To evaluate the impact of short cementless stem on several clinical and radiographic outcomes, with particular focus on blood loss, in comparison with conventional cementless stem in total hip arthroplasty (THA).
Materials and methods
Patients undergoing THA with GTS short stem or CLS conventional stem were included. Clinical data were retrospectively collected including preoperative and postoperative day 1 value for haemoglobin (HB); rate of postoperative blood transfusions; intraoperative bone infractions; stem alignment; 5-year follow-up Harris Hip Score (HHS) and rate of stem revision at 5 years of follow-up of the short and conventional cementless stem.
GTS and CLS stem group included 374 and 321 patients, respectively. The mean difference between the preoperative and postoperative day 1 HB value was 3.98 g/dL (SD 1.12) and 3.67 g/dL (SD 1.19) in the GTS and CLS group, respectively, which correspond to a crude effect (β) of 0.32 (95% CI 0.15; 0.49) and adjusted effect of 0.11 (95% CI − 0.08; 0.3). GTS group reported a significantly higher number of patients with excellent results in terms of HHS (p = 0.001). The rate of intraoperative bone infractions was 1.6% and 0.3% in the GTS and CLS group, respectively (p = 0.013). At radiographic assessment, the rate of varus position of the stem was 14% in the GTS group and 6% in the CLS group (p < 0.0001). The rate of stem revision at 5 years of follow-up was 0.8% and 0.4% in the GTS and CLS group, respectively (p = 0.63).
GTS short stem was not associated with a clinically significant lower blood loss in the immediately postoperative period. Unadjusted exploratory analyses show that GTS stem provides the same results of CLS stem in terms of HHS and rate of stem revision at 5 years of follow-up.
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No external funding was received for this study.
Conflict of interest
Mattia Loppini received research grant from Italian Ministry of Health (GR-2018-12367275), financial support for attending symposia and educational programs from Zimmer Biomet. He is also Scientific Director of Livio Sciutto Foundation Biomedical Research in Orthopaedics – ONLUS. Guido Grappiolo received honoraria for speaking at symposia, financial support for attending symposia and educational programs from Zimmer Biomet, and royalties from Zimmer Biomet and Innomed. Antonello Della Rocca received financial support for attending symposia and educational programs from Zimmer Biomet. Davide Ferrentino and Costanza Pizzi have no conflict of interest.
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Loppini, M., Della Rocca, A., Ferrentino, D. et al. Blood loss in primary total hip arthroplasty with a short versus conventional cementless stem: a retrospective cohort study. Arch Orthop Trauma Surg 140, 1551–1558 (2020). https://doi.org/10.1007/s00402-020-03561-w