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Calcar-guided short-stem total hip arthroplasty in fractures of the femoral neck: a prospective observational study of 68 hips

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The indications for cementless short-stem total hip arthroplasty (THA) have been expanded due to encouraging results. However, no evidence in cases of femoral neck fractures (FNFs) is available. We aimed to prospectively obtain data on the safety and the clinical outcomes of a cementless calcar-guided short stem in patients with FNFs.

Materials and methods

We conducted a prospective observational study of 68 patients diagnosed with FNFs who underwent short-stem THA between 2016 and 2019 with a calcar-guided stem. Complications during follow-up leading to revision were documented, and patient reported outcome measurements recorded. Stem migration was analyzed using the Einzel-Bild-Röntgen-Analysis Femoral Component Analysis software.

Results

The mean follow-up was 33.8 ± 14.8 months. The patient mortality at last follow-up was 10.6%. Two patients required stem revision, due to periprosthetic fracture and late aseptic loosening, respectively, corresponding to 96.2% stem survival. Survivorship for the endpoint of revision for any reason was 91.1% at 6 years. All revisions occurred in females. The mean Harris Hip Score at the last follow-up was 93.0 ± 8.9. The mean axial migration at last follow-up was 1.90 ± 1.81 mm. No significant influence on migration was found regarding gender, age, weight, and body mass index.

Conclusions

The clinical and radiological findings were satisfying and most patients benefited from the minimally invasive procedure. However, as for conventional THA as well, implant survivorship and mortality were markedly worse compared to results regarding osteoarthritis. Especially in elderly female patients with FNF, cementless short-stem THA is a concern and a cemented THA should be the first choice.

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Data availability

The data that support the findings of this study are available from the corresponding author, KPK, upon reasonable request. The present study contains data obtained as part of the dissertation thesis of AW.

Abbreviations

BMI:

Body mass index

CI:

Confidence intervals

DHS:

Dynamic hip screw

FNF:

Femoral neck fractures

HHS:

Harris hip score

OHS:

Oxford hip score

ONFH:

Osteonecrosis of the femoral head

PROM:

Patient reported outcome measurements

THA:

Total hip arthroplasty

VAS:

Visual analog scale

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany

    Karl Philipp Kutzner, Alexander Walz, Yama Afghanyar & Michael Schneider

  2. Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

    Karl Philipp Kutzner & Philipp Drees

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  1. Karl Philipp Kutzner
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Correspondence to Karl Philipp Kutzner.

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Conflict of interest

KP Kutzner is a medical advisor for Mathys Ltd., Bettlach, Switzerland. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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An independent ethics committee (Landesärztekammer Hessen FF11/2016) approved the study and informed consent was obtained from all patients prior to inclusion.

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Kutzner, K.P., Walz, A., Afghanyar, Y. et al. Calcar-guided short-stem total hip arthroplasty in fractures of the femoral neck: a prospective observational study of 68 hips. Arch Orthop Trauma Surg 144, 1793–1802 (2024). https://doi.org/10.1007/s00402-023-05170-9

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