scholarly journals Short versus conventional stem in cementless total hip arthroplasty

2021 ◽  
Vol 50 (4) ◽  
pp. 296-305
Author(s):  
Arnd Steinbrück ◽  
Alexander W. Grimberg ◽  
Johanna Elliott ◽  
Oliver Melsheimer ◽  
Volkmar Jansson
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Short Stem ◽  
Cumulative Probability ◽  
Term Survival ◽  
Total Hip ◽  
Survival Difference ◽  
Significant Difference ◽  
Short Stems

Abstract Background Short-stemmed total hip arthroplasty (THA) is well established and gaining popularity in Germany. The perception that short stems may predispose to primary instability in the femur has resulted in a more thorough follow-up of younger patient cohorts than the typical uncemented THA population. To address this issue, an evidence-based approach is presented for a retrospective mid-term survival analysis of a large registry-based cohort in primary cementless THA comparing short stems with a matched group of conventional stems. Material and methods Propensity score matching (PSM, see Infobox 1) was used on 131,580 primary cementless THAs fulfilling the inclusion criteria performed between November 2012 and September 2019 and the cumulative probability of revision (CPR) of short and conventional stems for any reason, for reasons excluding prosthetic joint infection (PJI), and due to PJI were compared. Results After PSM at 1:1 balanced groups of 17,526 short stems and of 17,526 conventional stems were achieved demonstrating no significant difference for CPR for any reason and for reasons excluding PJI. Matched CPR for any reason was 2.9% (95% confidence interval, CI, 2.4–3.5%) 5 years after primary THA in the short stem and 3.1% (95% CI 2.7–3.4%) in the conventional stem group. The CPR excluding PJI was 2.2% (95% CI 1.7–2.7%) vs. 2.1% (95% CI 1.8–2.4%). In contrast, the incidence of PJI was statistically significant lower for short stems. Conclusion For the considered period, there was no statistically significant survival difference in uncemented THA between comparison groups but a lower incidence for PJI in short-stem THA. Further analyses of registry data are required to rule out range of indications and late mechanical failure of short stems.

scholarly journals Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Georg Hauer ◽  
Maria Smolle ◽  
Sabrina Zaussinger ◽  
Joerg Friesenbichler ◽  
Andreas Leithner ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Sick Leave ◽  
Return To Work ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Multivariate Linear Regression Analysis ◽  
Stem Design ◽  
Total Hip ◽  
Straight Stem ◽  
Significant Difference

AbstractReturn to work (RTW) has been specifically identified as a high priority in patients undergoing total hip arthroplasty (THA). This investigation sought to assess the effect of the stem design on patients’ RTW. Secondly, the study aimed to identify risk factors that lead to a delayed RTW. Questionnaires inquiring about RTW, employment history, educational level, type of work, physical demands and joint awareness were administered by post. Further data were collected from patients’ hospital records. 176 patients who underwent THA using a short-stem and 97 patients using a straight-stem design were compared. The median return to work time was 10 weeks [IQR 7–14 weeks], with no significant difference between the two groups (short stems vs. straight stems; 10 [IQR 7–14] vs. 11 [7.5–13.5] weeks; p = 0.693). In the multivariate linear regression analysis, self-employment vs. employee (p = 0.001), dimension of preoperative workload (p = 0.001), preoperative sick leave (p < 0.001), and hospital length of stay (LOS) (p < 0.001) independently affected the period until work was resumed. The Forgotten-Joint-Score-12 showed no significant difference between the two groups. The data show that the majority of THA patients can expect to resume work and stem design has no impact on RTW. Employees with preoperative sick leave, prolonged hospital LOS and low workload are at higher risk for a delayed RTW.

scholarly journals Primary stability of calcar-guided short-stem total hip arthroplasty in the treatment of osteonecrosis of the femoral head: migration analysis using EBRA-FCA

2020 ◽  
Vol 140 (12) ◽  
pp. 2091-2100
Author(s):  
Yama Afghanyar ◽  
Christoph Danckwardt ◽  
Miriam Schwieger ◽  
Uwe Felmeden ◽  
Philipp Drees ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Migration Pattern ◽  
Short Stem ◽  
Stem Design ◽  
Total Hip ◽  
Migration Analysis ◽  
Short Stems

Abstract Introduction Osteonecrosis of the femoral head (ONFH) is a disabling condition that often results in secondary arthritis necessitating total hip arthroplasty (THA). Short-stem THA has constantly gained popularity. It remains controversial, whether ONFH represents a risk factor for failure after the implantation of short stems with pronounced metaphyseal anchorage. The potential spread of the osteonecrotic area and bone marrow edema into the metaphyseal bone might result in compromised stability. Early implant migration is considered predictive of subsequent aseptic loosening. The purpose of this study was a migration analysis of a modern, calcar-guided short-stem implant in patients with ONFH in a mid-term follow-up. Materials and methods This retrospective analysis investigated the migration pattern of 45 calcar-guided short stems in patients with ONFH, using Einzel-Bild-Roentgen-Analyse Femoral-Component-Analysis (EBRA-FCA). Influencing factors such as ARCO categories, age, gender, body weight and BMI were analyzed. Complications and adverse events were documented. Results At mid-term [48.1 months (SD 20.7 months)], mean axial migration was 1.56 mm (SD 1.77 mm). Mean migration rate stabilized after 2 years. No influence of ARCO categories, age and BMI was found. A tendency of increased axial migration was observed in male patients and in overweight patients. No revision surgeries had to be performed during follow-up. Conclusion The results indicate a migration pattern comparable to that of primary osteoarthritis patients with slight initial migration under full load followed by subsequent stabilization in the metaphyseal femur. The 100% survival rate at mid-term supports the usage of this short-stem design in patients with ONFH.

The migration pattern and initial stability of the Optimys short stem in total hip arthroplasty: a prospective 2-year follow-up study of 33 patients with RSA

2020 ◽  
pp. 112070002090184 ◽  
Author(s):  
Sheryl de Waard ◽  
Inger N Sierevelt ◽  
Renee Jonker ◽  
Daniel Hoornenborg ◽  
Harm M van der Vis ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Deep Infection ◽  
Migration Pattern ◽  
Short Stem ◽  
Leg Length ◽  
Total Hip ◽  
Initial Stability ◽  
Short Stems

Background and purpose: The consensus that bone stock preservation and optimal restoration of offset and leg length is important in total hip arthroplasty is now widespread, especially for young and active patients. Short stems seem promising in this aspect, though implant stability is still of concern. This study looked at the migration pattern of the Optimys short stem through RSA analysis. Patients and methods: 40 patients were included. RSA images were made directly postoperatively (within 5 days), at 6 weeks and at 3, 6, 12 and 24 months. Double examinations were made for precision measurement. HOOS and pain scores were obtained preoperatively and at 2 years. 4 patients were excluded due to protocol violation and 1 patient was excluded for RSA analysis with a CN number >110. 2 patients were lost to follow-up after 3 and 6 months ( n  = 1 lost, n  = 1 deep infection, respectively). Results: Mean age was 60 years with a mean BMI of 27. RSA analysis of 34 patients showed a significant initial median proximodistal translation (subsidence) of 0.21 mm (IQR 0.64–0.06) and anteversion-retroversion rotation of 0.59° (IQR 0.01–1.34) at 6 weeks, after which the stem stabilises and showed no further significant movement. Median migration in other directions was small. 4 patients had an initial subsidence of >2 mm, all showed secondary stabilisation. HOOS outcomes were satisfactory, with the domain symptoms and pain showing a median score of 95/100 at 2 years. Conclusions: After initial migration the Optimys achieves secondary stabilisation, suggesting low risk on long-term aseptic loosening. Clinical trials registration: NL47055.048.13.

scholarly journals Low rate of early periprosthetic fractures in cementless short-stem total hip arthroplasty using a minimally invasive anterolateral approach

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Matthias Luger ◽  
Günter Hipmair ◽  
Clemens Schopper ◽  
Bernhard Schauer ◽  
Rainer Hochgatterer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Minimally Invasive ◽  
Hip Arthroplasty ◽  
Supine Position ◽  
Short Stem ◽  
Anterolateral Approach ◽  
Total Hip ◽  
Asa Score ◽  
Short Stems

Abstract Purpose Minimally invasive (MIS) approaches in combination with short stems have gained popularity in recent years in total hip arthroplasty (THA). A decreased risk for periprosthetic femoral fractures (PFFs) is reported for cementless short-stem THA, but in contrast to other approaches, the risk factors for PFFs for short-stem THA using MIS anterolateral approach in supine position are not described in literature. Methods A single-center consecutive series of 1052 hips in 982 patients, performed between 2014 and 2019 with a short curved stem and a press fit using an MIS anterolateral approach in supine position, was retrospectively screened for inclusion. Fourteen patients were lost to follow-up. Therefore, 1038 THAs in 968 patients were included. Risk factors for intra- and postoperative PFFs within 90 days were analyzed. We investigated for sex, age, body mass index (BMI), diagnosis, and laterality. Results In total, 18 PFFs (1.7%) occurred. Intraoperative fracture occurred in ten cases ( 0.9%), with another eight cases (0.8%) occurring postoperatively. Increased American Society of Anesthesiologists (ASA) Score was a significant risk factor for PFF (p = 0.026), whereas sex (p = 0.155), age (p = 0.161), BMI (p = 0.996), and laterality (p = 1.000) were not. Seven PFFs (0.7%) required revision arthroplasty. Conclusion Cementless short-stem THA using the MIS anterolateral approach is a procedure with a low number of PFFs within 90 days from index surgery. Fracture rates are comparable to other MIS approaches, and comparable femoral short stems are used. Age, sex, and BMI were not identified as risk factors of PFF, while risk for PFF increased with ASA Score. Level of Evidence Level IV

scholarly journals More than a feeling?—Overruling the preoperatively templated offset option leads to a minor offset increase in short stem total hip arthroplasty

2022 ◽  
Author(s):  
Matthias Luger ◽  
Christian Stadler ◽  
Rainer Hochgatterer ◽  
Jakob Allerstorfer ◽  
Tobias Gotterbarm ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Leg Length ◽  
Digital Templating ◽  
Stem Size ◽  
Total Hip ◽  
Press Fit ◽  
A Minor ◽  
Short Stems

Abstract Purpose Short stems are increasingly used in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Digital templating is essential in determining the correct offset option and stem size in THA. However, the preoperative template sizes might be intraoperatively overruled. Patients and methods We evaluated the effect of intraoperative overruling of the preoperatively templated offset option of a short curved stem on hip offset, leg length, implant positioning, and femoral canal fill index. The overruling was performed in case of intraoperative instability, telescoping, or both. A series of 1052 consecutive THAs with a cementless short curved stem and press-fit cup was retrospectively screened. One hundred patients with unilateral THA and a contralateral native and morphologically healthy hip as a reference met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior–posterior postoperative radiographs. Patients were divided according to the overruling by offset option or stem size. Results Hip offset was increased in all groups, but only with significant increase if an offset option + 1 was used intraoperatively (p = 0.025). LLD was restored without significance in all groups (p = 0.323; p = 0.157). Conclusion Intraoperative overruling of the preoperative digital template in cementless short stem total hip arthroplasty results in an increase of hip offset compared to a contralateral healthy hip. However, the increase is marginal and clearly under 5 mm compared to the contralateral healthy hip.

scholarly journals Two-stage revision for the culture-negative infected total hip arthroplasty

2018 ◽  
Vol 100-B (1_Supple_A) ◽  
pp. 3-8 ◽  
Author(s):  
M. S. Ibrahim ◽  
H. Twaij ◽  
F. S. Haddad
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Similar Rate ◽  
Two Stage ◽  
Total Hip ◽  
Significant Difference ◽  
Complex Culture ◽  
Culture Positive ◽  
Culture Negative

Aims Periprosthetic joint infection (PJI) remains a challenging complication following total hip arthroplasty (THA). It is associated with high levels of morbidity, mortality and expense. Guidelines and protocols exist for the management of culture-positive patients. Managing culture-negative patients with a PJI poses a greater challenge to surgeons and the wider multidisciplinary team as clear guidance is lacking. Patients and Methods We aimed to compare the outcomes of treatment for 50 consecutive culture-negative and 50 consecutive culture-positive patients who underwent two-stage revision THA for chronic infection with a minimum follow-up of five years. Results There was no significant difference in the outcomes between the two groups of patients, with a similar rate of re-infection of 6%, five years post-operatively. Culture-negative PJIs were associated with older age, smoking, referral from elsewhere and pre-operative antibiotic treatment. The samples in the culture-negative patients were negative before the first stage (aspiration), during the first-stage (implant removal) and second-stage procedures (re-implantation). Conclusion Adherence to strict protocols for selecting and treating culture-negative patients with a PJI using the same two-stage revision approach that we employ for complex culture-positive PJIs is important in order to achieve control of the infection in this difficult group of patients. Cite this article: Bone Joint J 2018;(1 Supple A)100-B:3–8.

scholarly journals Comparison of radiographic changes in rectangular curved short stem with thin versus thick porous coating for cementless total hip arthroplasty: a retrospective study with a propensity score matching

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yutaro Munakata ◽  
Yujiro Kuramitsu ◽  
Yutaka Usui ◽  
Ken Okazaki
Keyword(s):  
Retrospective Study ◽  
Total Hip Arthroplasty ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Porous Coating ◽  
Significant Difference ◽  
Short Stems ◽  
Radiographic Changes

Abstract Background Radiographic changes that appear relatively quickly after fixation of cementless stem in total hip arthroplasty (THA) vary depending on the stem design and fixation style. The present study compared radiographic changes between two types of rectangular curved short stems of similar shape. Methods This retrospective study included 118 hips that underwent primary cementless THA with an anterolateral supine approach using a rectangular, curved, short stem performed by the same surgeon between June 2015 and June 2019. Among the examined hips, 39 had a thicker porous coating stem (thicker group) and 66 had a thinner porous coating and reduced tip stem (thinner group) and at least 12-month follow-up. Radiographs taken during the final course observation were assessed. Propensity score matching was performed based on demographic data and comparisons were made using pairs of 25 hips each. Statistical analysis was performed using chi-square test and p values ≤ 0.05 indicated statistical significance. Results The pattern of the radiolucent lines showed a significant difference after matching (p = 0.0044). A “proximal and distal” pattern was most common in the thicker group and a “distal only” pattern was most common in the thinner group. There was notable and significant difference in cortical hypertrophy in the thicker group after matching (p = 0.024). Conclusions Although the two short stems were similar shapes, the short-term radiographic changes were different. The thinner group showed fewer radiographic changes than the thicker group, making it a more “silent” stem.

scholarly journals Downsizing in total hip arthroplasty. A short stem as a revision implant

2021 ◽  
Author(s):  
Marcel Coutandin ◽  
Yama Afghanyar ◽  
Philipp Rehbein ◽  
Jens Dargel ◽  
Philipp Drees ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Case Series ◽  
Stress Shielding ◽  
Short Stem ◽  
Total Hip ◽  
The Mean ◽  
Short Stems

Abstract Background Short stems have constantly gained popularity in primary total hip arthroplasty (THA) over the last decade. Although cementless short stems are not primarily designed to be used as revision implants, there may be certain indications for which downsizing the femoral component in failed conventional THA is potentially advantageous. Methods In this single center retrospective case series, six patients who underwent revision using a calcar-guided short stem after failed THA are presented. The mean follow-up was 3.32 years (SD 0.63 years). The health status was evaluated by the EQ-5D-5L score. Patient reported outcome measurements (PROM) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain and satisfaction were assessed using a visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignment and signs of aseptic loosening. Complications were documented. Results At last follow-up the mean EQ-5D-5L index was 0.851 (SD 0.098). Clinical outcome was excellent (HHS ≥ 90) in 4 patients and moderate (HHS 71 and 79) in 2 patients. The mean WOMAC score was 9.20% (SD 12.61%). Pain and satisfaction on VAS were 1.00 (SD 1.15) and 9.17 (SD 0.37), respectively. No major complications occurred. To date, no further revision surgery was needed. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fractures were obvious. Conclusion The present case series indicates that in failed conventional THA downsizing may be considered a treatment option, using short stem THA in selected cases.

scholarly journals High varus stem alignment in short-stem total hip arthroplasty: a risk for reconstruction of femoro-acetabular offset, leg length discrepancy and stem undersizing?

2021 ◽  
Author(s):  
Matthias Luger ◽  
Julian Stiftinger ◽  
Jakob Allerstorfer ◽  
Rainer Hochgatterer ◽  
Tobias Gotterbarm ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Leg Length ◽  
Total Hip ◽  
Press Fit ◽  
Group A ◽  
Leg Length Difference ◽  
Group B ◽  
Short Stems

Abstract Purpose Short stems are increasingly used in in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Short stems can be inserted in a more varus position compared to conventional straight stems. This poses the risk of final varus misplacement of the femoral component, which is not intended in all femoral short stems. Methods We wanted to evaluate the effect of a high varus stem positioning in MIS THA on hip offset, leg length and femoral canal fill index. A series of 1052 consecutive THAs with a singular cementless femoral short stem and press-fit cup was retrospectively screened for inclusion. One hundred six patients with unilateral THA and a contralateral healthy hip met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior–posterior postoperative radiographs. Patients were divided into Group A (varus stem alignment ≤ 3°) and Group B (varus stem alignment > 3°). Results Hip offset (HO) increased significantly in Group B by 4 mm (p = 0.013). No influence on leg length difference was detected in both groups. Preoperative CCD angle was significantly lower in Group B (p < 0.001). Canal Fill Indices (CFI) were significantly lower in Group B (CFI I: p < 0.001; CFI II p = 0.003; CF III p = 0.002). Conclusion High varus stem alignment > 3° leads to a statistically significant but minor increase in HO and poses the risk of stem undersizing. A preoperatively low genuine CCD angle pose a risk for varus stem positioning.

scholarly journals The Influence of Tribological Pairings and Other Factors on Migration Patterns of Short Stems in Total Hip Arthroplasty

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Thilo Floerkemeier ◽  
Michael Schwarze ◽  
Christof Hurschler ◽  
Jens Gronewold ◽  
Henning Windhagen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Three Dimensions ◽  
Short Stem ◽  
Acetabular Cup ◽  
Bone Contact ◽  
Stem Size ◽  
Total Hip ◽  
Bearing Couple ◽  
Short Stems

Over the last decade, the number of short stem total hip arthroplasty procedures has increased. Along with the possible benefits associated with short stems is a smaller implant-bone contact surface, which may have a negative influence on primary stability and impair osseointegration. Previous studies observed migration of short stems, especially within the first three months. The variables that influence migration in short stem hip implants remain unknown. Therefore, the purpose of this study was to associate the migration of short stems with its possible influencing variables. Migration data from two different short stem studies were retrospectively analyzed. Migration within the first two postoperative years was determined by model-based Roentgen stereophotogrammetric analysis. Migration was correlated to bearing couple, type and size of stem, size of acetabular cup, and age, gender, weight, and height of patients using a multiple factor analysis. Eigenvalue analysis explained 80.7% of the overall variance for the first three dimensions. The four most dominant variables in the first dimension were weight, stem size, acetabular cup size, and patient height (correlations of 0.81, 0.80, 0.71, and 0.70, resp.). None of the analyzed parameters (bearing couple, type and size of stem, size of acetabular cup, and age, gender, weight, and height of patients) affected the migration pattern of short stem THA with primary metaphyseal fixation.

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