A Short Tapered Stem Reduces Intraoperative Complications in Primary Total Hip Arthroplasty

Abstract

Background While short-stem design is not a new concept, interest has surged with increasing utilization of less invasive techniques. Short stems are easier to insert through small incisions. Reliable long-term results including functional improvement, pain relief, and implant survival have been reported with standard tapered stems, but will a short taper perform as well? Questions/purposes We compared short, flat-wedge, tapered, broach-only femoral stems to standard-length, double-tapered, ream and broach femoral stems in terms of intraoperative complications, short-term survivorship, and pain and function scores. Patients and Methods We retrospectively reviewed the records of 606 patients who had 658 THAs using a less invasive direct lateral approach from January 2006 to March 2008. Three hundred sixty patients (389 hips) had standardlength stems and 246 (269 hips) had short stems. Age averaged 63 years, and body mass index averaged 30.7 kg/m 2 . We recorded complications and pain and function scores and computed short-term survival. Minimum followup was 0.8 months (mean, 29.2 months; range, 0.8-62.2 months). Results We observed a higher rate of intraoperative complications with the standard-length stems (3.1%; three trochanteric avulsions, nine femoral fractures) compared with the shorter stems (0.4%; one femoral fracture) and managed all complications with application of one or more cerclage cables. There were no differences in implant survival, Harris hip score, and Lower Extremity Activity Scale score between groups. Conclusions Fewer intraoperative complications occurred with the short stems, attesting to the easier insertion of these devices. While longer followup is required, our early results suggest shortened stems can be used with low complication rates and do not compromise the survival and functional outcome of cementless THA.

Long-term follow-up of primary total hip arthroplasty with the Alloclassic Variall system

“…Despite the excellent Harris hip score results in our study cohort, there were four intra-operative trochanteric fractures (1.5 %), which are, however, not uncommon during the implantation of standard-length stems through the direct lateral surgical approach [21].…”

Does stem design influence component positioning in total hip arthroplasty using a minimal invasive posterolateral approach?

“…Short stems potentially preserve more bone stock, improve proximal load transfer, optimize bone remodeling especially in the older population and decrease stress shielding [15,16]. Furthermore, short stems may be easier to insert through smaller, minimally invasive incisions.…”

Postoperative Migration of Short Stem Prosthesis of the Hip Joint

“…Wie lo ośrod ko we ba dania prze ży wal no ści stan dar do wych, zwa nych ta kże w li te ra tu rze kla sycz ny mi, bez ce men to wych en dopro tez ana to micz nych sta wu bio dro we go wy ka zu ją od 94-100% do brych wy ni ków w 20-let niej ob ser wacji [3,4]. Im plan ty krót ko trz pie nio we zo sta ły za projek to wa ne dla pa cjen tów, któ rych nie mo żna za kwali fi ko wać do ka po pla sty ki, a jed no cze śnie nie ma wskazań do za ło że nia stan dar do wej en do pro te zy ana tomicz nej [5,6].…”

“…Za pew nia ją one prze ży wal ność porów ny wal ną do kla sycz nych im plan tów ana to micznych 94-100% w 18-let niej ob ser wa cji. Ich za sto sowa nie za pew nia po nad to mniej szą licz bę po wi kłań w po sta ci zła mań awul syj nych krę ta rza lub zła mań ko ści udo wej 3,1 vs 0,4% [3,7]. En do pro te zy krót kotrz pie nio we umo żli wia ją po nadto za cho wa nie więk -szej czę ści ko ści wła snej przy na sa dy bli ższej ko ści udo wej, co jest nie wąt pli wą za le tą w ra zie ko nieczno ści ewen tu al nej re wi zji [8,9].…”