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

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.

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5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis

Journal of Clinical Medicine ◽

10.3390/jcm11020346 ◽

2022 ◽

Vol 11 (2) ◽

pp. 346

Author(s):

Ali Darwich ◽

Kim Pankert ◽

Andreas Ottersbach ◽

Marcel Betsch ◽

Sascha Gravius ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcome ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Hip Osteoarthritis ◽

Direct Anterior Approach ◽

Short Stem ◽

Total Hip ◽

The Mean

The aim of this study was to investigate the radiological and clinical outcome of the direct anterior approach (DAA) in total hip arthroplasty (THA) using a collared cementless femoral short-stem. This retrospective study included 124 patients with 135 THAs operated from 2014 to 2016 using a collared cementless triple tapered hydroxyapatite-coated femoral short-stem (AMIStem H Collared®, Medacta International, Castel San Pietro, Switzerland) implanted with a DAA. Follow-up was performed at three months, 12 months, and five years. Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence. The mean age was 67.7 ± 11.3 years and the mean body mass index (BMI) was 27.4 ± 4.4 kg/m2. The stem survival rate at five years was 99.1% with one revision due to recurrent dislocations. Mean HOOS score improved from 40.9 ± 18.3 preoperatively to 81.5 ± 19.7 at three months, 89.3 ± 10.9 at 12 months, and 89.0 ± 14.0 at five years (all with p < 0.001). No significant correlations were found between age, femoral bone morphology, BMI and HOOS, and the appearance of relevant radiolucencies.

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Mid-term results of short stem total hip arthroplasty in patients with osteonecrosis of the femoral head

Hip International ◽

10.1177/1120700018816011 ◽

2018 ◽

Vol 29 (6) ◽

pp. 603-608 ◽

Cited By ~ 4

Author(s):

Yingyong Suksathien ◽

Jithayut Sueajui

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Hip Arthroplasty ◽

Short Stem ◽

Stem Revision ◽

The Mean ◽

Bone Trabeculae ◽

Mid Term Results

Purpose: To evaluate the clinical and radiographic mid-term results of short-stem total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH). Methods: We reviewed 83 cases that underwent Metha stem between November 2010 and November 2012. The appearance of bone trabeculae development and radiolucent line were reviewed and HHS was recorded at 6 months postoperatively then yearly to evaluate the clinical results. Results: The mean age of patients was 43.8 years with the mean follow-up 69.3 (60–84) months. Harris Hip Score improved significantly from 44.7 preoperatively to 99.6 at the last follow-up ( p < 0.0001). There were 4 cases (4.8%) of intraoperative femoral fractures. There was 1 case (1.2%) of distal stem perforation that had stable bone ingrowth and there was 1 case (1.2%) of 5-mm subsidence, which was then stable at 3 months postoperatively. Bone trabecular development was detected at zone 1 (65.1%), 2 (69.9%), 3 (14.4%), 4 (1.2%), 6 (97.6%) and 7 (81.9%). There was 1 case (1.2%) where radiolucent lines were observed in zones 1 and 7. There was 1 femoral stem revision from periprosthetic fracture 4 years after index surgery and 1 cup revision from aseptic loosening. Kaplan-Meier survivorship with the end point of stem revision for any reason was 98.8% and for aseptic loosening it was 100% at 7 years. Conclusions: The mid-term clinical and radiographic results of the Metha stem in patients with ONFH were promising. Its design enables preservation of the bone stock and the bone trabeculae appear to confirm the assumption of proximal force transmission.

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

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03610-4 ◽

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.

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Wear of XLPE Liner against Zirconium Heads in Cementless Total Hip Arthroplasty for Patients under 40 Years of Age

Hip International ◽

10.5301/hipint.5000513 ◽

2017 ◽

Vol 27 (6) ◽

pp. 532-536 ◽

Cited By ~ 5

Author(s):

Motoki Sonohata ◽

Masaru Kitajima ◽

Shunsuke Kawano ◽

Masaaki Mawatari

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Polyethylene Wear ◽

Japanese Orthopaedic Association ◽

Young Patients ◽

Stress Shielding ◽

Developmental Dysplasia ◽

Total Hip ◽

The Mean

Introduction Total hip arthroplasty (THA) in the young is challenging. The purpose of this study was to retrospectively determine the clinical, radiographic, and polyethylene wear rate of relatively young patients. Methods We evaluated the outcome of consecutive patients receiving primary THA who were under 40 years of age with a minimum 10-year follow-up. Indications for THA in these patients were osteoarthritis due to developmental dysplasia of the hip joint (9 hips), osteonecrosis of the femoral head (7 hips), juvenile idiopathic arthritis (2 hips), and osteoarthritis due to Perthes disease (1 hip). All THA were performed with a cross-linked ultra-high-molecular-weight polyethylene (XLPE) liner against zirconium heads with cementless implants. Results The average Japanese Orthopaedic Association hip score significantly improved from 42 to 93 points at the latest follow-up. The mean steady wear was 0.015 mm/year (maximum 0.033 mm/year), and the mean creep wear was 0.111 mm (maximum 0.4 mm). Osteolysis was observed around 1 acetabular component and 2 stems. 1 femoral component had subsidence over 5 mm. All of the femoral components achieved fixation with an optimal interface with spot welds at the latest follow-up. Stress shielding was observed in all hips. Conclusions THA using an XLPE liner against zirconium heads appeared to have improved THA longevity. However, the imaging findings in some cases were suggestive of wear debris. A rigorous continual follow-up is required for relatively young patients undergoing THA.

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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

Hip International ◽

10.1177/1120700020901844 ◽

2020 ◽

pp. 112070002090184 ◽

Cited By ~ 1

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.

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Retrospective Clinical and Radiological Outcomes of Total Hip Arthroplasty in 51 Patients After a Mean 8.2 Years Using the Nanos® Short-stem Prosthesis

Surgical Technology Online ◽

10.52198/21.sti.39.os1473 ◽

2021 ◽

Vol 39 ◽

Author(s):

Christian Fischer ◽

◽

Julia Dietz ◽

Karl-Stefan Delank ◽

Alexander Zeh ◽

...

Keyword(s):

Patient Satisfaction ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Survival Rates ◽

Short Stem ◽

Harris Hip Score ◽

Leg Length ◽

Total Hip ◽

The Mean

Introduction: Over the past several years, femoral short-stem hip implants have become more popular as a treatment option in the field of primary hip arthroplasty for younger and more active patients. Current data on clinical outcomes and the implant survival rates in patients with short-stem implants cover a maximum of five to six years. The aim of this study was to assess the survival rates, as well as clinical and functional outcomes, in total hip arthroplasty (THA) using the Nanos® short-stem implant (Smith & Nephew, Marl, Germany) over a follow-up period exceeding 5 y. Materials and Methods: This single-center retrospective study included the first 100 patients who were treated at the Department of Orthopedics at the University Hospital Halle (Saale) between January 2008 and February 2009. Ultimately, the complete data of 51 patients (54 hips) were reviewed. The follow-up period was from May to November 2017. We evaluated patient satisfaction regarding pain and function using a grading system. The Harris Hip Score and Forgotten Joint Score were obtained to evaluate functional outcome after THA. Postoperative radiographic evaluation included the measurement of leg-length discrepancy, changes in the shaft axis, femoral offset and horizontal or vertical center of rotation. Potential postoperative shaft angulation or axial shaft migration was also determined. Radiographic images were checked for radiolucent lines and heterotopic ossification using the classification systems outlined by Green and Brooker. Results: The average follow-up was 97.8 months (8.2 y). The mean patient age at follow-up was 68 y and the body mass index was 28.2 kg/m2. The mean Harris hip score at follow-up was 92.0 and the Forgotten Joint Score was 91.7 %. Survey results showed that patient satisfaction and pain perception were rated very good. No significant change in leg length was observed (mean: 0.1 mm shortening). Overall, a rather varus stem positioning was detected postoperatively (mean: 3.1°). The femoral offset was slightly reduced on average in the entire patient group (mean: -1.8 mm). In the horizontal plane, lateralization of the center of rotation was detected overall (mean: 0.7 mm). In the vertical plane, cranialization was noted (mean: 1.4 mm). The CCD angle did not change. There was no further stem migration postoperatively. Radiolucent lines occurred in 10 cases in Gruen zones 1 and 7. Heterotopic ossification occurred in stages 1 to 3 according to the Brooker classification system. We found no cases of aseptic loosening or other reasons for revision. Conclusion: The outcomes after a mean follow-up of 97.8 months (8.2 y) showed that high levels of patient satisfaction and functional outcome can be achieved with the use of a short-stem endoprosthesis. Sufficient restoration of the patient's individual anatomy paired with high survival rates makes this short-stem prosthesis a reliable implant in total hip arthroplasty.

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Minimum 15-year results of metasul 28-mm metal-on-metal total hip arthroplasty in patients younger than 50 years of age

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02352-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Sheng-Yu Jin ◽

Jing-Yao Jin ◽

Joon-Kyoo Kang ◽

Taek-Rim Yoon ◽

Kyung-Soon Park

Keyword(s):

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Hip Arthroplasty ◽

Second Generation ◽

Long Term Results ◽

Total Hip ◽

Metal On Metal ◽

The Mean

Abstract Background Some propitious mid- and long-term studies had been reported for MoM bearings; however, most studies have addressed specific patient groups rather than younger, active patients, who probably represent the most suitable population for investigations on wear and osteolysis. The purpose of this study to evaluate the long-term results of second-generation metal-on-metal cementless total hip arthroplasty (THA) in patients aged <50 years. Methods From December 1997 to January 2004, primary THA using a metal-on-metal bearing cementless implant was performed in 63 patients (72 hips) aged <50 years. The mean follow-up duration was 18.6 (range, 15.9–22.1) years, and the mean age at initial operation was 39 (range, 22–49) years. Clinical results, complications, survivorship, osteolysis, and aseptic loosening were evaluated. Results The mean Harris hip score and Western Ontario and McMaster Universities Arthritis Index scores were improved from 57.8 (range, 28–69) points and 73.4 (range, 63–94) points preoperatively to 91.7 (range, 80–100) points and 25.5 points (range, 17–38) points, respectively, at the last follow-up. Osteolysis lesions were found in 12 hips (acetabulum, 6 and femur, 6). The notching occurred on the femoral stem neck occurred in 12 hips. The mean serum cobalt and chromium concentrations were 2.3 (range, 0.2–10.6) μg/L and 1.7 (range, 0.4–8.1) μg/L, respectively, at a mean follow-up of 12.7 years in 32 patients (50.1%). The Kaplan-Meier survivorship curve analysis with revision for any reason as the endpoint revealed that 93.1% survived at 18.6 years’ follow-up. Conclusions Second-generation metal-on-metal cementless THA was found to produce satisfactory clinical and radiographic results with a low revision rate for osteolysis and aseptic loosening in patients aged less than 50 years.

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LONG-TERM RESULTS OF ENHANCED TAPERED STEM VerSys ET USE IN PRIMARY TOTAL HIP ARTHROPLASTY

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2010-0-3-7-15 ◽

2010 ◽

Vol 16 (3) ◽

pp. 7-15

Author(s):

R. M. Tikhilov ◽

V. M. Shapovalov ◽

I. I. Artyukh ◽

V. A. Shubnyakov

Keyword(s):

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Hip Arthroplasty ◽

High Efficiency ◽

Long Term Results ◽

Harris Hip Score ◽

Total Hip ◽

The Mean ◽

Primary Total Hip Arthroplasty

The authors reported the outcome at a minimum of five years of 130 consecutive arthroplasties of VerSys ET (Zimmer) in 111 patients. The procedures were performed between 2001 and 2004. In 129 cases (99.2%) Trilogy cup (Zimmer) was used in one case - Muller's acetabular cage (Mathys). The mean age of patients was 49.5 (SD 11.5) (23 to 73), male 76 (58.5%), female - 54 (41.5%), overweight patients 109 (83.8%). Majority of patients had activity in Charnley class A. The most frequent was femur Dorr type A (27,0%) and Dorr type В (66,1%). The mean follow-up was 76 months (60 to 96). The outcomes assessed in 103 patients (120 hips) (92.3%). Outcomes of ten cases were not determined. The mean Harris Hip score improves from 35.1 (SD 8.3) preoperatively to 94.3 (SD 8.5) post-operatively. Kaplan-Meier analysis with revision of the stem as the end-point demonstrated 97,7% survival in term 60 to 96 months, for aseptic loosening - 99,2%. Subsidence of the implants in 61 (50.8%) patients was fixed at a mean follow-up 18.3 (SD3.7) months after surgery and did not progress further. After surgery stem position was neutral 91(75.8%) patients, varus - 14 (12.1%) and valgus - 14 (12.1%). Complications were observed in 8 (6.7%) cases: among them - periprosthetic fractures 6 (5.0%), stem aseptic loosening - 1 (0.8%), recurrent dislocation - 1 (0.8%). Four patients undergone revision surgery We consider the high efficiency of VerSys ET stem use for primary total hip arthroplasty.

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Excellent Clinical and Radiographic Outcomes with Direct Superior Total Hip Arthroplasty with a Minimum of Two-Year Follow Up

Surgical Technology Online ◽

10.52198/21.sti.38.os1336 ◽

2021 ◽

Author(s):

Moritz Sharabianlou ◽

Prerna Arora ◽

Derek Amanatullah

Keyword(s):

Total Hip Arthroplasty ◽

Functional Recovery ◽

Hip Arthroplasty ◽

Case Series ◽

Harris Hip Score ◽

Timed Up And Go ◽

Total Hip ◽

Radiologic Evaluation ◽

Superior Approach

This study aims to establish the midterm safety and performance for the direct superior approach to minimally invasive surgery total hip arthroplasty (MIS-THA). We used a unicentric, single-surgeon, retrospective, consecutive case series analysis of the first 40 patients who received primary unilateral direct superior MIS-THA. Special attention was given to functional recovery by measuring Harris Hip Score (HHS) and timed-up-and-go (TUG) with a mean follow up of 2.2 ± 0.4 years. A radiologic evaluation was performed. HHS and TUG improved significantly at three months and one year (p < 0.001). All components were placed within the Lewinnek safe zone with no change position or signs of loosening at two years. With a minimum of two years of follow up, the direct superior approach appears to be safe without any obvious or consistent postoperative complications—clinically or radiographically—with excellent functional recovery. Additionally, our subgroup analysis supported no late learning curve effect.

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