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Subsidence after calcar-guided short stem total hip arthroplasty: five-year results of a prospective multicentre study

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Abstract

Purpose

Calcar-guided short-stem total hip arthroplasty (THA) has shown excellent clinical outcomes. However, the migration pattern of such prostheses and its effect on clinical outcomes are less known. Therefore, we assessed the five-year subsidence after calcar-guided short-stem THA and its implications on clinical outcomes, patient-related factors, and complications.

Methods

In this prospective multicentre study, we enrolled 213 patients (224 hips) who underwent calcar-guided short-stem THA mostly for degenerative hip diseases. We examined patients radiographically and clinically after six to 12 weeks, one year, two years, and five years. We evaluated subsidence using Einzel-Bild-Roentgen-Analyse femoral component analysis, assessed clinical outcomes, and systematically recorded all complications.

Results

Overall, 131 patients (133 hips) were available for final follow-up at a median of 60 months (range, 2 to 72 months). We found a mean subsidence of 0.63 ± 1.22 mm at three months, 1.03 ± 1.60 mm at one year, 1.21 ± 1.91 mm at two years, and 1.54 ± 1.97 mm at five years. Patient-related factors (sex, age, weight, and BMI) did not significantly impact subsidence at five years (P > 0.05). Additionally, the Harris hip score, pain, and satisfaction improved significantly at five years compared to pre-operative values (P < 0.0001). Lastly, five patients underwent revision.

Conclusion

Calcar-guided short-stems revealed the highest subsidence rate within the first three months after THA and stabilisation after one year through the final follow-up examination. Moreover, patient-related factors had no influence on subsidence. Finally, clinical scores and patient satisfaction remained high at five years.

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Data Availability

Data available on request due to privacy/ethical restrictions.

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Acknowledgements

We thank Dr Dominik Pfluger at numerics data GmbH for the statistical analysis, Mathys Orthopädie GmbH Bochum, Germany for partially funding this study, and Medical Minds GmbH for medical writing and editorial support.

Funding

The work was partially supported by Mathys Orthopädie GmbH Bochum, Germany. Funds sponsored statistical analysis through an independent consultant as well as medical writing and editorial support from a medical writing agency. No other external sources were involved. Mathys Orthopädie GmbH Bochum, Germany had no role in the analysis or interpretation of the data, or the decision to submit results.

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Authors and Affiliations

  1. Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz GmbH, Linz, Austria

    Conrad Anderl & Reinhold Ortmaier

  2. Klinikum Dahme-Spreewald GmbH, Lübben (Spreewald), Germany

    Carsten Johl

  3. Abteilung Für Orthopädie Und Unfallchirurgie, Collm Klinik Oschatz GmbH, Oschatz, Germany

    Thomas Krüger

  4. Kreiskrankenhaus Stollberg GmbH, Stollberg, Germany

    Wilmar Hubel

  5. Praxis Für Orthopädie Und Unfallchirurgie, Erkner, Germany

    Ulrich Weigert

  6. UKSH Campus Lübeck, Klinik Für Orthopädie und Unfallchirurgie Sektion Orthopädie, Lübeck, Germany

    Hagen Mittelstaedt

Authors
  1. Conrad Anderl
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  2. Carsten Johl
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  3. Thomas Krüger
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  4. Wilmar Hubel
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  6. Hagen Mittelstaedt
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  7. Reinhold Ortmaier
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Contributions

All authors have substantially contributed to the conception and design of the study, the acquisition, analysis interpretation of data, and drafting of the manuscript. All authors commented on previous versions of the manuscript and also read and approved the final manuscript.

Corresponding author

Correspondence to Conrad Anderl.

Ethics declarations

Ethics approval

All procedures involving human participants complied with the ethical standards of the institutional and / or national research committee as well as with the 1964 Declaration of Helsinki and its later amendments. The Ethics Committee of the University of Lübeck (AZ 12–112) and the Ethics Committee of Ärztekammer Sachsen-Anhalt (AZ 8/17) approved the study protocol. The Bundesamt für Strahlenschutz authorised the radiographic follow-up examination of the patients (AZ Z5-22462/2–2016-111).

Consent to participate

All patients participated on a voluntary basis and gave their informed consent.

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Informed consent regarding data publishing was obtained from all individual participants included in the study.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

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No benefits in any form have been received from a commercial party related directly or indirectly to this article.

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Anderl, C., Johl, C., Krüger, T. et al. Subsidence after calcar-guided short stem total hip arthroplasty: five-year results of a prospective multicentre study. International Orthopaedics (SICOT) 48, 229–234 (2024). https://doi.org/10.1007/s00264-023-05934-3

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