Comparison of Specific Femoral Short Stems and Conventional-Length Stems in Primary Cementless Total Hip Arthroplasty

Abstract

There are several reported disadvantages with conventional-length femoral stems in cementless total hip arthroplasty (THA). Therefore, various efforts have been made to develop a specific femoral short stem to improve physiologic bone remodeling at the femoral aspect of a cementless THA. However, there are potential disadvantages with specific femoral short stems, such as malalignment, inadvertent subsidence, and potential proximal femoral fracture. Therefore, the authors quantitatively compared radiographic and clinical outcomes as well as component-specific complications between 2 groups of patients following primary cementless THA. A matched comparison was made between specific femoral short stems (n=50) and conventional-length femoral stems (n=50) in cementless THA procedures performed between January 2008 and January 2012. Patients were matched for age, sex, body mass index, height, surgical approach, and surgeon. No significant differences were found between the 2 groups in mean postoperative radiographic outcomes, functional outcomes, or complications. Both groups showed satisfactory performance at 5-year follow-up. Specific femoral short stems resulted in a higher incidence of malalignment and subsidence and a lower incidence of thigh pain and proximal bone resorption compared with conventional-length femoral stems. Although longer follow-up is required, specific femoral short stems may have clinical and radiographic advantages with equivalent perioperative complications relative to conventional-length femoral stems. However, this technique requires proper patient selection in combination with careful preoperative planning and meticulous surgical technique.

Short-stem prostheses in primary total hip arthroplasty

“…[ 24 25 ] A pooled analysis of the data showed a low incidence of thigh pain in SSs when comparing with CSs, and several studies have demonstrated the low incidence of thigh pain with SSs, [ 21 26–28 ] which can be attributed to the design of the femoral stem. Shin et al [29] also reported that a lower incidence of thigh pain in SSs than in CSs. An SS can reduce proximal stress shielding through diaphyseal fixation of the femoral stem and the development of excellent mechanical transmission.…”

A comparison of patient-reported outcome measures (PROMs) between short and conventional stem hip replacements: a systematic review and meta-analysis

“…McCalden et al 19 SMF Synergy Lateral Meyer et al 5 Fitmore CLS straight Lateral Salemyr et al 20 Proxima Bimetric Posterolateral Schilcher et al 21 Taperloc Microplasty Taperloc Posterior Sluimer et al 22 Omnifit-HA 1090 Omnifit-HA 1017 Posterolateral van Oldenrijk et al 23 CFP Zweymuller Lateral von Roth et al 24 Fitmore CLS Anterolateral S, short stem; C, conventional stem. 32 Retrospective Short Citation Multiple Posterolateral Shin et al 33 Prospective Metha Bicontact Posterolateral Tahim et al 34 Retrospective Microtaperloc Taperloc Posterior Tomazewski et al 35 Prospective Proxima ABG II Anterolateral + Posterolateral No data Yu et al 36 Retrospective Tri-locked stem Corail Posterolateral…”

“…Individually all 4 showed no statistical difference in HHS between short and conventional stems. 22,25,28,33 Therefore, 17 studies presented the necessary data for meta-analysis, representing 1926 total hip replacements. A random effects model was applied as heterogeneity testing revealed an I 2 value of 52%.…”

Uncemented short stems in primary total hip arthroplasty

“…Shin et al 39 compared the METHA stem with a conventional-length femoral stem (BiCONTACT, Aesculap) including 50 hips in each group matched for age, sex, body mass index (BMI), height, surgical approach and surgeon. The authors did not find significant differences between the two groups in terms of post-operative radiographic outcomes, functional outcomes or complications.…”