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Comparison of short-stem versus conventional stem for hip arthroplasty in patients younger than 60 years: 7–14 years follow-up

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Short-stem prostheses in hip arthroplasty have emerged as an alternative to conventional stems, especially in younger patients.

The purpose of this study was to compare functional and radiological results of a short metaphyseal fitting cementless stem versus a conventional stem implant, in patients younger than 60 years.

Methods

All patients operated from January 2006 to April 2013 were included, obtaining a minimum follow-up of 7 years.

Harris Hip Score (HHS) and SF-36 (quality of life) questionnaires were applied and the presence of “thigh pain” was specifically assessed. We also compared complication rate, revision rate and average prosthesis survival. Femoral stress shielding (Gruen scale), stem subsidence, varus-valgus tilt and implant stability (Engh scale) were also compared.

Results

A total of 101 short-stem and 74 conventional arthroplasties were included, with an average follow-up of 9.82 (7–14) years.

HHS functional score and SF-36 were excellent in both implants and no significant difference between them (p > 0.05) was found. However, “thigh pain” was present in 7 patients with conventional stems and none with short-stems (p < 0.001).

The survival rate at 13 years was 99%, for both implants, and no significant differences were found between them (χ2(2) = 0.178; p = 0.673).

Conventional stems had stress shielding at the greater trochanter in 72% of the cases and 43% at the calcar, being statistically superior (p < 0.001) to the stress shielding observed in the short stems.

Conclusion

According to our results, this short-stem seems to allow preservation of bone stock, with decreased stress shielding and also a lower incidence of thigh pain compared to conventional stems.

Level of Evidence

Level III retrospective comparative study.

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References

  1. Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370:1508–1519. https://doi.org/10.1016/S0140-6736(07)60457-7

    Article  PubMed  Google Scholar 

  2. Kurtz SM, Lau E, Ong K et al (2009) Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 467:2606–2612. https://doi.org/10.1007/s11999-009-0834-6

    Article  PubMed  PubMed Central  Google Scholar 

  3. Skyttä ET, Jarkko L, Antti E et al (2011) Increasing incidence of hip arthroplasty for primary osteoarthritis in 30-to 59-year-old patients: a population based study from the Finnish Arthroplasty Register. Acta Orthop 82:1–5. https://doi.org/10.3109/17453674.2010.548029

    Article  PubMed  PubMed Central  Google Scholar 

  4. MJ D, (2009) Cemented femoral fixation: the North Atlantic divide. Orthopedics 32:32

    Google Scholar 

  5. AOA (2014) Australian Orthopaedic Association National Joint Replacement Registry. Annual Report

  6. Spotorno L, Romagnoli S, Ivaldo N et al (1993) The CLS system. Theoretical concept and results. Acta Orthop Belg 59:144–148

    PubMed  Google Scholar 

  7. Grappiolo G, Blaha JD, Gruen TA et al (2002) Primary total hip arthroplasty using a grit-blasted, press-fit femoral prosthesis. Long-term results with survivorship analysis. HIP Int 12:55–72. https://doi.org/10.1177/112070000201200201

    Article  PubMed  Google Scholar 

  8. Goebel D, Schultz W (2009) The Mayo cementless femoral component in active patients with osteoarthritis. HIP Int 19:206–210. https://doi.org/10.1177/112070000901900303

    Article  PubMed  Google Scholar 

  9. Morrey BF, Adams RA, Kessler M (2000) A conservative femoral replacement for total hip arthroplasty. J Bone Jt Surg Ser B 82:952–958. https://doi.org/10.1302/0301-620X.82B7.10420

    Article  CAS  Google Scholar 

  10. Malhotra R, Kumar V (2016) Mid-term outcome of total hip arthroplasty using a short stem. J Orthop Surg 24:323–327. https://doi.org/10.1177/1602400310

    Article  Google Scholar 

  11. Rometsch E, Bos PK, Koes BW (2012) Survival of short hip stems with a “modern”, trochanter-sparing design—a systematic literature review. HIP Int 22:344–354. https://doi.org/10.5301/HIP.2012.9472

    Article  PubMed  Google Scholar 

  12. Banerjee S, Pivec R, Issa K et al (2013) Outcomes of short stems in total hip arthroplasty. Orthopedics 36:700–707. https://doi.org/10.3928/01477447-20130821-06

    Article  PubMed  Google Scholar 

  13. Althuizen MNR, Hooff MLV, Saskia SHMVD et al (2012) Early failures in large head metal-on-metal total hip arthroplasty. HIP Int 22:641–647. https://doi.org/10.5301/HIP.2012.10340

    Article  PubMed  Google Scholar 

  14. Bosker BH, Ettema HB, Boomsma MF et al (2012) High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: A prospective cohort study. J Bone Jt Surg - Ser B 94(B):755–761. https://doi.org/10.1302/0301-620X.94B6.28373

    Article  CAS  Google Scholar 

  15. Kim YH, Kim JS, Park JW, Joo JH (2011) Total hip replacement with a short metaphyseal-fitting anatomical cementless femoral component in patients aged 70 years or older. J Bone Jt Surg Ser B 93(B):587–592. https://doi.org/10.1302/0301-620X.93B5.25994

    Article  Google Scholar 

  16. Santori FS, Santori N (2010) Mid-term results of a custom-made short proximal loading femoral component. J Bone Jt Surg Ser B 92:1231–1237. https://doi.org/10.1302/0301-620X.92B9.24605

    Article  CAS  Google Scholar 

  17. 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 NO 141:17–27. https://doi.org/10.1097/00003086-197906000-00002

    Article  Google Scholar 

  18. Martell JM, Pierson RH, Jacobs JJ et al (1993) Primary total hip reconstruction with a titanium fiber-coated prosthesis inserted without cement. J Bone Jt Surg Ser A 75:554–571. https://doi.org/10.2106/00004623-199304000-00010

    Article  CAS  Google Scholar 

  19. Engh C, Massin P, Suther K (1990) Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 257:107–128

    Article  Google Scholar 

  20. Choi YW, Kim S-G (2016) The short-term clinical outcome of total hip arthroplasty using short metaphyseal loading femoral stem. Hip Pelvis 28:82. https://doi.org/10.5371/hp.2016.28.2.82

    Article  PubMed  PubMed Central  Google Scholar 

  21. Tóth K, Mécs L, Kellermann P (2010) Early experience with the DePuy ProximaTM short stem in total hip arthroplasty. Acta Orthop Belg 76:613–618

    PubMed  Google Scholar 

  22. Kim YH, Park JW, Kim JS (2016) Ultrashort versus conventional anatomic cementless femoral stems in the same patients younger than 55 Years. Clin Orthop Relat Res 474:2008–2017. https://doi.org/10.1007/s11999-016-4902-4

    Article  PubMed  PubMed Central  Google Scholar 

  23. Henry BM, Wrażeń W, Hynnekleiv L et al (2016) Health-related quality-of-life and functional outcomes in short-stem versus standard-stem total hip arthroplasty An 18-month follow-up cohort study. Med Sci Monit 22:4406–4414. https://doi.org/10.12659/MSM.900610

    Article  PubMed  PubMed Central  Google Scholar 

  24. Østbyhaug PO, Klaksvik J, Romundstad P, Aamodt A (2009) An in vitro study of the strain distribution in human femora with anatomical and customised femoral stems. J Bone Jt Surg Ser B 91:676–682. https://doi.org/10.1302/0301-620X.91B5.21749

    Article  Google Scholar 

  25. Bourne RB, Rorabeck CH, Ghazal MELM (1994) Pain in the thigh following total hip replacement with a porous-coated anatomic prosthesis for osteoarthrosis: a five-year follow-up study. Bone Jt Surg Am 76:1464–1470

    Article  CAS  Google Scholar 

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The author declares that the research for and writing of this independent body of work does not constitute any financial or other conflict of interest.

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Authors and Affiliations

  1. Hip Unit, Department of Orthopaedics, Centro Hospitalar E Universitário Do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal

    Arnaldo Sousa, João Vale, Sara Diniz, Pedro Neves, Joaquim Ramos & Rafaela Coelho

  2. Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal

    Arnaldo Sousa, João Vale, Sara Diniz, Pedro Neves, Joaquim Ramos & Rafaela Coelho

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  1. Arnaldo Sousa
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  2. João Vale
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  3. Sara Diniz
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  4. Pedro Neves
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Correspondence to Arnaldo Sousa.

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Sousa, A., Vale, J., Diniz, S. et al. Comparison of short-stem versus conventional stem for hip arthroplasty in patients younger than 60 years: 7–14 years follow-up. Eur J Orthop Surg Traumatol 32, 693–700 (2022). https://doi.org/10.1007/s00590-021-03017-w

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  • DOI: https://doi.org/10.1007/s00590-021-03017-w

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