Risk factors of thigh pain following total hip arthroplasty with short, tapered-wedge stem



The occurrence of thigh pain following cementless total hip arthroplasty (THA) may be dependent on multiple factors, which may differ with design of the prosthesis. Thus, this study aimed to investigate the frequency of thigh pain following cementless THA using a short, tapered-wedge stem to identify risk factors for thigh pain.


This retrospective cohort study analysed 222 joints of patients who underwent THA with a short, tapered-wedge stem. Thigh pain was evaluated using a questionnaire during each follow-up visit, and the clinical and radiographic assessments were compared.


Thigh pain occurred in 37 patients (16.7%) during the follow-up period. The pain started two to 24 months after THA. Multivariate analysis demonstrated that higher University of California, Los Angeles, activity rating (odds ratio 7.2; 95% confidence interval (CI) 3.0–17.2); Dorr type C femoral bone shape (odds ratio 1.5; 95% CI 1.1–2.0); and stem tip-cortical bone contact (odds ratio 8.2; 95% CI 2.3–29.4) were significant risk factors of thigh pain following THA. Post-operatively, cortical hypertrophy at Gruen zone 4 was significantly found in patients with thigh pain (p value = 0.032).


Risk factors of pain following THA with short, tapered-wedge stem were high activity level, Dorr type C femoral bone shape, and stem tip contacting the distal bone surface. Moreover, post-operative cortical hypertrophy at the distal stem tip significantly increased the incidence of thigh pain. Therefore, we must pay attention to the aforementioned factors to avoid post-operative thigh pain when using a short, tapered-wedge stem.

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  1. 1.

    Caton J, Prudhon JL (2011) Over 25 years survival after Charnley’s total hip arthroplasty. Int Orthop 35:185–188. https://doi.org/10.1007/s00264-010-1197-z

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Aldinger PR, Jung AW, Breusch SJ, Ewerbeck V, Parsch D (2009) Survival of the cementless Spotorno stem in the second decade. Clin Orthop Relat Res 467:2297–2304. https://doi.org/10.1007/s11999-009-0906-7

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Pivec R, Johnson AJ, Mears SC, Mont MA (2012) Hip arthroplasty. Lancet 380:1768–1777. https://doi.org/10.1016/S0140-6736(12)60607-2

    Article  PubMed  Google Scholar 

  4. 4.

    Barrack RL, Paprosky W, Butler RA, Palafox A, Szuszczewicz E, Myers L (2000) Patients’ perception of pain after total hip arthroplasty. J Arthroplast 15:590–596. https://doi.org/10.1054/arth.2000.6634

    CAS  Article  Google Scholar 

  5. 5.

    Nikolajsen L, Brandsborg B, Lucht U, Jensen TS, Kehlet H (2006) Chronic pain following total hip arthroplasty: a nationwide questionnaire study. Acta Anaesthesiol Scand 50:495–500. https://doi.org/10.1111/j.1399-6576.2006.00976.x

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Domb B, Hostin E, Mont MA, Hungerford DS (2000) Cortical strut grafting for enigmatic thigh pain following total hip arthroplasty. Orthopedics 23:21–24

    CAS  PubMed  Google Scholar 

  7. 7.

    Lavernia C, D’Apuzzo M, Hernandez VH, Lee DJ (2005) Patient-perceived outcomes in thigh pain after primary arthroplasty of the hip. Clin Orthop Relat Res 441:268–273. https://doi.org/10.1097/00003086-200512000-00041

    Article  PubMed  Google Scholar 

  8. 8.

    Campbell AC, Rorabeck CH, Bourne RB, Chess D, Nott L (1992) Thigh pain after cementless hip arthroplasty. Annoyance or ill omen. J Bone Joint Surg Br 74:63–66

    CAS  Article  Google Scholar 

  9. 9.

    Nam D, Nunley RM, Clohisy JC, Lombardi AV, Berend KR, Barrack RL (2019) Does patient-reported perception of pain differ based on surgical approach in total hip arthroplasty? Bone Joint J 101-B:31–36. https://doi.org/10.1302/0301-620X.101B6.BJJ-2018-1575.R1

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Nam D, Nunley RM, Sauber TJ, Johnson SR, Brooks PJ, Barrack RL (2015) Incidence and location of pain in young, active patients following hip arthroplasty. J Arthroplast 30:1971–1975. https://doi.org/10.1016/j.arth.2015.05.030

    Article  Google Scholar 

  11. 11.

    Engh CA, Bobyn JD (1988) The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop Relat Res:7–28

  12. 12.

    Whiteside LA (1989) The effect of stem fit on bone hypertrophy and pain relief in cementless total hip arthroplasty. Clin Orthop Relat Res:138–147

  13. 13.

    Amendola RL, Goetz DD, Liu SS, Callaghan JJ (2017) Two- to 4-year followup of a short stem tha construct: excellent fixation, thigh pain a concern. Clin Orthop Relat Res 475:375–383. https://doi.org/10.1007/s11999-016-4974-1

    Article  PubMed  Google Scholar 

  14. 14.

    Maier MW, Streit MR, Innmann MM, Kruger M, Nadorf J, Kretzer JP, Ewerbeck V, Gotterbarm T (2015) Cortical hypertrophy with a short, curved uncemented hip stem does not have any clinical impact during early follow-up. BMC Musculoskelet Disord 16:371. https://doi.org/10.1186/s12891-015-0830-9

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Pepke W, Nadorf J, Ewerbeck V, Streit MR, Kinkel S, Gotterbarm T, Maier MW, Kretzer JP (2014) Primary stability of the Fitmore stem: biomechanical comparison. Int Orthop 38:483–488. https://doi.org/10.1007/s00264-013-2138-4

    Article  PubMed  Google Scholar 

  16. 16.

    Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 17-27

  17. 17.

    Dorr LD (1986) Total hip replacement using APR system. Tech Orthop 22

  18. 18.

    Engh CA, Bobyn JD, Glassman AH (1987) Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br) 69:45–55

    CAS  Article  Google Scholar 

  19. 19.

    Noble PC, Box GG, Kamaric E, Fink MJ, Alexander JW, Tullos HS (1995) The effect of aging on the shape of the proximal femur. Clin Orthop Relat Res 31-44

  20. 20.

    Albers A, Aoude AA, Zukor DJ, Huk OL, Antoniou J, Tanzer M (2016) Favorable results of a short, tapered, highly porous, proximally coated cementless femoral stem at a minimum 4-year follow-up. J Arthroplast 31:824–829. https://doi.org/10.1016/j.arth.2015.08.020

    Article  Google Scholar 

  21. 21.

    Ulivi M, Orlandini LC, Meroni V, Lombardo MDM, Peretti GM (2018) Clinical performance, patient reported outcome, and radiological results of a short, tapered, porous, proximally coated cementless femoral stem: results up to seven years of follow-up. J Arthroplast 33:1133–1138. https://doi.org/10.1016/j.arth.2017.11.046

    Article  Google Scholar 

  22. 22.

    Pierannunzii LM (2008) Thigh pain after total hip replacement: a pathophysiological review and a comprehensive classification. Orthopedics 31:691–699; quiz 700-691. https://doi.org/10.3928/01477447-20110505-05

    Article  PubMed  Google Scholar 

  23. 23.

    Dalury DF, Kelley TC, Adams MJ (2012) Modern proximally tapered uncemented stems can be safely used in Dorr type C femoral bone. J Arthroplast 27:1014–1018. https://doi.org/10.1016/j.arth.2011.12.019

    Article  Google Scholar 

  24. 24.

    Paul JP (1999) Strength requirements for internal and external prostheses. J Biomech 32:381–393. https://doi.org/10.1016/s0021-9290(98)00190-0

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Tsubosaka M, Hayashi S, Hashimoto S, Takayama K, Kuroda R, Matsumoto T (2018) Patients with a Dorr type C femoral bone require attention for using a Summit cementless stem: results of total hip arthroplasty after a minimum follow-up period of 5 years after insertion of a Summit cementless stem. J Orthop Sci 23:671–675. https://doi.org/10.1016/j.jos.2018.05.001

    Article  PubMed  Google Scholar 

  26. 26.

    Jo WL, Lee YK, Ha YC, Park MS, Lyu SH, Koo KH (2016) Frequency, developing time, intensity, duration, and functional score of thigh pain after cementless total hip arthroplasty. J Arthroplast 31:1279–1282. https://doi.org/10.1016/j.arth.2015.12.016

    Article  Google Scholar 

  27. 27.

    Fottner A, Woiczinski M, Kistler M, Schroder C, Schmidutz TF, Jansson V, Schmidutz F (2018) Varus malalignment of cementless hip stems provides sufficient primary stability but highly increases distal strain distribution. Clin Biomech (Bristol, Avon) 58:14–20. https://doi.org/10.1016/j.clinbiomech.2018.07.006

    Article  Google Scholar 

  28. 28.

    Braun A, Papp J, Reiter A (2003) The periprosthetic bone remodelling process--signs of vital bone reaction. Int Orthop 27(Suppl 1):S7–S10

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Correspondence to Shinya Hayashi.

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Hayashi, S., Hashimoto, S., Matsumoto, T. et al. Risk factors of thigh pain following total hip arthroplasty with short, tapered-wedge stem. International Orthopaedics (SICOT) 44, 2553–2558 (2020). https://doi.org/10.1007/s00264-020-04762-z

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  • THA
  • Thigh pain
  • Femoral bone shape
  • Physical activity