Mid-Term Outcome of Total Hip Arthroplasty Using a Short Stem

Purpose To review the outcome of total hip arthroplasty (THA) using a short femoral stem in 33 hips. Methods Records of 33 hips in 20 men and 10 women aged 25 to 40 (mean, 30) years who underwent cementless THA using a short femoral stem by a single senior surgeon were reviewed. The diagnosis included avascular necrosis (n=9), ankylosing spondylitis (n=12), rheumatoid arthritis (n=7), post-traumatic arthritis (n=4), and Hurler syndrome (n=1). Clinical outcome was assessed using the Harris Hip Score. Radiological outcome was assessed according to a modified Gruen zoning system. Stem positioning (neutral, varus, valgus) and bone contact were evaluated, as were fixation and early host response as well as subsidence and changes in the calcar region (zone 5). Trabecular response (trabecular attachment), spot welds, cortical hypertrophy, and pedestal formation were determined. Heterotopic ossification was graded by the Brooker classification. Results The mean follow-up period was 6.5 years. The mean Harris Hip Score improved from 40 to 90. All hips achieved immediate postoperative stability. No patient had thigh pain. Four hips had varus placement (5°–7°) of the stem; all were asymptomatic and remained stable without any migration. Evidence of proximal load transfer (endosteal spot welds) between the endosteum and the stem in zones 2 and/or 4 was noted in 12 hips on both sides and in 8 hips on the lateral side only. At one year, all stems showed evidence of osseointegration. None had subsidence or progressive varus migration. There was no radiolucent line or osteolysis around the stem, pedestal formation or buttressing at the prosthesis tip, or cortical hypertrophy. One patient had grade I heterotopic ossification that was not clinically significant. One patient had a 1.5 cm leg lengthening. One patient had a discharging sinus, a loosened acetabular component, and intrapelvic migration at 2 years and underwent implant removal and debridement. One patient developed a crack in the proximal femur even with the smallest stem. The stem was fixed with cerclage wiring and remained stable with no migration. Conclusion A short femoral stem design that transfers load proximally through a prominent lateral flare achieved good short-term outcome in younger patients. Nonetheless, the ease of removal and preservation of bone at the time of revision should guide the choice of the design of the short stem.

[1]  Michael M Morlock,et al.  A new short uncemented, proximally fixed anatomic femoral implant with a prominent lateral flare: design rationals and study design of an international clinical trial , 2008, BMC musculoskeletal disorders.

[2]  D. Lazovic,et al.  Modular short-stem prosthesis in total hip arthroplasty: implant positioning and the influence of navigation. , 2007, Orthopedics.

[3]  K Püschel,et al.  Migration and cyclic motion of a new short-stemmed hip prosthesis--a biomechanical in vitro study. , 2006, Clinical biomechanics.

[4]  J. Fetto,et al.  Preservation of femoral bone mass after total hip replacements with a lateral flare stem , 2004, International Orthopaedics.

[5]  C. Engh,et al.  Clinical Consequences of Stress Shielding After Porous-Coated Total Hip Arthroplasty , 2003, Clinical orthopaedics and related research.

[6]  Ching-Lung Tai,et al.  Finite element analysis of the cervico-trochanteric stemless femoral prosthesis. , 2003, Clinical biomechanics.

[7]  C. Engh,et al.  Fractures of the greater trochanter induced by osteolysis with the anatomic medullary locking prosthesis. , 2002, The Journal of arthroplasty.

[8]  P. Jalovaara,et al.  A proximal fixed anatomic femoral stem reduces stress shielding , 2001, International Orthopaedics.

[9]  Naoto Saito,et al.  Poor bone quality or hip structure as risk factors affecting survival of total-hip arthroplasty , 2000, The Lancet.

[10]  J. Hua,et al.  Stability and Bone Preservation in Custom Designed Revision Hip Stems , 2000, Clinical orthopaedics and related research.

[11]  J. S. Kim,et al.  Primary total hip arthroplasty with a cementless porous-coated anatomic total hip prosthesis: 10- to 12-year results of prospective and consecutive series. , 1999, The Journal of arthroplasty.

[12]  C. Engh,et al.  Total Hip Arthroplasty: Concerns With Extensively Porous Coated Femoral Components , 1998, Clinical orthopaedics and related research.

[13]  P. Herberts,et al.  Scandinavian multicenter porous coated anatomic total hip arthroplasty study. Clinical and radiographic results with 7- to 10-year follow-up evaluation. , 1997, The Journal of arthroplasty.

[14]  L. Whiteside,et al.  Effect of neck resection on torsional stability of cementless total hip replacement. , 1995, American journal of orthopedics.

[15]  J. Fetto,et al.  Reexamination of hip biomechanics during unilateral stance. , 1995, American journal of orthopedics.

[16]  W. Harris,et al.  The contribution of the nonporous distal stem to the stability of proximally porous-coated canine femoral components. , 1993, The Journal of arthroplasty.

[17]  H. Amstutz,et al.  "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. , 1979, Clinical orthopaedics and related research.

[18]  P. Banaszkiewicz.  Ectopic Ossification Following Total Hip Replacement: Incidence and a Method of Classification , 2014 .

[19]  N. Santori,et al.  Ultra-short stems with proximal load transfer: Clinical and radiographic results at five-year follow-up. , 2006, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[20]  R Passariello,et al.  Bone Remodelling in THA: A Comparative DXA Scan Study between Conventional Implants and a New Stemless Femoral Component. A Preliminary Report , 2006, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[21]  M. Morlock,et al.  Biomechanics of a new short-stemmed uncemented hip prosthesis: An in-vitro study in human bone. , 2006, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[22]  C. Albanese,et al.  Bone Preservation with a Conservative Metaphyseal Loading Implant , 2006 .

[23]  M. Michel,et al.  MicroHip: A Minimally Invasive Procedure for Total Hip Replacement Surgery: A modified Smith-Petersen approach , 2006 .

[24]  V. Wylde,et al.  Early Clinical Experience with a Metaphyseal Loading Implant: Why have a Stem? , 2006, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[25]  P. Witschger,et al.  MicroHip: A minimally invasive procedure for total hip replacement surgery A modified Smith-Petersen approach. , 2006 .

[26]  J. Fetto,et al.  The effect of a lateral flare feature on implant stability , 2002, International Orthopaedics.

[27]  F. Mayer,et al.  Bone mineral density of the proximal femur after unilateral cementless total hip replacement , 1999, International Orthopaedics.

[28]  H. Skinner,et al.  Stem loosening and thigh pain in THA: are they related to prosthesis stiffness? , 1997, Orthopedics.

[29]  M. Gallinaro,et al.  Thigh pain in cementless hip replacement. Clinical and radiographic correlations. , 1992, Italian journal of orthopaedics and traumatology.

[30]  M. Freeman,et al.  The effect of retention of the femoral neck and of cement upon the stability of a proximal femoral prosthesis. , 1990, The Journal of arthroplasty.

[31]  M. Smith-Petersen.  Approach to and exposure of the hip joint for mold arthroplasty. , 1949, The Journal of bone and joint surgery. American volume.