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

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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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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Displacement of Femoral Stem during Closed Reduction of Total Hip Arthroplasty

Hip International ◽

10.1177/112070009700700302 ◽

1997 ◽

Vol 7 (3) ◽

pp. 125-127

Author(s):

J. Cordes ◽

K. Sperling ◽

M. Kramhøft

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Closed Reduction ◽

Femoral Stem ◽

Stem Design ◽

Total Hip ◽

Straight Stem ◽

Image Intensification

In the literature, only one case of displacement of a cemented femoral stem from its cement bed during closed reduction of a dislocation has been reported. In that case, it was suggested that the stem design may in part be the explanation for the displacement. Another case with a cemented Müller straight stem is now presented, emphasizing the use of image intensification if reduction proves difficult.

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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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Short versus conventional stem in cementless total hip arthroplasty

Der Orthopäde ◽

10.1007/s00132-021-04083-y ◽

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.

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Comparison of Bone Remodeling Between an Anatomic Short Stem and a Straight Stem in 1-Stage Bilateral Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2016.07.016 ◽

2017 ◽

Vol 32 (2) ◽

pp. 594-600 ◽

Cited By ~ 13

Author(s):

Gaku Koyano ◽

Tetsuya Jinno ◽

Daisuke Koga ◽

Yuki Yamauchi ◽

Takeshi Muneta ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Bone Remodeling ◽

Hip Arthroplasty ◽

Short Stem ◽

Total Hip ◽

Straight Stem

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Comparison of Patient-Reported Outcomes of Total Hip Arthroplasty between a Neck-Preserving Short-Stem Implant and a Conventional Neck-Sacrificing Implant

The Journal of Hip Surgery ◽

10.1055/s-0039-1681081 ◽

2019 ◽

Vol 03 (02) ◽

pp. 078-085

Author(s):

Stefany J. K. Malanka ◽

Marius Dettmer ◽

Amir Pourmoghaddam ◽

Mitchell Veverka ◽

Stefan W. Kreuzer

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Patient Reported Outcomes ◽

Short Stem ◽

Stem Design ◽

Total Hip ◽

Physiological Loading ◽

Patient Reported ◽

Age Cohort

AbstractFemoral neck-preserving short- (NPS) stem implants for total hip arthroplasty (THA) bear several advantages over longer-stem implants, such as native hip structure preservation and improved physiological loading. However, there still is a gap of knowledge regarding the potential benefits of a short-stem design over conventional neck-sacrificing stems in regards to patient-reported outcomes (PROs). The authors investigated the differences in PROs between a neck-sacrificing stem design and NPS stem design arthroplasty. They hypothesized that PROs of NPS stem THA would be higher in the medium-term in comparison to the neck-sacrificing implant system. Neck-sacrificing implant patients (n = 90, age 57 ± 7.9 years) and a matched (body mass index [BMI], age) cohort group of NPS implant patients (n = 105, age 55.2 ± 9.9 years) reported both preoperative and postoperative hip disability and osteoarthritis outcome scores (HOOS). Average follow-up was 413 ± 207 days (neck sacrificing implant) and 454 ± 226 days (NPS implant). The authors applied multivariate analysis of variance (MANOVA) and Mann–Whitney tests for statistical analyses. Significance levels were Holm–Bonferroni adjusted for multiple comparisons. HOOS Subscores increased significantly after surgery independent of implant type (p < 0.001). There was a significant time by surgery interaction (p = 0.02). Follow-up HOOS subscores were significantly higher in the NPS implant group: symptoms (p < 0.001), pain (p < 0.001), activities of daily living (ADL; p = 0.011), sports and recreation (p = 0.011), and quality of life (QOL; p = 0.007). While long-term studies are required for further investigation, evidence from the current study suggests that NPS implants may provide a significant benefit to primary THA patients, which could be due to physiological loading advantages or retention of bone tissue.

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Reproducibility of Femoral Offset Following Short Stem and Straight Stem Total Hip Arthroplasty

Orthopedics ◽

10.3928/01477447-20140626-61 ◽

2014 ◽

Vol 37 (7) ◽

pp. e678-e684 ◽

Cited By ~ 16

Author(s):

Philipp von Roth ◽

Carsten Perka ◽

Hermann O. Mayr ◽

Bernd Preininger ◽

Friedrich Ziebula ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Short Stem ◽

Femoral Offset ◽

Total Hip ◽

Straight Stem

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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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