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Neck-Preserving Femoral Stems

  • Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip
  • Published:
HSS Journal ®

Abstract

Background

Surgeons undertaking total hip arthroplasty (THA) routinely perform a distal femoral neck resection. It has been argued that retaining the femoral neck during THA can provide mechanical and biological advantages.

Purposes

The objectives of this study were to review: (1) the current evidence on the advantages of femoral neck preservation during THA and (2) the clinical and radiological outcome of neck-preserving femoral stems.

Methods

A search of the English-language literature on neck-preserving THA and on the individual neck-preserving implants was performed using PubMed, Ovid SP and Science Direct.

Results

Studies have indicated that neck preservation offers superior tri-planar implant stability and allows more accurate restoration of the hip geometry and biomechanics. The trend towards tissue sparing surgery has contributed to the development of bone-conserving short-stem implants that offer variable levels of neck preservation. Despite an initial learning curve, these implants have generated promising early clinical results, with low revision rates and high outcome scores. However, radiological evaluation of some neck-preserving implants has detected a characteristic pattern of proximal femoral bone loss with distal cortical hypertrophy. The long-term implications of this finding are not yet known.

Conclusions

Preserving the femoral neck during THA has biomechanical advantages. However, long-term outcome data are needed on neck-preserving femoral stems to evaluate on-going bone remodelling and assess implant performance and survival.

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Disclosures

Each author (REF) certifies that he or she has or may receive payments or benefits from a commercial entity (Stryker) related to this work. One or more of the authors, or his institution has received payments or benefits from a commercial entity that could be perceived as a potential conflict of interest.

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Authors and Affiliations

  1. Queen’s Hospital, Rom Valley Way, Romford, Essex, RM7 0AG, UK

    Karthig Rajakulendran MSc, MRCS

  2. The South West London Elective Orthopaedic Centre, Dorking Road, Epsom, Surrey, KT18 7EG, UK

    Richard E. Field PhD, FRCS, FRCS (Orth)

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  1. Karthig Rajakulendran MSc, MRCS
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  2. Richard E. Field PhD, FRCS, FRCS (Orth)
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Correspondence to Karthig Rajakulendran MSc, MRCS.

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Level of Evidence: Level IV: Therapeutic Study. See levels of evidence for a complete description.

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Rajakulendran, K., Field, R.E. Neck-Preserving Femoral Stems. HSS Jrnl 8, 295–303 (2012). https://doi.org/10.1007/s11420-012-9302-z

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  • DOI: https://doi.org/10.1007/s11420-012-9302-z

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