The learning curve following adoption of a novel short-stem prosthesis in total hip arthroplasty: implications on short-term patient outcomes

Short-stem hip prostheses were developed to treat active patients requiring total hip arthroplasty (THA). This study provides short-term data about a short-stem total hip arthroplasty system. Functional and radiological outcomes as well as return to sports and activity level were assessed. A series of 55 patients was primarily included. Data were available for 47 patients at an average follow-up of 38 ± 4.6 months. The back-to-sports analysis showed a 98% return-to-sports rate (46/47 patients). The average time for return to sports was 13 weeks (± 8) postoperatively. Five patients (10.6%) were more active postoperatively. The Harris Hip Score (HHS) improved from 34.8 (±9.4) preoperatively to 94.7 (±8.4, p ≤ 0.001) and the University of California, Los Angeles (UCLA) score improved from 4.5 (±1.8) to 6.9 (±1.9) (p ≤ 0.001). The High Activity Arthroplasty Score (HAAS) was 12 (±3.6) at 3-year follow-up. Pre- and postoperative UCLA and postoperative HHS and HAAS scores had a positive influence on the return-to-sports rate (p ≤ 0.05). The collection of radiographic data during all postoperative follow-ups showed no signs of radiolucent lines or bone fissures. The complication rate was at 5%. Short-stem systems are equaling conventional prostheses and offer benefits regarding soft tissue and bone stock preservation. Fast recovery and return to sports can be achieved.

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The direct anterior approach for simultaneous bilateral total hip arthroplasty: a short-term efficacy analysis

Arthroplasty ◽

10.1186/s42836-020-00040-w ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

Chang Chen ◽

Yiran Yin ◽

Liu Juncai ◽

Ge Chen

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Direct Anterior Approach ◽

Short Term ◽

Total Hip ◽

Efficacy Analysis ◽

Term Efficacy

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Abductor Muscle Force after Straight-Stem Compared to Short-Stem Total Hip Arthroplasty through a Modified Direct Lateral Approach: Functional Assessment of 70 Consecutive Patients of a Randomized Controlled Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm10061235 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1235

Author(s):

Michael Fuchs ◽

Marie-Anne Hein ◽

Martin Faschingbauer ◽

Mirco Sgroi ◽

Ralf Bieger ◽

...

Keyword(s):

Clinical Trial ◽

Muscle Strength ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Lateral Approach ◽

Short Stem ◽

Abductor Muscle ◽

Total Hip ◽

Straight Stem ◽

Direct Lateral Approach

Because of preservation of proximal femoral bone stock and minimized soft tissue trauma, short-stem implants are becoming increasingly important in total hip arthroplasty (THA). The postulated advantage regarding the functional outcome has not been verified. We hypothesized an increased abductor muscle strength by the use of a short-stem design. Seventy consecutive patients of a randomized clinical trial were included. Of these, 67 patients met the inclusion criteria after 12 months. Thirty-five patients received a standard straight stem and 32 patients a short-stem femoral component. All surgeries were performed by a modified direct lateral approach. Isometric muscle strength of the hip abductors was evaluated preoperatively 3 and 12 months after surgery. Harris hip score (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated. After three months, there were no differences between the two groups; the abductor force was comparable to the preoperative initial values. After 12 months, a significant increase in muscle strength for the short stem patient group compared to preoperative baseline values was measured (straight-stem THA, 0.09 Nm/kg ± 0.4, p = 0.32; short-stem THA, 0.2 Nm/kg ± 0.3, p = 0.004). Comparison of the 12-month postoperative total HHS and WOMAC revealed no significant differences between both groups. A significant increase in hip abductor muscle strength 12 months after short-stem THA compared to conventional-stem THA was observed.

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

Scientific Reports ◽

10.1038/s41598-021-82805-0 ◽

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.

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Short-term outcomes vary by surgical approach in total hip arthroplasty: a network meta-analysis

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04131-4 ◽

2021 ◽

Author(s):

Aaron Gazendam ◽

Anthony Bozzo ◽

Seper Ekhtiari ◽

Colin Kruse ◽

Nancy Hiasat ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Surgical Approach ◽

Meta Analysis ◽

Short Term ◽

Total Hip

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The learning curve for the direct anterior total hip arthroplasty: a systematic review

International Orthopaedics ◽

10.1007/s00264-021-04986-7 ◽

2021 ◽

Author(s):

Leah Nairn ◽

Lauren Gyemi ◽

Kyle Gouveia ◽

Seper Ekhtiari ◽

Vickas Khanna

Keyword(s):

Systematic Review ◽

Total Hip Arthroplasty ◽

Learning Curve ◽

Hip Arthroplasty ◽

Total Hip

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The impact of reducing the femoral stem length in total hip arthroplasty during gait

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03852-w ◽

2021 ◽

Author(s):

Anatole Vilhelm Wiik ◽

Adeel Aqil ◽

Bilal Al-Obaidi ◽

Mads Brevadt ◽

Justin Peter Cobb

Keyword(s):

Total Hip Arthroplasty ◽

Gait Analysis ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Short Stem ◽

Stem Length ◽

Practical Consideration ◽

Total Hip ◽

Long Stem ◽

The Impact

Abstract Aim The length of the femoral stem in total hip arthroplasty (THA) is a practical consideration to prevent gait impairment. The aim of this study was to determine if reducing the femoral stem length in THA would lead to impaired gait biomechanics. Methods Patients uniformly with the same brand implant of differing lengths (100 mm vs 140–166 mm) were taken retrospectively from a prospective trial introducing a new short stem. Twelve patients without any other disorder to alter gait besides contralateral differing length stem THA were tested at differing gradients and speed on a validated instrumented treadmill measuring ground reaction forces. An anthropometrically similar group of healthy controls were analysed to compare. Results With the same posterior surgical approach, the offset and length of both hips were reconstructed within 5 mm of each other with an identical mean head size of 36 mm. The short stem was the last procedure for all the hips with gait analysis occurring at a mean of 31 and 79 months postoperatively for the short and long stem THA, respectively. Gait analysis between limbs of both stem lengths demonstrated no statistical difference during any walking condition. In the 90 gait assessments with three loading variables, the short stem was the favoured side 51% of the time compared 49% for the long stem. Conclusion By testing a range of practical walking activities, no lower limb loading differences can be observed by reducing the femoral stem length. A shorter stem demonstrates equivalence in preference during gait when compared to a reputable conventional stem in total hip arthroplasty.

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Safety of vitamin E-infused highwall liners for routine use in primary total hip arthroplasty: single centre, short-term follow-up of 1221 cases

Hip International ◽

10.1177/1120700020969644 ◽

2020 ◽

pp. 112070002096964

Author(s):

Kirill Gromov ◽

Nanna H Sillesen ◽

Thomas Kallemose ◽

Henrik Husted ◽

Henrik Malchau ◽

...

Keyword(s):

Patient Safety ◽

Vitamin E ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Single Centre ◽

Short Term ◽

Total Hip ◽

Arthroplasty Registry ◽

Primary Total Hip Arthroplasty

Background: Introduction of new implants should be monitored closely to capture any signs of compromising patient safety. Vitamin E infused highly-crosslinked polyethylene liners (VEPE) offer the potential for reduced wear. Highwall liners have been hypothesised to result in increased wear and potential liner fractures. The aim of this study was to determine the 3–7-year follow-up of highwall VEPE for primary total hip arthroplasty (THA), focusing on liner-related complications. Methods: We included 1221 consecutive THA operations from July 2010 to May 2014 with minimum follow-up of 3 (3.1–6.8) years Data collected included demographics, implant data, complications, reoperations, and deaths. Data were cross-referenced with the Danish Hip Arthroplasty Registry in order to ensure validity and completeness. Acetabular shell position was measured using Martell Hip Analysis Suite in a subgroup of 931 THAs. Results: Cumulative stem revision and shell revision at 3-year follow-up was 3.4% and 0.4% respectively. There were no revisions due to liner failure. Reason for revision included 11 dislocations, 15 soft-tissue revisions for infection, 44 stem revisions of which 34 were periprosthetic fractures and 13 shell revisions of which 6 were combined shell and stem revisions. Conclusion: Early follow-up of VEPE liners for primary THA have not shown any revisions associated with liner failure. Continued monitoring of new materials are necessary to capture any signs of compromised patient safety.

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