Different Designs of Proximal Femoral Stems for Total Hip Arthroplasty: Mid-Term Clinical and Patient-Reported Functional Outcomes

Abstract

Introduction: A comprehensive comparison of the performance of different femoral stem geometries in total hip arthroplasty (THA) is yet to be described. The primary aim of this study was to evaluate objective and subjective outcome measures in primary THA with different femoral implant styles. Methods: Stems were classified into the following five classes: cemented, conical, fit and fill, modular, and wedge. The objective outcomes of interest were the length of inpatient hospital stay (LOS), 90-day readmission rate, one-year revision rate, and two-year mortality rate. Preoperative and postoperative patient-reported outcome measures (PROMs), including hip disability and osteoarthritis outcome score (HOOS) - physical function shortform (HOOS-PS), patient-reported outcomes measurement information system physical function short form 10a (PROMIS PF-10a), and patient-reported outcomes measurement information system - short form - mental 10a (PROMIS M-10a) were recorded and compared between different classes. Results: Patients with a wedge stem had a significantly lower LOS versus every other stem group, while patients with a cemented stem had the highest LOS, approximately twofold that of the wedge stem group. Accounting for potential confounders, the conical and fit and fill groups had a significantly higher two-year mortality rate than the wedge stem group. Fit and fill stems conferred a slight risk of revision THA at one-year compared to wedge stems. There was no significant difference in the rates of failure to achieve the minimal clinically important difference (MCID) for the PROMs. Conclusion: Placement of wedge stems resulted in a significantly lower LOS compared to every other stem class and a lower mortality rate than the conical, fit and fill, and modular stems. As for the 90-day readmission, one-year revision, and the rates of failure to achieve the MCID for general or hip-specific PROMs, stem design had no meaningful effect.

The extent of first-time THA revision is not associated with patient-reported outcomes at 1-year follow-up: a study of 426 aseptic revisions

“…Pain, physical function, and quality of life were in line with previous publications on rTHA [13][14][15][16][17] with improvements in all 4 groups from preoperatively until 1-year follow-up, which is considered both statistically significant and clinically relevant [18][19][20][21]. The greatest improvements occurred within 3 months and thereafter levelled off at 1 year.…”

Radiographic Outcomes using a Diaphyseal Engaging Femoral Stem for Revision Total Hip Arthroplasty

“…Merchant, Kelly, and Quinlan 2014), in which all patients had a successful recovery, few studies have reported outcomes of this revision femoral stem. Several studies do report outcomes of using several different stems within the same cohort, making it difficult to draw conclusions about any singe stem (Katakam et al 2021;Parry et al 2018;Wood et al 2019). Hancock et al retrospectively reviewed 48 revision THAs using the same femoral stem as our study with mean 1 year follow-up (Hancock et al 2018).…”

Relevant Predictors in the Association Between Patients’ Functional Status and Scar Outcomes After Total Hip Arthroplasty

“…Total hip arthroplasty (THA) is the standard method for treating OA; it is considered the most successful orthopedic surgery, resulting in a major improvement in the quality of life by eliminating the pain and regaining joint mobility [ 7 , 8 ]. Arthroplasty techniques have evolved rapidly in recent years in the context of the development of new biomaterials and orthopedic implants, with or without cementation [ 9 ]. Currently, hip replacement is done through minimally invasive surgery.…”