10-Year Experience With Short Stem Total Hip Arthroplasty

Abstract

Since 1998, short stem total hip arthroplasty (THA) has been performed at the authors' institution. Currently, 30% of THAs are performed with short stems. This article reports on complications that required revision of a short stem THA. Between September 2005 and February 2012, a total of 1953 Metha short stem THAs were performed; of these, 38 required revision due to mechanical complications. In 12 cases, the modular titanium neck adapter failed. In 19 cases, aseptic implant loosening occurred; of these, 11 cases were due to major stem subsidence. In 2 cases, via falsa (cortical penetration) implantation occurred. In 5 cases, periprosthetic fractures led to revision. This corresponds to an aseptic total revision rate of 1.3% for 26 short stems and 1.9% including the cases of all 38 documented revision cases. Thirty-four cases were revised with cementless standard hip stems, 2 cases were revised with short stems, and 2 cases were revised with long revision stems. Undersizing was analyzed in 58% of aseptic revisions. Fifty-four percent of revisions were performed in male patients - 23% with osteonecrosis of the femoral head, and 7% with short hip stems positioned in varus in coxa vara deformities. Seventy-two percent of revisions after marked early stem subsidence and position change into valgus were performed in female patients. Dysplastic hips with coxa valga did not show elevated revision rates. No revisions were performed for dislocation or femoral thigh pain. Short stem THA with the Metha implant is a bone-preserving option for various indications in select patient groups.

How to Proceed with Asymptomatic Modular Dual Taper Hip Stems in the Case of Acetabular Revision

“…Lewinski and Floerkemeier [13] described their 10-year experience with short stem TH based on 1953 Metha®short stem procedures with an overall aseptic stem revision rate of 1.3% and 1.9% including 12 modular Ti alloy neck adapter failures based on 190 modular stems with Ti alloy necks implanted before the product recall in November 2006 [16]. Schnurr et al [14] recorded data for 1888 Metha®short stem implantations from 2004 to 2014 with three implanted versions: Modular Ti 6 Al 4 V alloy stems with Ti alloy (n = 314) or CoCr (n = 230) neck adapters and mono-bloc Ti alloy stems (n = 1090) with a mean follow-up of 6 years (range 1-11).…”

“…The mid-to long-term clinical results for some modular dual taper stem designs are comparable to the implant survivorship of mono-bloc cementless stem designs [7,9,[11][12][13][14][15]. Examining the effectiveness of neck modularity in THA considering sex differences in hip morphology, Traina et al [7] retrospectively reviewed the clinical results of 2131 modular stems implanted in 1051 men and 1080 women.…”

Trends in Total Hip Arthroplasty in Germany from 2007 to 2016: What Has Changed and Where Are We Now?

“…Subsequently, numerous innovations and modifications of short femoral implants have been introduced to the market [9,15,16]; however, some shortstem designs have already been withdrawn for various reasons [17]. Additionally, only short-and mid-term results are available for most new generation short-stem designs [18,19].…”

A Differentiated View on Short Stemmed Hip Arthroplasty – What are the Differences in Fixation and Biomechanics?

“…This prosthesis has since been withdrawn from the market. The Metha prosthesis (Aesculap), which was originally similar in design, attempted to offset the disadvantages of the Mayo prosthesis by means of modularity [18]. However, a material failure with a subsequent cone breakage occurred in the region of the adapter in 9.4 % of cases for the titanium cones and in 4.6 % of cases for the cobalt-chromium cones [17].…”