Calcar-guided short-stem total hip arthroplasty in fractures of the femoral neck: a prospective observational study of 68 hips

Kutzner, Karl Philipp; Walz, Alexander; Afghanyar, Yama; Drees, Philipp; Schneider, Michael

doi:10.1007/s00402-023-05170-9

Cited by 2 publications

(1 citation statement)

References 40 publications

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“…Several studies have reported good short-to midterm results for the optimys™ stem (Mathys Ltd., Bettlach, Switzerland) in osteoarthritis with high patient satisfaction 9,10 and a survivorship of 98.4-100% at mid-term follow-up 11,12 . In addition, a 96.2% survivorship was reported for femoral neck fractures 13 and even 100% survivorship for osteonecrosis 14 , all at midterm investigating the same stem. Despite these promising mid-term results there is little data on long-term outcome of short stems.…”

Section: Introductionmentioning

confidence: 99%

Subsidence rate and long-term outcome of a calcar-guided short stem: A prospective 10-year follow-up study

Thut,

Rohner,

Kellner

et al. 2024

Preprint

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Background: Several studies have reported good to excellent mid-term outcomes for various types of calcar-guided or metaphyseal-anchoring short stems. In our current long-term study, we investigated the subsidence rate of the optimys stem at 10-year follow, correlated the data with clinical outcome and identified potential risk-factors for failure. Methods: In our cohort we included 41 patients with 43 hips with an average age of 62.5 years and a minimum follow-up of ten years. Ein-Bild-Roentgen-Analyse (EBRA) was used to detect potential subsidence. Clinical outcome and complication rate were analyzed. Results: We found an average subsidence of 0.66 mm (SD 0.60) at 3 months, 0.92 (SD 0.88) at 12, 1.5 (SD 1.19) at 60 and 1.8 (SD 1.47) at 120 months respectively. We identified increased femoral offset (2.19mm vs 0.90 p = 0.0099) and head size (28, 0.34mm vs. 32 1.48 Vs. 36 2.50, p = 0.0052), as well as gender (female 1.21mm vs. male 2.35, p = 0.0067) as risk factors for increased subsidence. The amount of subsidence did not impact clinical outcome. Conclusions: The evaluated calcar-guided short stemshows an average subsidence of 1.8mm at 10-year follow up, with most pronounced subsidence within the first 3 months and stabilizing thereafter. In our study male gender and offset seem to be more susceptible to pronounced subsidence whereas this did not correlate with revision rate or inferior clinical outcome in terms of Harris Hip Score (HHS), patient satisfaction and pain. Trial registration: This prospective study was approved by the ethics commission board of northwest- and central- Switzerland (BASEC Nr 2023-00375).

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Section: Introductionmentioning

confidence: 99%

Subsidence rate and long-term outcome of a calcar-guided short stem: A prospective 10-year follow-up study

Thut,

Rohner,

Kellner

et al. 2024

Preprint

View full text Add to dashboard Cite

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Same same but different: Introduction of a classification system in calcar-guided short-stem total hip arthroplasty

Kutzner

2024

HIP International

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Background: The concept of calcar-guided short-stem THA (ssTHA) has largely emerged over the last decade, especially in Europe, and today modern calcar-guided short stems are among the most successful primary femoral implants in terms of complications and revision rates as indicated by multiple registry data. The philosophy originally comprised an individualised reconstruction of the hip anatomy by following the calcar of the femoral neck providing bone- and soft-tissue-sparing characteristics. However, as the stem design allows either metaphyseal fixation alone or additional diaphyseal anchoring, depending on the stem alignment and indication, distinct knowledge is required regarding the implantation technique, the broad variation of positioning and fixation and its potential clinical consequences. Aim: To report on and highlight the characteristics of different ways of performing calcar-guided ssTHA as well as to introduce a classification in order to systematically account for the variety of strategies and the respective implications on the type of fixation. Surgical technique: Already when templating preoperatively, surgeons need to weigh up the different fixation types taking into account a number of patient-related factors. Intraoperatively, by individually controlling the level of osteotomy, the intended type of anchorage can be implemented. Intraoperative radiography to confirm the result, is mandatory. Results: Despite numerous options of stem alignment, depending on the patient’s anatomy, the bone quality or the indication for operation, a total of 4 categories were identified to characterise different fixation strategies in calcar-guided ssTHA. Conclusions: The classification system should be used for the preoperative determination of the intended type of anchorage. Whenever a short-stem philosophy with metaphyseal fixation (Type I (M)) is possible, it should be pursued.

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Calcar-guided short-stem total hip arthroplasty in fractures of the femoral neck: a prospective observational study of 68 hips

Cited by 2 publications

References 40 publications

Subsidence rate and long-term outcome of a calcar-guided short stem: A prospective 10-year follow-up study

Subsidence rate and long-term outcome of a calcar-guided short stem: A prospective 10-year follow-up study

Same same but different: Introduction of a classification system in calcar-guided short-stem total hip arthroplasty

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