Cementless short-stem total hip arthroplasty in the elderly patient - is it a safe option?: a prospective multicentre observational study

Abstract

Background Due to its bone preserving philosophy, short-stem total hip arthroplasty (THA) has primarily been recommended for young and active patients. However, there may be benefits for elderly patients given a less invasive operative technique due to the short curved implant design. The purpose of this study was to compare the clinical and radiological outcomes as well as perioperative complications of a calcar-guided short stem between a young (< 60 years) and a geriatric (> 75 years) population. Methods Data were collected in a total of 5 centers, and 400 short-stems were included as part of a prospective multicentre observational study between 2010 and 2014 with a mean follow-up of 49.2 months. Preoperative femur morphology was analysed using the Dorr classification. Clinical and radiological outcomes were assessed in both groups as well as perioperative complications, rates and reasons for stem revision. Results No differences were found for the mean visual analogue scale (VAS) values of rest pain, load pain, and satisfaction, whereas Harris Hip Score (HHS) was slightly better in the young group. Comparing both groups, none of the radiological parameters that were assessed (stress-shielding, cortical hypertrophy, radiolucency, osteolysis) reached differences of statistical significance. While in young patients aseptic loosening is the main cause of implant failure, in the elderly group particularly postoperative periprosthetic fractures due to accidental fall have to be considered to be of high risk. The incidence of periprosthetic fractures was found to be 0% in Dorr type A femurs, whereas in Dorr types B and C fractures occurred in 2.1 and 22.2% respectively. Conclusions Advanced age alone is not necessarily to be considered as contra-indications for calcar-guided short-stem THA, although further follow-up is needed. However, markedly reduced bone quality with femur morphology of Dorr type C seems to be associated with increased risk for postoperative periprosthetic fractures, thus indication should be limited to Dorr types A and B. Trial registration German Clinical Trials Register; DRKS00012634 , 07.07.2017 (retrospectively registered).

Mid-term subsidence and periprosthetic radiolucency of the AMIStem: a 5-year EBRA-FCA analysis

“…Examining the Optimys short stem (Mathys, Bettlach, Switzerland), Gkagkalis et al demonstrated bone resorption in up to 15%, Values are given as mean and standard deviation (SD). None of the investigated parameters showed a statistical significant influence on subsidence at the latest follow-up, indicated by a p value > 0.05 occurring mainly in the proximal zones 1, 2, and 7 at a mean follow-up of 49 months, However, only 1.7% of the investigated implants revealed radiolucent lines of less than 2 mm [40]. Using an ultra-short, metaphyseal-fitting femoral component (Proxima, DePuy, Leeds, UK), Kim et al found no radiolucent lines at all at a mean follow-up of 7.9 years [41].…”

“…Regarding radiolucent lines, the investigated short stem demonstrated a high rate of periprosthetic radiolucency compared to other short stem designs. Examining the Optimys short stem (Mathys, Bettlach, Switzerland), Gkagkalis et al demonstrated bone resorption in up to 15%, occurring mainly in the proximal zones 1, 2, and 7 at a mean follow-up of 49 months, However, only 1.7% of the investigated implants revealed radiolucent lines of less than 2 mm [ 40 ]. Using an ultra-short, metaphyseal-fitting femoral component (Proxima, DePuy, Leeds, UK), Kim et al found no radiolucent lines at all at a mean follow-up of 7.9 years [ 41 ].…”

Midterm Survivorship of an Uncemented Hydroxyapatite-Coated Titanium Femoral Component and Clinically Meaningful Outcomes in Patients Older Than 75 Years

“…[ 22 , 23 , 24 , 25 ] Among the main risks for periprosthetic fractures in cementless THA, higher patient age has been identified. [ 21 ] In contrast, cemented femoral stems have been shown to minimize the risk of early complications with excellent long-term survivorship. [ 5 , 26 , 27 ] Therefore, cemented THA was predominantly used in older patients.…”

Risk Factors of Femoral Fractures in Lateral Decubitus Direct Anterior Approach Total Hip Arthroplasty Using Conventional Stem: A Retrospective Analysis

“…In the United States, Europe and many hospital in China, DAA THA was mainly performed in supine position with short femoral stem, which required special operation bed and high cost [9,10]. There was not special operation bed in our Hospital.…”