Bone Remodeling Characteristics of a Short-Stemmed Total Hip Replacement

Chen, Hsiang Ho; Morrey, B.F.; An, Kai Nan; Luo, Zong Ping

doi:10.1016/j.arth.2008.07.014

Cited by 116 publications

(90 citation statements)

References 28 publications

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“…Excellent clinical and radiographic mid-term results have been reported, but most of the short stems have not been able to reduce BMD loss in the proximal femoral regions (Albanese et al 2009, Chen et al 2009, Gotze et al 2010, Lerch et al 2012, Lazarinis et al 2013). …”

Section: Discussionmentioning

confidence: 99%

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Salemyr¹,

Muren²,

Ahl³

et al. 2015

Acta Orthopaedica

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Background and purpose — We hypothesized that an ultra-short stem would load the proximal femur in a more physiological way and could therefore reduce the adaptive periprosthetic bone loss known as stress shielding.Patients and methods — 51 patients with primary hip osteoarthritis were randomized to total hip arthroplasty (THA) with either an ultra-short stem or a conventional tapered stem. The primary endpoint was change in periprosthetic bone mineral density (BMD), measured with dual-energy x-ray absorptiometry (DXA), in Gruen zones 1 and 7, two years after surgery. Secondary endpoints were change in periprosthetic BMD in the entire periprosthetic region, i.e. Gruen zones 1 through 7, stem migration measured with radiostereometric analysis (RSA), and function measured with self-administered functional scores.Results — The periprosthetic decrease in BMD was statistically significantly lower with the ultra-short stem. In Gruen zone 1, the mean difference was 18% (95% CI: −27% to −10%). In zone 7, the difference was 5% (CI: −12% to −3%) and for Gruen zones 1–7 the difference was also 5% (CI: −9% to −2%). During the first 6 weeks postoperatively, the ultra-short stems migrated 0.77 mm more on average than the conventional stems. 3 months after surgery, no further migration was seen. The functional scores improved during the study and were similar in the 2 groups.Interpretation — Up to 2 years after total hip arthroplasty, compared to the conventional tapered stem the ultra-short uncemented anatomical stem induced lower periprosthetic bone loss and had equally excellent stem fixation and clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Salemyr¹,

Muren²,

Ahl³

et al. 2015

Acta Orthopaedica

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“…There has been much evidence demonstrating standardlength, tapered, titanium, porous plasma-sprayed components perform well in the short, mid, and long term [10- recent interest in less invasive surgery through smaller incisions, shorter cementless stems have been popularized and utilized to achieve femoral fixation [15,24,40,56,62,66]. We therefore compared the intraoperative and perioperative complication rate, short-term survival, and preoperative and postoperative HHSs and LEAS scores for pain and function between groups receiving standardlength double-tapered stems and shorter, flat-wedge, ''microplasty'' tapered stems.…”

Section: Discussionmentioning

confidence: 99%

“…Short stems are thought to preserve more native host bone and optimize proximal load transfer, and while not a novel concept, they have become increasingly utilized with the advent of less invasive surgery and rapid-recovery protocols [15,24,40,56,62,66]. There are several proposed advantages of short stems, including easier insertion through smaller incisions and less invasive techniques, simpler femoral preparation with a ''broach only'' system, and their basic inherent bone-conserving nature allowing for more favorable conditions in the potential revision setting.…”

Section: Introductionmentioning

confidence: 99%

“…There are several proposed advantages of short stems, including easier insertion through smaller incisions and less invasive techniques, simpler femoral preparation with a ''broach only'' system, and their basic inherent bone-conserving nature allowing for more favorable conditions in the potential revision setting. Several studies have demonstrated overall survivorship of short stems ranging from 94% to 100% at up to 18 years' followup and incidences of thigh pain ranging from 0% to 4% [13,15,28,33,52,54]. To justify using shorter tapered stems when more traditional standard-length tapered stems provide pain relief, restore function, and have high survivorship [9-11, 17-19, 25, 42, 43, 58, 60], it is important to show advantages with equal long-term survivorship and demonstrate similar intraoperative reproducibility with equivalent and/or decreased perioperative complications.…”

Section: Introductionmentioning

confidence: 99%

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

Molli¹,

Lombardi²,

Berend³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

153

112

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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.

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“…En do pro te za krót kotrz pie nio wa po zwa la ta kże za cho wać nie na ru szo ną ja mę szpi ko wą w czę ści bli ższej trzo nu, co w przypad ku jej ob lu zo wa nia da je mo żli wość re wi zji z uży -ciem stan dar do we go trzpie nia ana to micz ne go [10]. Istot na jest ta kże opty ma li za cja prze no sze nia ob cią -żeń po mię dzy im plan tem a tkan ką kost ną [11]. Według do stęp ne go pi śmien nic twa, za sto so wa nie implan tu krót ko trz pie nio we go zmniej sza re sorp cję kości we wszyst kich stre fach Gru en'a w po rów na niu do kla sycz nych trzpie ni ana to micz nych [12][13][14][15].…”

Section: Wstępunclassified

Postoperative Migration of Short Stem Prosthesis of the Hip Joint

Kaminski¹,

Szmyd²,

Ambroży³

et al. 2015

Ortop Traumatol Rehabil

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STRESZCZENIEWstęp. Alo pla sty ka sta wu bio dro we go jest po wszech nie sto so wa ną pro ce du rą da ją cą prze wi dy wal ne, dłu go trwałe do bre wy ni ki. En do pro te zy krót ko trz pie nio we po zwa la ją za cho wać nie na ru szo ną ja mę szpi ko wą oraz część bli ż -szą trzo nu. Wy ka za no, że w po rów na niu do en do pro tez ze stan dar do wym trzpie niem, da ją lep sze wy ni ki kli nicz ne. Ce lem pra cy by ła oce na mi gra cji trzpie nia en do pro te zy sta wu bio dro we go Pro xi ma. Mi gra cję okre śla no ja ko zmianę ką ta po ło że nia trzpie nia w kie run ku szpo ta wo ści.Ma te riał i me to dy. Do ba da nia włą czo no gru pę 164 cho rych (83 ko bie ty, 81 mę żczyzn) ope ro wa nych w latach 2007-2012 w Kra kow skim Cen trum Re ha bi li ta cji i Or to pe dii, u któ rych wy ko na no alo pla sty ki przy uży ciu 185 en do pro tez ty pu Pro xi ma.Wy ni ki. Pod da no ana li zie ra dio lo gicz nej se rię trzech zdjęć wy ko na nych u ka żde go cho re go w do bie "0", po 6 i po 12 mie sią cach. Stwier dzo no mi gra cję w kie run ku szpo ta we go usta wie nia trzpie nia w okre sie ob ser wa cji. Wy kaza no ko re la cję po mię dzy zmia ną ką ta szpo ta we go po ło że nia en do pro te zy a cza sem ob ser wa cji. Po 12 mie sią cach śred nia zmia na ką ta szpo ta wo ści wy no si ła 8,21º. Wy ka za no istot ną sta ty stycz nie ró żni cę w ką cie szpo ta we go po ło -że nia en do pro te zy w za le żno ści od płci pa cjen ta. Po 12 mie sią cach, zmia na łącz na wy no si ła u ko biet 6,82º, a u męż -czyzn 9,65º. Nie wy ka za no istot nej ko re la cji po mię dzy BMI pa cjen ta, wie kiem pa cjen ta oraz su ma rycz ną dłu go ścią szyj ki sto so wa ne go im plan tu a pro gre sją ką ta szpo ta we go po ło że nia en do pro te zy.Wnio ski. 1. Im plant krót ko trz pie nio wy Pro xi ma ule ga naj więk sze mu prze miesz cze niu w kie run ku szpo ta wo ści w okre sie pierw szych 6 mie się cy od za ło że nia. 2. Zmia na ką ta szpo ta we go po ło że nia en do pro te zy za le żna jest od wyj ścio we go osa dze nia en do pro te zy oraz płci. 3. Zmia na ką ta szpo ta we go po ło że nia en do pro te zy nie jest za le żna od wie ku cho re go oraz BMI.Słowa kluczowe: endoproteza krótkotrzpieniowa, całkowita aloplastyka stawu biodrowego, migracja trzpienia endoprotezy SUMMARY Background. Hip replacement surgery is a popular procedure that provides predictable, long-lasting and good effects. The use of short stem prostheses helps preserve an intact medullary cavity and proximal diaphysis. It has been demonstrated that the use of short stem prostheses leads to better clinical results compared to standard stem prostheses. The study aimed to assess the migration of the stem of the Proxima hip prosthesis. Migration was defined as a change in the angle of stem position towards a varus deformity.Material and methods. The study involved 164 patients (83 women, 81 men) who underwent hip replacement surgery with a total of 185 Proxima prostheses in the Cracow Rehabilitation Centre between 2007 and 2012.Results. Radiographic analysis included a ...

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Bone Remodeling Characteristics of a Short-Stemmed Total Hip Replacement

Cited by 116 publications

References 28 publications

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty

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

Postoperative Migration of Short Stem Prosthesis of the Hip Joint

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