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A Short Tapered Stem Reduces Intraoperative Complications in Primary Total Hip Arthroplasty

  • Symposium: Papers Presented at the Annual Meetings of The Hip Society
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Clinical Orthopaedics and Related Research®

Abstract

Background

While short-stem design is not a new concept, interest has surged with increasing utilization of less invasive techniques. Short stems are easier to insert through small incisions. Reliable long-term results including functional improvement, pain relief, and implant survival have been reported with standard tapered stems, but will a short taper perform as well?

Questions/purposes

We compared short, flat-wedge, tapered, broach-only femoral stems to standard-length, double-tapered, ream and broach femoral stems in terms of intraoperative complications, short-term survivorship, and pain and function scores.

Patients and Methods

We retrospectively reviewed the records of 606 patients who had 658 THAs using a less invasive direct lateral approach from January 2006 to March 2008. Three hundred sixty patients (389 hips) had standard-length stems and 246 (269 hips) had short stems. Age averaged 63 years, and body mass index averaged 30.7 kg/m2. We recorded complications and pain and function scores and computed short-term survival. Minimum followup was 0.8 months (mean, 29.2 months; range, 0.8–62.2 months).

Results

We observed a higher rate of intraoperative complications with the standard-length stems (3.1%; three trochanteric avulsions, nine femoral fractures) compared with the shorter stems (0.4%; one femoral fracture) and managed all complications with application of one or more cerclage cables. There were no differences in implant survival, Harris hip score, and Lower Extremity Activity Scale score between groups.

Conclusions

Fewer intraoperative complications occurred with the short stems, attesting to the easier insertion of these devices. While longer followup is required, our early results suggest shortened stems can be used with low complication rates and do not compromise the survival and functional outcome of cementless THA.

Level of Evidence

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Author notes

  1. Ryan G. Molli DO

    Present address: Orthopedic Institute of Michigan, 14555 Levan Road, Suite 116, Livonia, MI, 48154, USA

Authors and Affiliations

  1. Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH, 43054, USA

    Ryan G. Molli DO, Adolph V. Lombardi Jr MD, FACS, Keith R. Berend MD, Joanne B. Adams BFA & Michael A. Sneller BS

  2. Department of Orthopaedics, The Ohio State University, Columbus, OH, USA

    Adolph V. Lombardi Jr MD, FACS & Keith R. Berend MD

  3. Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA

    Adolph V. Lombardi Jr MD, FACS

  4. Mount Carmel Health System, New Albany, OH, USA

    Ryan G. Molli DO, Adolph V. Lombardi Jr MD, FACS & Keith R. Berend MD

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  1. Ryan G. Molli DO
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  2. Adolph V. Lombardi Jr MD, FACS
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  3. Keith R. Berend MD
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Corresponding author

Correspondence to Adolph V. Lombardi Jr MD, FACS.

Additional information

One or more of the authors (AVL, KRB) receive royalties and institutional research support from and have consulting agreements with Biomet, Inc (Warsaw, IN, USA). One author (KRB) has consulting agreements with Salient Surgical Technologies (Portsmouth, NH, USA). One author (AVL) receives royalties from Innomed, Inc (Savannah, GA, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Joint Implant Surgeons, Inc.

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Molli, R.G., Lombardi, A.V., Berend, K.R. et al. A Short Tapered Stem Reduces Intraoperative Complications in Primary Total Hip Arthroplasty. Clin Orthop Relat Res 470, 450–461 (2012). https://doi.org/10.1007/s11999-011-2068-7

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