Hip replacement in young patients: Experience with a femoral neck preserving short stem
DOI:
https://doi.org/10.1016/j.rccot.2020.02.011Keywords:
total hip replacement, short stemsAbstract
Background: The growing trend in the use of non-cemented implants and the development of technologies that attempt to restore the anatomy and joint function with greater bone preservation has increased the use of short stems in the total hip replacement (THR). The objective of this study is to describe functional results, radiological restoration of the anatomy, complication and revision rate of patients undergoing THR using short femoral stems with metaphyseal cervical fixation with lateral cortical support.
Materials and Methods: A prospective descriptive study was performed that included 45 hips of patients with hip osteoarthritis of any origin. The follow-up was 18 months. The outcome variables evaluated were: 1. Integration of the implant, 2. Complications dependent on the femoral implant, 3. Subsidence, and 4. Re-intervention. The functional result was additionally evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC).
Results: During the period from December 2011 to July 2017, an improvement was observed in functional status in 97% (n: 44) of patients, with no reoperations.
Discussion: Bone integration of the implant was observed in 100% of the cases, making the results comparable with the reports in the literature. It is believed that the use of short stems in total hip replacement is a safe procedure, with good outcomes. It also has the advantage of an adequate bone integration of the implant, and guaranteeing a better bone stock in the next surgery.
Evidence Level: IV.
Downloads
References
Garellick G, Kärrholm J, Rogmark C, Herberts P. 2009 The Swedish Hip Arthroplasty Register Annual Report. 2008.
Kienapfel H, Sprey C, Wike A, Griss P. Implant Fixation by Bone Ingrowth. J of Arthropalsty. 1999;14:355-68. https://doi.org/10.1016/S0883-5403(99)90063-3
Tobias Renkawitz, Francesco S, Santori, Joachim Grifka, Carlos Valverde, Michael M, Morlock, Ian D, Learmonth. A new short uncemented, proximally fixed anatomic femoral implant with a prominent lateral flare: design rationals and study design of an international clinical trial BMC Musculoskeletal Disorders. 2008;9:147. https://doi.org/10.1186/1471-2474-9-147
Koch JC. The laws of bone architecture. Am J Anat. 1917;21:177-298. https://doi.org/10.1002/aja.1000210202
Fetto J, Leali A, Moroz A. Evolution of the Koch model of the biomechanics of the hip: clinical prespective. J Orthop Sci. 2002;7:724-30. https://doi.org/10.1007/s007760200130
Learmonth ID. Conservative stem in total hip replacement. Hip Int. 2009;19:195-200. https://doi.org/10.1177/112070000901900301
Van Oldenrijk J, Molleman J, Klaver M, Poolman RW, Haverkamp D. Revision Rate after short - stem total hip arthroplasty. a systematic review of 49 clinical studies. Acta Orthop. 2014;85:250-8. https://doi.org/10.3109/17453674.2014.908343
Escobar A, Quintana JM, Bilbao A, Azcarate J, Guenaga JI. Validation of the Spanish version of the WOMAC questionnaire for patients with hip and knee osteoarthritis Wester Ontario McMaster Universities Osteoarthritis index. Clin Rheumatol. 2002;21:466-71. https://doi.org/10.1007/s100670200117
Gruen TA, McNeige GM, Amtutz HC. modes of failure'' of cementd stem - type femoral components: A radiographic análisis of loosening. Clin Orthop Relat Res. 1979;141:14-27. https://doi.org/10.1097/00003086-197906000-00002
Hsiang - Ho chen, Beranrd F, Morrey, Kai - Nan An, Zong - Ping Luo. Bone remodeling characteristics of short - stemmed total hip replacement. J of arthroplasty. 2009;24:945-50. https://doi.org/10.1016/j.arth.2008.07.014
Weinans H, Huiskes R, Grootenboer HJ. Effects of material properties of femoral hip components on bone remodeling. J orthop Res. 1992;10:845. https://doi.org/10.1002/jor.1100100614
Krismer M, Biedermann R, Stockl B, Fischer M, Bauer R, Haid C. The prediction of failure of the stem in THR by measurement of early migration using EBRA-FCA Einzel-Bild-RoentgenAnalyse- femoral component analysis. J Bone Joint Surg Br. 1999;81:273-80. https://doi.org/10.1302/0301-620X.81B2.0810273
Kroell A, Beaulé P, Krismer M, Behensky H, Stoeckl B, Biedermann R. Aseptic stem loosening in primary THA: migration analysis of cemented and cementless fixation. Int Orthop. 2009;33:1501-5. https://doi.org/10.1007/s00264-008-0701-1
Schmidutz F, Graf T, Mazoochian F, Fottner A, Bauer-Melnyk A, Jansson V. Acta Orthop. 2012;83:360-5. https://doi.org/10.3109/17453674.2012.712891
Gronewold J, Berner S, Olender G, Hurschler C, Windhagen H, von Lewinski G. Floerkemeier. Changes in strain patterns after implantation of a short stem with metaphyseal anchorage compared to standard stem: an experimental study in synthetic bone. Orthop Rev (pavia). 2014;6:5211. https://doi.org/10.4081/or.2014.5211
Lerch M, Weigel N, Windhagen H, Ettinger M, Thorey F, Kurtz A, Stukenborg - Colsman C, Bouquecha A. Finite element model of a novel short stemed total hip arthropalsty implant developed from cross sectional CT scans. Technol Health Care. 2013;21:493-500. https://doi.org/10.3233/THC-130743
Morrey BF, Adams RA, Kessler M. A A conservative femoral replacement for total hip arthoplasty. A prospective study. J bone Joint surg Br. 2000;82:952. https://doi.org/10.1302/0301-620X.82B7.0820952
Lacko M, Filip V, Cellar R, Vasko G. Our experience with metha short hip stem. Acta Chir Orthp Traumatol Cech. 2014;81:70-6. https://doi.org/10.55095/achot2014/008
Pons M. Learning curve and short -term results with a short stem CFP system. Hip Int. 2010;20 suppl 7:s52-7. https://doi.org/10.5301/HIP.2010.4443
Giardina F, Castagnini F, Stea S, Bordini B, Montalti M, Toni A. Short stems versus Conventional stems in cementless total hip arthroplasty: A long term registry study. J Arthroplasty. 2018;33:1794-9, https://doi.org/10.1016/j.arth.2018.01.005
Wacha H, Domsel G, Herrmann E. Long-term follow up of 1217 consecutive short stem total hip arthroplasty (THA): a retrospective single -center experience. Eur J Trauma Emerg Surg. 2018;44:457-69, https://doi.org/10.1007/s00068-017-0895-2
Mayle RE, Della Valle CJ. Fractures about the hip Intra-operative fractures during THA. J Bone Joint Surg Br. 2012;94-B 11 Suppl A:26-31. https://doi.org/10.1302/0301-620X.94B11.30614
Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA. Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am. 2008;90-A:2000-12. https://doi.org/10.2106/JBJS.H.00331
Michael Dietrich, Method Kabelitz, Claudio Dora, Patrick o, Zingg. Perioperative fractures in cementless total hip arthroplasty using direct anterior minimally invasive approach: Reduced Risk whit short stems. J. Arthroplasty. 2008;33:548-54. https://doi.org/10.1016/j.arth.2017.09.015
