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Long-term follow-up of 1217 consecutive short-stem total hip arthroplasty (THA): a retrospective single-center experience

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

An arthroplasty registry in Germany has been recently established but long-term results for most short-stem innovations are missing. Short-stem hip arthroplasty is usually indicated in young active patients. Our indication was extended to older age groups, femoral neck fractures (FNF), and dysplasia. We evaluated all total hip arthroplasties (THAs) in this population with a collum femoris preserving stem (CFP) performed from 2003 to 2013.

Methods

A consecutive cohort of 1217 CFP THAs with a mean age of 68.7 years was followed retrospectively for a median of 4.8 years (patient follow-up interquartile range from 3.0 to 6.9 years). A questionnaire, which we used in two previous studies, was answered by 89.15% of patients and included information regarding complaints, grade of satisfaction, re-operations, and dislocation. Of the 1217 patients, 77 had died. Survival of the stem and the cup was assessed using a competing risks approach according to an Aalen–Johanson estimator with revision for septic or aseptic loosening or death as a competing endpoint.

Results

Of the patients who answered the questionnaire, 92.5% had no complaints related to the procedures. In all 1217 patients, there were 43 revisions (4.2%) as follows: stem and cup revisions due to aseptic loosening of the stem (n = 10), infections (n = 6), pain (n = 4), or trauma (n = 3); cup revisions due to aseptic loosening (n = 3), dislocation (n = 5), and offset revisions (n = 12). Survivorship was 96% for the stem and 99% for the cup 9 years postoperatively. Statistical analysis confirmed a higher risk for revision in patients with a younger age (p = 0.033), male sex (p = 0.040), dysplasia (p = 0.032), and undersized or extra-large stems for stem revisions (p = 0.001) and female sex (p = 0.036) for cup revisions. FNF (p > 0.20) and age ≥ 80 years (p = 0.114) had no higher risk for loosening of the stem. Our data is also compared with the current literature, especially with the available CFP studies.

Conclusion

The survival rate of the CFP stem was as high as 96% after 9 years of followup which compares well-to-previously published long-term survival rates. There is no higher risk for revision in patients 80 years old or older and in cases with femoral neck fractures. The CFP preserves also allowed using standard stems in the rare cases of revision.

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Author information

Authors and Affiliations

  1. Department of Surgery, Hospital zum Heiligen Geist, Academic Hospital of the Goethe University, Frankfurt am Main, Germany

    H. Wacha & G. Domsel

  2. Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt/M, Frankfurt am Main, Germany

    E. Herrmann

Authors
  1. H. Wacha
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  2. G. Domsel
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  3. E. Herrmann
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Contributions

HW and GD collected all information and reports from the patients, HW prepared the database for statistical analysis, EH performed the statistical analysis and all authors were involved in writing the manuscript.

Corresponding author

Correspondence to H. Wacha.

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Conflict of interest

This study was partially financed by FA Link, Hamburg, Germany. The authors did not receive benefits for personal use.

Ethical approval

This study was approved by the local Ethical board Review Committee: FF66/2015.

Informed consent

This retrospective study does not afford additional informed consent bedsides the preoperative consent of the patients.

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Wacha, H., Domsel, G. & Herrmann, E. Long-term follow-up of 1217 consecutive short-stem total hip arthroplasty (THA): a retrospective single-center experience. Eur J Trauma Emerg Surg 44, 457–469 (2018). https://doi.org/10.1007/s00068-017-0895-2

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