Abstract
Background
Routine total hip arthroplasty (THA) using a short cemented stem as compared with a standard length cemented stem may have benefits in terms of stress distribution, bone preservation, stem subsidence and ease of revision surgery. Two senior arthroplasty surgeons transitioned their routine femoral implant from a standard 150 mm Exeter V40 cemented stem to a short 125 mm Exeter V40 cemented stem for all patients over the course of several years. We analysed revision rates, adjusted survival, and PROMS scores for patients who received a standard stem and a short stem in routine THA.
Methods
All THAs performed by the two surgeons between January 2011 and December 2021 were included. All procedures were performed using either a 150 mm or 125 mm Exeter V40 stem. Demographic data, acetabular implant type, and outcome data including implant survival, reason for revision, and post-operative Oxford Hip Scores were obtained from the New Zealand Joint Registry (NZJR), and detailed survival analyses were performed. Primary outcome was revision for any reason. Reason for revision, including femoral or acetabular failure, and time to revision were also recorded.
Results
1335 THAs were included. 516 using the 150 mm stem and 819 using the 125 mm stem. There were 4055.5 and 3227.8 component years analysed in the standard stem and short stem groups respectively due to a longer mean follow up in the 150 mm group. Patient reported outcomes were comparable across all groups. Revision rates were comparable between the standard 150 mm stem (0.44 revisions/100 component years) and the short 125 mm stem (0.56 revisions/100 component years) with no statistically significant difference found (p = 0.240).
Conclusion
Routine use of a short 125 mm stem had no statistically significant impact on revision rate or PROMS scores when compared to a standard 150 mm stem. There may be benefits to routine use of a short cemented femoral implant.
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Appendix: Survival analysis data with revision free years of follow up and number of revisions recorded
Appendix: Survival analysis data with revision free years of follow up and number of revisions recorded
N | Sum comp. Yrs | Revisions | Rate/100-component-years | Lower 95% CI | Upper 95% CI | |
|---|---|---|---|---|---|---|
125 mm | ||||||
819 | 3227.8 | 18 | 0.56 | 0.33 | 0.88 | |
Revision-Free | Lower 95% CI | Upper 95% CI | Revisions | Prostheses Available | ||
Year of follow-up | 1 | 98.17% | 97.25% | 99.09% | 15 | 795 |
2 | 97.90% | 96.92% | 98.89% | 17 | 635 | |
3 | 97.90% | 96.92% | 98.89% | 17 | 506 | |
4 | 97.71% | 96.65% | 98.76% | 18 | 393 | |
5 | 97.71% | 96.65% | 98.76% | 18 | 275 | |
6 | 97.71% | 96.65% | 98.76% | 18 | 162 | |
7 | 97.71% | 96.65% | 98.76% | 18 | 63 | |
150 mm | ||||||
516 | 4055.5 | 18 | 0.44 | 0.25 | 0.69 | |
Revision-Free | Lower 95% CI | Upper 95% CI | Revisions | Prostheses Available | ||
Year of follow-up | 1 | 97.86% | 96.61% | 99.11% | 11 | 498 |
2 | 97.07% | 95.60% | 98.53% | 15 | 473 | |
3 | 96.86% | 95.35% | 98.37% | 16 | 462 | |
4 | 96.86% | 95.35% | 98.37% | 16 | 448 | |
5 | 96.64% | 95.07% | 98.21% | 17 | 420 | |
6 | 96.40% | 94.76% | 98.04% | 18 | 391 | |
7 | 96.40% | 94.76% | 98.04% | 18 | 362 | |
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Boyle, A.B., Kuperus, T., Maheno, T. et al. Equivalent revision rates and patient reported outcomes with routine use of a short (125mm) cemented stem for total hip arthroplasty compared to a standard length (150mm) cemented stem. A two surgeon series of 1335 patients. Arch Orthop Trauma Surg 144, 2019–2026 (2024). https://doi.org/10.1007/s00402-024-05235-3
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DOI: https://doi.org/10.1007/s00402-024-05235-3