidnezhad
  • Thomas Pufe
  • Wolf Drescher
Original Paper
  • 38 Downloads

Abstract

Purpose

Short-stem hip arthroplasty has the potential advantage of femoral bone stock preservation, especially in view of the expected revisions in the often relatively young patients. Despite short-stem hip prosthesis are increasingly used for total hip arthroplasty, there are no sufficient mid- and long-term results especially for patients with avascular femoral head osteonecrosis. The present study investigates mid-term functional results as well as the revision rate following implantation of a short-stem prosthesis.

Methods

In the period 06/2005 until 12/2013, a total of 351 short-stem hip prostheses were implanted. The study included 331 complete data sets. A retrospective analysis was performed using the Oxford Hip Score. All revisions were registered.

Results

In a total of 331 prostheses, the Oxford Hip Score was “excellent” in 66.2%, “good” in 12.7%, “fair” in 13.0%, and “poor” in 8.2% with a mean follow-up of 57.4 months (SD ± 29.8; range 24–115). In 26 cases, aseptic osteonecrosis of the hip was the indication (7.9%). The Oxford Hip Score was “excellent” in 66.7%, “good” in 0.0%, “fair” in 20.8%, and “poor" in 12.5%. The cumulated five year survival rate was 96.7%.

Conclusion

In mid-term observation, the Metha® short-stem prosthesis shows no disadvantage in functional outcome and in survival time compared to a standard hip stem. Providing a correct indication, the Metha® short stem is a valuable option in total hip arthroplasty for younger patients with avascular osteonecrosis of the femoral head. Evaluation has shown no significant differences between aseptic osteonecrosis and other indications.

Keywords

Short-stem hip arthroplasty Avascular necrosis Hip 

Notes

Compliance with ethical standards

The study has been approved by the Ethic Committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg (Application No.: 330_15 B) and has been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki. Furthermore, the study has been performed in accordance with the regulations of the US Health Insurance Portability and Accountability Act (HIPAA).

Conflict of interest

David Merschin, Richard Häne, Thomas Pufe, and Mersedeh Tohidnezhad do not have any conflict of interest. Wolf Drescher works as a consultant for Zimmer Biomet and as an instructor for B. Braun Aesculap.

References

  1. 1.
    Smith SW, Fehring TK, Griffin WL, Beaver WB (1995) Core decompression of the osteonecrotic femoral head. J Bone Joint Surg Am 77(5):674–680CrossRefPubMedGoogle Scholar
  2. 2.
    Wengler A, Nimptsch U, Mansky T (2014) Hip and knee replacement in Germany and the USA: analysis of individual inpatient data from German and US hospitals for the years 2005 to 2011. Dtsch Arztebl Int 111(23–24):407–416.  https://doi.org/10.3238/arztebl.2014.0407 PubMedPubMedCentralGoogle Scholar
  3. 3.
    Floerkemeier T, Budde S, Gronewold J, Radtke K, Ettinger M, Windhagen H, von Lewinski G (2015) Short-stem hip arthroplasty in osteonecrosis of the femoral head. Arch Orthop Trauma Surg 135(5):715–722.  https://doi.org/10.1007/s00402-015-2195-9 CrossRefPubMedGoogle Scholar
  4. 4.
    Fink B, Rüther W (2000) Teil- und Totalgelenkersatz bei Hüftkopfnekrosen. Orthopade 29:449–456PubMedGoogle Scholar
  5. 5.
    Gotze C, Ehrenbrink J, Ehrenbrink H (2010) [Is there a bone-preserving bone remodelling in short-stem prosthesis? DEXA analysis with the Nanos total hip arthroplasty]. Z Orthop Unfall 148 (4):398–405. doi: https://doi.org/10.1055/s-0030-1250151
  6. 6.
    Chammai Y, Brax M (2015) Medium-term comparison of results in obese patients and non-obese hip prostheses with Metha(R) short stem. Eur J Orthop Surg Traumatol : Orthop Traumatol 25(3):503–508.  https://doi.org/10.1007/s00590-014-1574-1 CrossRefGoogle Scholar
  7. 7.
    Ishaque B (2017) Allgemeine Aspekte. In: Jerosch J (ed) Kurzschaftendoprothesen an der Hüfte, vol 1. Springer Verlag, p 46Google Scholar
  8. 8.
    Floerkemeier T, Tscheuschner N, Calliess T, Ezechieli M, Floerkemeier S, Budde S, Windhagen H, von Lewinski G (2012) Cementless short stem hip arthroplasty METHA(R) as an encouraging option in adults with osteonecrosis of the femoral head. Arch Orthop Trauma Surg 132(8):1125–1131.  https://doi.org/10.1007/s00402-012-1524-5 CrossRefPubMedGoogle Scholar
  9. 9.
    Thorey F, Hoefer C, Abdi-Tabari N, Lerch M, Budde S, Windhagen H (2013) Clinical results of the metha short hip stem: a perspective for younger patients? Orthop Rev 5(4):e34.  https://doi.org/10.4081/or.2013.e34 CrossRefGoogle Scholar
  10. 10.
    von Lewinski G, Floerkemeier T (2015) 10-year experience with short stem total hip arthroplasty. Orthopedics 38(3 Suppl):S51–S56.  https://doi.org/10.3928/01477447-20150215-57 CrossRefGoogle Scholar
  11. 11.
    Jerosch J (2014) [Differences between short stem prostheses]. Der Orthopade 43 (8):783–795; quiz 796. doi: https://doi.org/10.1007/s00132-014-2308-0
  12. 12.
    Dawson J, Fitzpatrick R, Carr A, Murray D (1996) Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br 78(2):185–190CrossRefPubMedGoogle Scholar
  13. 13.
    Naal FD, Sieverding M, Impellizzeri FM, von Knoch F, Mannion AF, Leunig M (2009) Reliability and validity of the cross-culturally adapted German Oxford hip score. Clin Orthop Relat Res 467(4):952–957.  https://doi.org/10.1007/s11999-008-0457-3 CrossRefPubMedGoogle Scholar
  14. 14.
    Chandler HP, Reineck FT, Wixson RL, McCarthy JC (1981) Total hip replacement in patients younger than thirty years old. A five-year follow-up study. J Bone Joint Surg Am 63(9):1426–1434CrossRefPubMedGoogle Scholar
  15. 15.
    Huggler AH, Jacob HA, Bereiter H, Haferkorn M, Ryf C, Schenk R (1993) Long-term results with the uncemented thrust plate prosthesis (TPP). Acta Orthop Belg 59(Suppl 1):215–223PubMedGoogle Scholar
  16. 16.
    Morrey BF, Adams RA, Kessler M (2000) A conservative femoral replacement for total hip arthroplasty. A prospective study. J Bone Joint Surg Br 82(7):952–958CrossRefPubMedGoogle Scholar
  17. 17.
    Hube R, Zaage M, Hein W, Reichel H (2004) [Early functional results with the Mayo-hip, a short stem system with metaphyseal-intertrochanteric fixation]. Orthopade 33 (11):1249–1258. doi: https://doi.org/10.1007/s00132-004-0711-7
  18. 18.
    Ender SA, Machner A, Pap G, Hubbe J, Grashoff H, Neumann HW (2007) Cementless CUT femoral neck prosthesis: increased rate of aseptic loosening after 5 years. Acta Orthop 78(5):616–621.  https://doi.org/10.1080/17453670710014301 CrossRefPubMedGoogle Scholar
  19. 19.
    Decking R, Rokahr C, Zurstegge M, Simon U, Decking J (2008) Maintenance of bone mineral density after implantation of a femoral neck hip prosthesis. BMC Musculoskelet Disord 9:17.  https://doi.org/10.1186/1471-2474-9-17 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    van Oldenrijk J, Molleman J, Klaver M, Poolman RW, Haverkamp D (2014) Revision rate after short-stem total hip arthroplasty: a systematic review of 49 studies. Acta Orthop 85(3):250–258.  https://doi.org/10.3109/17453674.2014.908343 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kantor SG, Huo MH, Huk OL, Salvati EA (1996) Cemented total hip arthroplasty in patients with osteonecrosis. A 6-year minimum follow-up study of second-generation cement techniques. J Arthroplast 11(3):267–271CrossRefGoogle Scholar
  22. 22.
    Goffin E, Baertz G, Rombouts JJ (2006) Long-term survivorship analysis of cemented total hip replacement (THR) after avascular necrosis of the femoral head in renal transplant recipients. Nephrol Dial Transplant 21(3):784–788.  https://doi.org/10.1093/ndt/gfi233 CrossRefPubMedGoogle Scholar
  23. 23.
    Baek SH, Kim SY (2008) Cementless total hip arthroplasty with alumina bearings in patients younger than fifty with femoral head osteonecrosis. J Bone Joint Surg Am 90(6):1314–1320.  https://doi.org/10.2106/JBJS.G.00755 CrossRefPubMedGoogle Scholar
  24. 24.
    Hungerford MW, Hungerford DS, Jones LC (2009) Outcome of uncemented primary femoral stems for treatment of femoral head osteonecrosis. Orthop Clin North Am 40(2):283–289.  https://doi.org/10.1016/j.ocl.2008.10.006 CrossRefPubMedGoogle Scholar
  25. 25.
    Capone A, Bienati F, Torchia S, Podda D, Marongiu G (2017) Short stem total hip arthroplasty for osteonecrosis of the femoral head in patients 60 years or younger: a 3- to 10-year follow-up study. BMC Musculoskelet Disord 18(1):301.  https://doi.org/10.1186/s12891-017-1662-6 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Ballard WT, Callaghan JJ, Sullivan PM, Johnston RC (1994) The results of improved cementing techniques for total hip arthroplasty in patients less than fifty years old. A ten-year follow-up study. J Bone Joint Surg Am 76(7):959–964CrossRefPubMedGoogle Scholar
  27. 27.
    Dudkiewicz I, Covo A, Salai M, Israeli A, Amit Y, Chechik A (2004) Total hip arthroplasty after avascular necrosis of the femoral head: does etiology affect the results? Arch Orthop Trauma Surg 124(2):82–85.  https://doi.org/10.1007/s00402-003-0630-9 CrossRefPubMedGoogle Scholar
  28. 28.
    Radl R, Egner S, Hungerford M, Rehak P, Windhager R (2005) Survival of cementless femoral components after osteonecrosis of the femoral head with different etiologies. J Arthroplast 20(4):509–515.  https://doi.org/10.1016/j.arth.2004.09.050 CrossRefGoogle Scholar
  29. 29.
    Radl R, Hungerford M, Materna W, Rehak P, Windhager R (2005) Higher failure rate and stem migration of an uncemented femoral component in patients with femoral head osteonecrosis than in patients with osteoarthrosis. Acta Orthop 76(1):49–55.  https://doi.org/10.1080/00016470510030319 CrossRefPubMedGoogle Scholar
  30. 30.
    Yuan B, Taunton MJ, Trousdale RT (2009) Total hip arthroplasty for alcoholic osteonecrosis of the femoral head. Orthopedics 32(6):400.  https://doi.org/10.3928/01477447-20090511-06 CrossRefPubMedGoogle Scholar
  31. 31.
    Swedish Hip Arthroplasty Register (2014) Annual report 2013. http://www.shpr.se/Libraries/Documents/AnnualReport_2013-04-1_1.sflb.ashx. Accessed 16.02.2016
  32. 32.
    Australian Orthopaedic Association National Joint Replacement Registry (2015) Annual report 2015. https://aoanjrr.sahmri.com/documents/10180/217745/Hip%20and%20Knee%20Arthroplasty. Accessed 16.02.2016
  33. 33.
    Shin YS, Suh DH, Park JH, Kim JL, Han SB (2016) Comparison of specific femoral short stems and conventional-length stems in primary cementless total hip arthroplasty. Orthopedics:1–7. doi: https://doi.org/10.3928/01477447-20160222-04
  34. 34.
    Keeney JA, Ellison BS, Maloney WJ, Clohisy JC (2012) Is routine mid-term total hip arthroplasty surveillance beneficial? Clin Orthop Relat Res 470(11):3220–3226.  https://doi.org/10.1007/s11999-012-2411-7 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Adelani MA, Keeney JA, Palisch A, Fowler SA, Clohisy JC (2013) Has total hip arthroplasty in patients 30 years or younger improved? A systematic review. Clin Orthop Relat Res 471(8):2595–2601.  https://doi.org/10.1007/s11999-013-2975-x CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Ancelin D, Reina N, Cavaignac E, Delclaux S, Chiron P (2016) Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: case-control study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement. Orthop Traumatol Surg Res 102(8):1029–1034.  https://doi.org/10.1016/j.otsr.2016.08.021 CrossRefPubMedGoogle Scholar
  37. 37.
    Brinker MR, Rosenberg AG, Kull L (1994) Primary total hip arthroplasty using noncemented porous-coated femoral components in patients with osteonecrosis of the femoral head. J Arthroplast 9:457–468CrossRefGoogle Scholar
  38. 38.
    Arlot ME, Bonjean M, Chavassieux PM (1983) Bone histology in adults with aseptic necrosis. Histomorphometric evaluation of iliac biopsies in seventy-seven patients. J Bone Joint Surg [Am] 65:1319–1327CrossRefGoogle Scholar
  39. 39.
    Delank KS, Drees P, Eckardt A (2001) [Results of the uncemented total hip arthroplasty in avascular necrosis of the femoral head]. Z Orthop Ihre Grenzgeb 2001 139:525–530Google Scholar
  40. 40.
    Tingart M, Beckmann J, Opolka A (2009) Analysis of bone matrix composition and trabecular microarchitecture of the femoral metaphysis in patients with osteonecrosis of the femoral head. J Orthop Res 27:1175–1181Google Scholar
  41. 41.
    Mont MA, Hungerford MW (2000) [Therapy of osteonecrosis. Basic principles and decision aids]. Orthopade 29 (5):457–462Google Scholar
  42. 42.
    Kendoff DO, Citak M, Egidy CC, O’Loughlin PF, Gehrke T (2013) Eleven-year results of the anatomic coated CFP stem in primary total hip arthroplasty. J Arthroplast 28(6):1047–1051.  https://doi.org/10.1016/j.arth.2012.10.013 CrossRefGoogle Scholar
  43. 43.
    Kim YH, Park JW, Kim JS, Kang JS (2014) Long-term results and bone remodeling after THA with a short, metaphyseal-fitting anatomic cementless stem. Clin Orthop Relat Res 472(3):943–950.  https://doi.org/10.1007/s11999-013-3354-3 CrossRefPubMedGoogle Scholar
  44. 44.
    Zeh A, Weise A, Vasarhelyi A, Bach AG, Wohlrab D (2011) [Medium-term results of the Mayo short-stem hip prosthesis after avascular necrosis of the femoral head]. Z Orthop Unfall 149 (2):200–205. doi: https://doi.org/10.1055/s-0030-1270710
  45. 45.
    Suksathien Y, Sueajui J (2015) The short stem THA provides promising results in patients with osteonecrosis of the femoral head. J Med Assoc Thailand = Chotmaihet thangphaet 98(8):768–774Google Scholar
  46. 46.
    Swarup I, Shields M, Mayer EN, Hendow CJ, Burket JC, Figgie MP (2017) Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip. Hip Int : J Clin Exp Res Hip Pathol Ther 27(3):286–292.  https://doi.org/10.5301/hipint.5000457 CrossRefGoogle Scholar
  47. 47.
    Braun A, Sabah A (2009) [Two-year results of a modular short hip stem prosthesis—a prospective study]. Z Orthop Unfall 147 (6):700–706. doi: https://doi.org/10.1055/s-0029-1185899
  48. 48.
    Budde S, Floerkemeier T, Thorey F, Ezechieli M, Claassen L, Ettinger M, Bredow J, Windhagen H, Lewinski GV (2016) A short-stem hip implant with metaphyseal anchorage in patients with developmental dysplasia of the hip. Technol Health Care.  https://doi.org/10.3233/THC-161151
  49. 49.
    Lewinski G (2017) Versagensmechanismen der Kurzschäfte und ihre Implikationen für die Zukunft. In: Jerosch J (ed) Kurzschaftendoprothesen an der Hüfte. p 61ffGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • David Merschin
    • 1
  • Richard Häne
    • 2
  • Mersedeh Tohidnezhad
    • 3
  • Thomas Pufe
    • 3
  • Wolf Drescher
    • 2
  1. 1.Clinic for Trauma Surgery and OrthopaedicsBG Klinikum Unfallkrankenhaus BerlinBerlinGermany
  2. 2.Department of Orthopaedic Surgery of the Lower Limb and ArthroplastyHospital RummelsbergSchwarzenbruckGermany
  3. 3.Institut für Anatomie und ZellbiologieUniklinik RWTH AachenAachenGermany

Personalised recommendations